[Russian study on brain aneurysm surgery: a continuation (RIHA II)]

OBJECTIVE

To assess the main performance indicators of neurosurgical departments in surgical treatment of cerebral aneurysms in the Russian Federation.

MATERIAL AND METHODS

We analyzed 22 neurosurgical departments (19 regional and 3 federal hospitals) in 2017 and 2021. The study enrolled 6.135 patients including 3.160 ones in 2017 and 2.975 ones in 2021. We studied the features of surgical treatment of cerebral aneurysms in different volume hospitals and factors influencing postoperative outcomes.

RESULTS

The number of surgeries for cerebral aneurysms decreased from 2.950 in 2017 to 2.711 in 2021. Postoperative mortality rate was 6.3% and 5.6%, respectively. The number of microsurgical interventions decreased from 60% in 2017 to 48% in 2021. The share of endovascular interventions increased from 40% to 52%, respectively. Endovascular embolization was accompanied by stenting in 55% of cases. Simultaneous revascularization was carried out in 2% of cases. In 2021, the number of patients undergoing surgery in acute period of hemorrhage increased to 70% (in 2017 - 61%). The number of hospitals performing more than 50 surgical interventions for cerebral aneurysms annually increased from 14 in 2017 to 17 in 2021.

CONCLUSION

Certain changes in neurosurgical service occurred in 2021 compared to 2017. Lower number of surgical interventions for cerebral aneurysms, most likely caused by the COVID-19 pandemic, is accompanied by lower postoperative mortality. Endovascular interventions and revascularization techniques became more common. The number of surgeries in acute period after aneurysm rupture and hospitals performing more than 50 surgical interventions for cerebral aneurysms annually increased.

[Use of invasive intracranial pressure monitoring in patients with severe traumatic brain injury]

OBJECTIVE

To evaluate the effectiveness of the use of invasive intracranial pressure (ICP) monitoring on treatment outcomes in patients with severe traumatic brain injury (TBI).

MATERIAL AND METHODS

We analyzed 50 case histories of patients with severe TBI who received treatment in the Krasnoyarsk Regional Clinical Hospital for the period 2021-2022. Comparisons were made between patients with and without invasive intraventricular ICP monitoring.

RESULTS

With the same initial condition of patients, ICP monitoring allows for a faster and more timely response to changes in the clinical condition, which significantly affects the clinical outcome.

CONCLUSION

The use of invasive ICP monitoring improves the outcome of treatment of patients with severe TBI and justifies the money spent on it.

[Idiopathic hypertrophic pachymeningitis]

The article presents a case of idiopathic hypertrophic pachymeningitis of a 61-year-old male patient with severe cephalgia and progressive neuropathy of the oculomotor nerves. The diagnosis was confirmed by MRI with gadolinium, which revealed thickening of the dura mater with accumulation of paramagnetic in the convexital parts of the frontal and temporal regions, as well as on the base of the skull and tentorium. During the use of pulse therapy with glucocorticosteroids (GCS) the symptoms regressed, but when the therapy was stopped, there was a relapse of ptosis and oculomotor abnormalities on the other side followed by a slower effect of GCS therapy. The article also presents a brief review of current knowledge about this pathology.

Development of DNA Aptamers for Visualization of Glial Brain Tumors and Detection of Circulating Tumor Cells

Here, we present DNA aptamers capable of specific binding to glial tumor cells in vitro, ex vivo, and in vivo for visualization diagnostics of central nervous system tumors. We selected the aptamers binding specifically to the postoperative human glial primary tumors and not to the healthy brain cells and meningioma, using a modified process of systematic evolution of ligands by exponential enrichment to cells; sequenced and analyzed ssDNA pools using bioinformatic tools and identified the best aptamers by their binding abilities; determined three-dimensional structures of lead aptamers (Gli-55 and Gli-233) with small-angle X-ray scattering and molecular modeling; isolated and identified molecular target proteins of the aptamers by mass spectrometry; the potential binding sites of Gli-233 to the target protein and the role of post-translational modifications were verified by molecular dynamics simulations. The anti-glioma aptamers Gli-233 and Gli-55 were used to detect circulating tumor cells in liquid biopsies. These aptamers were used for in situ, ex vivo tissue staining, histopathological analyses, and fluorescence-guided tumor and PET/CT tumor visualization in mice with xenotransplanted human astrocytoma. The aptamers did not show in vivo toxicity in the preclinical animal study. This study demonstrates the potential applications of aptamers for precise diagnostics and fluorescence-guided surgery of brain tumors.

[Ischemic stroke at a young age on the context of chronic myeloleukosis]

The article describes the clinical search for diagnosis and treatment of a patient who developed a severe ischemic stroke at a young age, when specifying the cause of which chronic myeloleucosis was identified. The unavailability of patient compliance and non-compliance with the recommended examination at the outpatient stage led to the development of severe complications. It would seem that the diagnosis of chronic myeloid leukemia, which does not represent excessive complexity, with the development of an acute condition in a young patient, such as an ischemic stroke, results in a complex diagnostic search, complicated by developing comorbidities due to general decompensation of the body.

[Surgical treatment of cerebral aneurysms in the Russian Federation]

OBJECTIVE

The objective of this study was to evaluate the results of surgical treatment of cerebral aneurysms in the Russian Federation.

MATERIAL AND METHODS

We analyzed performance indicators in neurosurgical departments of regional and federal health institutions of the Russian Federation for 2017. The results of surgical treatment of cerebral aneurysms (CAs) were analyzed in 19 regional vascular centers (RVCs) in several federal districts and in 3 federal centers (FCs) with the most dynamically developing vascular neurosurgery and smoothly running system of statistical data processing.

RESULTS

The study included 3160 patients hospitalized to 22 medical institutions in 2017. Of these, 1808 patients were treated in RVCs, and 1352 patients were treated in FCs. We analyzed factors affecting the treatment outcome in CA patients. We identified features of CA treatment in clinics with a different amount of surgical intervention.

CONCLUSION

An increase in the surgical activity in centers and simultaneous development of microsurgical and endovascular treatments for cerebral aneurysms reduce postoperative mortality. Due to the presence of a RVC network in the Russian Federation, many patients could receive necessary specialized treatment. The number of operations for cerebral aneurysms has increased 6-fold for the past 10 years.