RESUMEN
Trigeminal neuralgia (TN) is a disabling disease with severe impairment of quality of life and everyday activity of patients. Range of treatment modalities is wide and includes conservative therapy, surgical methods and stereotactic radiosurgery (SRS). SRS is a minimally invasive technique which provides good results and minimal rate of complications. High geometrical and clinical precision of frameless SRS using CyberKnife system allows its application in TN when high dose is delivered to a small volume. The given paper focuses on the first Russian experience of frameless SRS of TN using robotized system CyberKnife. Since April 2009 till June 2011 4 patients with TN were treated in department for radiation therapy of Burdenko Neurosurgical Institute using CyberKnife system. Mean age was 63 years. Mean and maximal target dose reached 70 and 90 Gy, respectively. Data of catamnestic clinical examination were available in all 4 patients. Follow-up period reached 8 months. Response to treatment was observed in all cases. In 2 (50%) patients full effect was reached while in the rest only partial effect was present. No complications were encountered. Effectiveness and safety of SRS using CyberKnife system is comparable with framed SRS.
Asunto(s)
Neuronavegación , Radiocirugia , Neuralgia del Trigémino/cirugía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neuronavegación/instrumentación , Neuronavegación/métodos , Dimensión del Dolor , Dosis de Radiación , Radiocirugia/instrumentación , Radiocirugia/métodos , Planificación de la Radioterapia Asistida por Computador , Resultado del Tratamiento , Neuralgia del Trigémino/diagnósticoRESUMEN
The paper presents the experience of application of single-photon emission computed tomography (SPECT) and CT in neurosurgery. Combination of these two techniques in the single system provides higher precision of both methods. The novel technique allows assessment of tumor spread in the brain, differential diagnosis of tumor regrowth and radiation-induced necrosis, evaluation of cerebral perfusion in epilepsy, traumatic brain injury (TBI), and diagnostics of secondary CNS lesions. Examples of primary diagnosis, dynamic follow-up and differential diagnosis of cerebral neoplasms, localization of epileptogenic foci in planning of surgery, prediction of outcome after TBI and evaluation of spread of metastatic skeletal involvement and further application of acquire data are presented.
Asunto(s)
Encefalopatías/cirugía , Imagen Multimodal , Procedimientos Neuroquirúrgicos , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Encefalopatías/diagnóstico por imagen , Encefalopatías/patología , Lesiones Encefálicas/diagnóstico por imagen , Lesiones Encefálicas/patología , Lesiones Encefálicas/cirugía , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Imagen Multimodal/instrumentación , Imagen Multimodal/métodos , Procedimientos Neuroquirúrgicos/instrumentación , Procedimientos Neuroquirúrgicos/métodos , Pertecnetato de Sodio Tc 99m , Resultado del Tratamiento , Adulto JovenRESUMEN
Radiation methods are essential in management of certain types of neurooncological, neurovascular and functional brain pathology. Application of stereotactic technique of irradiation allows sufficient damaging impact on target (tumor, AVM, functional structures) and maximal protection of surrounding brain tissues. Indications to radiation treatment of intracranial lesions are expanding with evolution of stereotactic methods. The paper deals with the first experience of linear accelerator-based treatment of patients with intracranial neurosurgical pathology in this country. Techniques of stereotactic radiotherapy (SRT) and radiosurgery (SRS), indications to SRS and SRT in different modes of fractioning are described in details. Additionally specific complications, radiation reactions and feasibility of neurovisualization in diagnosis of radiation-induced brain damage are discussed.
Asunto(s)
Neoplasias Encefálicas/terapia , Radiocirugia/métodos , Radioterapia/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Lesiones Encefálicas/etiología , Lesiones Encefálicas/prevención & control , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Traumatismos por Radiación/etiología , Traumatismos por Radiación/prevención & control , Radiocirugia/efectos adversos , Radioterapia/efectos adversos , Estudios RetrospectivosRESUMEN
Aim of this study is to assess the role of stereotactic radiosurgery (SRS) and radiotherapy (SRT) in management of cranial nerves schwannomas by analysis of tumor control, clinical response and variables affecting treatment outcomes. Between April 2005 and January 2009 patients with schwannomas of VIII (63), V (14) and caudal nerves (2) were treated in Burdenko Moscow Neurosurgical Institute using linear accelerator. Mean age was 49 years (13-82). In 42 cases radiation treatment was preceded by surgical resection. 13 patients had type I or II neurofibromatosis. Mean volume of the tumor was 3.9 cm3 (0.5-14.4 cm3) and 13.4 cm3 (2.8-41.3 cm3) for SRS and SRT, respectively. Mean SRS dose was 12 Gy (10.8-14.4 Gy) for vestibular schwannomas and 15 Gy (13.2-18 Gy) for schwannomas of other nerves. In hypofractionated SRT the dose of 35 Gy was delivered in 7 fractions or 30 Gy in 6 fractions. In cases of classical fractioning total dose of 50-60 Gy was divided into daily fractions of 1.8-2.0 Gy. Radiographic tumor control rate reached 97.5% at the last follow-up. 5 patients experienced trigeminal dysfunction, it was transient in 3 cases and persistent in 2. Permanent decline in House-Brackmann facial nerve scale developed in 2 of 79 patients. After treatment effective hearing (class I-II) was preserved in 7 of 9 patients (67%) who had same level of hearing before SRS. Linear accelerator-based stereotactic radiation treatment provides long-term tumor control associated with high rates of preservation of neurological functions. No further tumor surgery was necessary in 100% of cases with solitary tumors with a minimal follow-up of 5 years.
Asunto(s)
Neoplasias Encefálicas/terapia , Neurilemoma/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Encefálicas/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neurilemoma/diagnóstico por imagen , Radiografía , Radiocirugia/métodos , Radioterapia/métodos , Inducción de Remisión , Estudios RetrospectivosRESUMEN
Radionuclide cisternomyelography performed in 324 patients with posttraumatic injuries revealed the abnormality of the brain liquor tracts. The radiological picture of craniocerebral injury sequelae showed a great diversity of radionuclide signs, detected both morphological changes in the liquor tracts, and liquorodynamic disorders. The morphological disorders recorded by radionuclide cisternomyelography appeared as hydrocephalus, porencephalitis, arachnoidal cysts and liquorrheas. The liquorodynamic disorders recorded by this tool manifested themselves as altered liquor circulation and resorption. Radionuclide cisternomyelography provides valid data on the performance of the drainage system during operations on the liquor tracts of the brain and spine.
Asunto(s)
Lesiones Encefálicas/líquido cefalorraquídeo , Lesiones Encefálicas/diagnóstico por imagen , Adolescente , Adulto , Quistes Aracnoideos/líquido cefalorraquídeo , Quistes Aracnoideos/diagnóstico por imagen , Quistes Aracnoideos/etiología , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/cirugía , Líquido Cefalorraquídeo/diagnóstico por imagen , Niño , Preescolar , Femenino , Cámaras gamma , Humanos , Hidrocefalia/líquido cefalorraquídeo , Hidrocefalia/diagnóstico por imagen , Hidrocefalia/etiología , Masculino , Persona de Mediana Edad , Cintigrafía , Reoperación , Pentetato de Tecnecio Tc 99mRESUMEN
Simple and available for wide clinical practice methods of treatment and prevention of complicated forms of dental caries in patients with hemophilia and Willebrand's disease have been presented, as well as effective methods for prevention of hemorrhage from the small cavity after a tooth removal in these patients under conditions of hematological centres.
Asunto(s)
Atención Dental para la Persona con Discapacidad/métodos , Hemofilia A , Enfermedades de von Willebrand , Adolescente , Atención Ambulatoria/métodos , Instituciones de Atención Ambulatoria , Hemofilia A/genética , Humanos , Enfermedades de von Willebrand/genéticaRESUMEN
The paper is concerned with the results of single-photon emission tomography and gamma-topography in patients with cerebral tumors, cerebral circulatory disorders and pathology of the liquor system. Tomographic investigation was shown to enhance the accuracy and reliability of the detection of cerebral tumors. Single-photon emission computerized gamma-tomography (SPECT) permitted the detection of structural and morphological cerebral changes in disturbed cerebral circulation of various etiology. SPECT together with computerized tomography and radionuclide cisternography was shown to be an auxiliary method for visualization of the cerebral cisterns. Radionuclide tomographic images as compared to gamma-topographic findings of the brain possessed a high statistical significance and good resolution.
Asunto(s)
Neoplasias Encefálicas/diagnóstico por imagen , Líquido Cefalorraquídeo/diagnóstico por imagen , Trastornos Cerebrovasculares/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único/instrumentación , Adulto , Encéfalo/diagnóstico por imagen , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Compuestos de Organotecnecio , Oximas , Pertecnetato de Sodio Tc 99m , Exametazima de Tecnecio Tc 99m , Tomografía Computarizada de Emisión de Fotón Único/métodosRESUMEN
A study was made of the cerebral hemodynamics by assessing the distribution in single-photon emission computerized tomography with 99mTc-hexamethyl-propyleneminoxyne in health using a Testascan in 9 standard slices. The whole set of tomographic slices was conventionally divided into 3 levels. For better orientation in gamma-tomographic images, pictures were presented where in addition to scintigrams a morphological scheme of the cerebral parts with the marked parts perfused by cerebral arteries, was given.
Asunto(s)
Encéfalo/diagnóstico por imagen , Circulación Cerebrovascular , Compuestos de Organotecnecio , Oximas , Tomografía Computarizada de Emisión de Fotón Único/métodos , Encéfalo/irrigación sanguínea , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/fisiopatología , Circulación Cerebrovascular/fisiología , Trastornos Cerebrovasculares/diagnóstico por imagen , Trastornos Cerebrovasculares/fisiopatología , Medios de Contraste , Hemodinámica/fisiología , Humanos , Exametazima de Tecnecio Tc 99m , Tomografía Computarizada de Emisión de Fotón Único/instrumentaciónRESUMEN
A TESTASCAN single-photon emission multidetector gamma tomograph is a special purpose unit designed to investigate RP distribution in the brain. It permits obtaining transversal tomographic images with the resolution of about 10 mm, the thickness of an emitted layer being about 15 mm. The time of patient's examination during obtaining an image of 10-12 layers does not exceed 30 min. and can be reduced by increasing RP activity and minimizing the number of emitted transversal sections. The clinical testing of the unit has shown that it is reliable in maintenance and simple to operate during radionuclide data collection, reproduction and analysis. Emission computerized tomography in brain tumors can be regarded as a method increasing the accuracy and reliability of radionuclide diagnostic examination of neurosurgical and neurological patients.
Asunto(s)
Tomografía Computarizada de Emisión/instrumentación , Neoplasias Encefálicas/diagnóstico por imagen , Encefalitis/diagnóstico por imagen , Diseño de Equipo , Estudios de Evaluación como Asunto , Humanos , Modelos Estructurales , Pertecnetato de Sodio Tc 99m , Tomografía Computarizada de Emisión/métodosRESUMEN
Prompt and durable hemostasis was achieved in 56 hemophilic patients and 62 patients with von Willebrand disease in 131 and 62 teeth extractions, respectively. The antihemophilic globulin-containing drug was infused as only a single dose in 61 of the 146 cases. Kaprofer, hemostatic sponge with kanamycin and tamponade were locally applied. No bleedings were observed.
Asunto(s)
Trastornos de la Coagulación Sanguínea/congénito , Técnicas Hemostáticas , Hemorragia Bucal/terapia , Complicaciones Posoperatorias/terapia , Extracción Dental , Trastornos de la Coagulación Sanguínea/complicaciones , Trastornos de la Coagulación Sanguínea/terapia , Niño , Hemofilia A/complicaciones , Hemofilia A/terapia , Hemofilia B/complicaciones , Hemofilia B/terapia , Humanos , Hemorragia Bucal/etiología , Complicaciones Posoperatorias/etiología , Enfermedades de von Willebrand/complicaciones , Enfermedades de von Willebrand/terapiaRESUMEN
Radionuclide cisternography (RCG) was performed in 78 children with different forms of hydrocephalus: external, internal (ventricular) and obstructive. Radiological signs were determined by spatial-time distribution of a radiopharmaceutical over the liquor pathways. Morphological and liquorodynamic disorders (liquor circulation and resorption disorders) served as a basis for the differentiation of hydrocephalus forms.
Asunto(s)
Hidrocefalia/diagnóstico por imagen , Adolescente , Niño , Preescolar , Humanos , Lactante , Métodos , Ácido Pentético , Cintigrafía , Tecnecio , Pentetato de Tecnecio Tc 99mRESUMEN
Analysis of the findings of radionuclide cisternography in 34 patients with a hypertension syndrome of unclear genesis allowed 3 variants of an aggregate of radiological signs to be distinguished. The 1st and 2nd variants indicate diminution of the drainage function of the cerebral submeningeal space, which does not exclude the presence of a pathological process, one of tumorous genesis among others. The third variant which reveals open internal hydrocephalus (ventricular hydrocephalus) with diminished drainage activity of the submeningeal space of the brain excludes the existence of a three-dimensional pathological process, that of tumorous origin also. In hypertension syndrome of unclear genesis disturbed circulation of cerebrospinal fluid was always attended by its impaired resorption; not only a diminished reaction (function) but an accelerated reaction of drainage of the cerebrospinal fluid from its passages may occur when the maintaining drainage function of the submeningeal space of the spinal cord is manifested.
Asunto(s)
Encefalopatías/diagnóstico por imagen , Presión Intracraneal , Encefalopatías/líquido cefalorraquídeo , Humanos , Hidrocefalia/diagnóstico por imagen , Indio , Ácido Pentético , Seudotumor Cerebral/diagnóstico por imagen , Cintigrafía , Espacio Subaracnoideo , Síndrome , Tecnecio , Pentetato de Tecnecio Tc 99mRESUMEN
Using the findings of ventriculo- and cisternography with 99mDTPA performed in 30 patients, it has been shown that the signs of open hydrocephalus should be considered the following: the visualization of the lateral ventricles, the third and fourth ventricles, the great cistern and the subdural space of the cervical part of the spinal cord (in preset time intervals); RPH complete absence (even after 24 h) in the subdural space of the brain (convencital, medial and parasagittal parts). Significant radiological signs of occlusive hydrocephalus are obtained from the visualization of one or two lateral ventricles; the visualization of the third ventricle and the great cistern. CSF disturbances revealed in radionuclide ventriculography can be used for the assessment of CSF resorption as well as the stage of process (decompensated stage).
Asunto(s)
Ventrículos Cerebrales/diagnóstico por imagen , Hidrocefalia/diagnóstico por imagen , Ventriculografía Cerebral , Preescolar , Cisterna Magna/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Hidrocefalia/líquido cefalorraquídeo , Hidrocefalia/clasificación , Lactante , Ácido Pentético , Neumoencefalografía , Cintigrafía , Tecnecio , Pentetato de Tecnecio Tc 99m , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
An analysis of the radiological signs is presented proceeding from the results of examination of the visualization of the CSF tract in 123 patients in whom radionuclide cisternography with 99mTc-DTPA was performed 1,3,6 and 24 h after administration of a radiopharmaceutical. The radiological appearance of pathology of the CSF system in a long-term period after penetrating craniocerebral wound was developed.
Asunto(s)
Lesiones Encefálicas/diagnóstico por imagen , Cisterna Magna/diagnóstico por imagen , Heridas por Arma de Fuego/diagnóstico por imagen , Anciano , Neoplasias Encefálicas/diagnóstico por imagen , Rinorrea de Líquido Cefalorraquídeo/diagnóstico por imagen , Trastornos Cerebrovasculares/diagnóstico por imagen , Encefalitis/diagnóstico por imagen , Humanos , Meningitis/diagnóstico por imagen , Persona de Mediana Edad , Ácido Pentético , Cintigrafía , Tecnecio , Pentetato de Tecnecio Tc 99m , Factores de TiempoRESUMEN
The comparative investigations of DNA complexes with daunomycin and proflavine were proceeded by the technique of spectrophotometry, viscometry and flow birefringence for two ionic strengths of environment (mu). According to the spectrophotometry data there is an unique type of ligand binding with DNA for mu = 0.1. The intrinsic viscosity and optical anisotropy of DNA-daunomycin complex increase nonlinearly together with its equilibrium rigidity as the amount of the binding ligand (r) rises, contrary to the behaviour of the same characteristics of DNA-proflavine complexes. The discussion of the experimental data within a scope of different models of binding reveals the best agreement with the intercalation model. Evaluation of the angels between the orientation planes of chromophore and aminoglucose residue of a daunomycin molecule and the axis of DNA double-helix was performed. Apart from intercalation there is a process of external binding of daunomycin with DNA in the low ionic strength (mu = 0.001) solutions which arises mainly at higher values of r. This type of binding weakens the long-range electrostatic interactions (and also to a certain extent the short-range ones) in DNA chain that determine the behaviour of the parameters under study.