Анатомическое исследование возможности прямого эндоскопического выключения решетчатых артерий для деваскуляризации структур передних отделов основания черепа
Background. Many tumors of different histologic structure originate from the anterior skull base. These lesions may be highly vascularized leading to limited resection and severe intraoperative blood loss. Midline tumors are primarily supplied by ethmoidal arteries, which are not subject to endovascular embolization. Aim of this study was comparative experimental analysis of different surgical approaches to the ethmoidal arteries.
Materials and methods. The anatomical study was performed on 12 fresh human cadavers without diseases involving the anterior skull base, orbits, and paranasal sinuses (24 sides). In all specimens internal and external carotid arteries were injected by silicone dye. Anatomical dissection was carried on investigating four different minimally invasive endoscopic approaches to the ethmoidal arteries: 1) transorbital approach to the ethmoidal arteries via bicoronal incision; 2) pre/trans/retrocaruncular approach to the ethmoidal arteries; 3) endoscopic endonasal transethmoidal approach to the canals of ethmoidal arteries; 4) endoscopic endonasal transethmoidal-transorbital approach to the ethmoidal arteries in the orbit.
Results. Surgical technique of the mentioned approaches was described, and their advantages and disadvantages were analyzed. We propose the algorithm for selection of direct endoscopic ligation of ethmoidal arteries based on selected surgical approach for tumor resection and its extracranial extension.
Conclusion. Decision making for tumor devascularization must be substantiated by visualization of vasculature (CT or MR angiography). The study has demonstrated advantages and disadvantages of different endoscopic approaches to the ethmoidal arteries for their ligation aiming at early devascularization of anterior skull base lesions. All four are minimally invasive and provide good functional outcome and cosmesis.
The article presents the literature data on the structural variability and age-related features of the midline anatomical structures of the anterior skull base (frontal sinus, ethmoid bone, anterior parasellar region, and medial orbital wall). This is the area of surgical interests of neurosurgeons and rhinosurgeons. The study objective is to analyze the literature data on the individual variability and age-related anatomy of these structures. The work is illustrated with original images from the authors’ personal archive. The individual anatomical features of eloquent structures in the surgical area (structures within the surgical corridor, key anatomical landmarks, optic tract, internal carotid and ethmoidal arteries, etc.) should be considered in planning surgery in patients of all age groups because they can limit the view and the amount of safe manipulations or increase the risk of complications. The presented data may be useful for neurosurgeons and otolaryngologists whose surgical interests are focused on the midline structures of the anterior skull base.
Objective. To identify the most frequently occurring symptoms resulting from the affection of internal and external skull base in patients with benign tumors of the anterior and middle cranial base. Material and methods. The authors analyzed a complex of history, clinical, and instrumental data as well as results of combined treatment of 642 patients with benign tumors of the anterior and middle cranial base operated Medical Research between 2007 and 2011. Results. Neurological signs and symptoms in patients with benign tumors of the anterior cranial base, parasellar region, and middle cranial fossa were studied. In the majority of cases, the tumor extended extracranially. The most common groups of symptoms were identified and described, the most important groups are presented in the diagrams. The proposed scheme is applicable also for malignant tumors or other mass lesions of the same localization. Conclusion. Effective treatment and selection of the best management of a patient depends on modern medical approaches and techniques including neuroimaging. Careful assessment of symptoms is crucial in detection of tumors in the early stage. Dynamic monitoring of the patient using the proposed scheme will contribute to early detection of tumor recurrence or progression.
Background. The aim of the project was to show the peculiarities of manipulations in two-dimensional (2D) visualization and to enlighten young neurosurgical residents for further independent training of their manual skills in the anatomic lab. The course followed a step-by-step training program starting with artificial models in a static 2D exoscopic view field with subsequent transition to cadaveric animal models and the use of dynamic four-hand techniques and endoscopy.
Materials and methods. Since 2015, two 2-day workshops and four 1-day workshops have been organized. All courses consisted of short theoretical and prevailing hands-on practical part and were designed mainly for manual skills training. For optimal practical training, each pair of trainees were engaged with a separate working place equipped with a video system, exoscope, drill, suction, and a set of microsurgical and endoscopic instruments. A total of 48 trainees, including residents of the Nikolay Nilovich (NN) Burdenko National Medical Research Center of Neurosurgery (NMRCN), the Russian Medical Academy of Continuous Postgraduate Education, and other institutions from different regions of Russia, completed the program. Analysis of evaluation sheets revealed that over 90% of trainees were under the age of 30.
Results. The key idea – accommodation to endoscopy through a series of microsurgical exercises in 2D visualization – has been successfully actualized and met with interest. After analyzing the questionnaires, we found that an overall satisfaction rate was high. The vast majority of trainees intended to gain further experience and apply new techniques in their clinical neurosurgical and microsurgical practice. The number of practiced techniques and the quality of the provided equipment were considered by the participants as good or very good. The highly individualized training course with a participant/tutor ratio of 4:1 and the use of tissue models (no sacrifice of living animals) was well appreciated.
Conclusion. The demand for a workshop indicates a lack of such training activities for young professionals, such as the one we presented herein. Evaluation of the courses by the trainees showed that the contents of workshops corresponded to their tasks and expectations, regardless of their previous experience. The workshop was not only the 'stepping stone' from which the path of practical self-development should begin but also initiated the development of a whole series of specially focused training workshops on microsurgery and endoscopy for neurosurgeons.
Background: The ability of the human body to produce metabolic energy from light modifies fundamental concepts of biochemistry.
Objective: This review discusses the relationships between the long-accepted concept is that glucose has a unique dual role as an energy source and as the main source of carbon chains that are precursors of all organic matter. The capability of melanin to produce energy challenges this premise.
Results: The prevalent biochemical concept, therefore, needs to be adjusted to incorporate a newly discovered state of Nature based on melanin’s ability to dissociate water to produce energy and to reform water from molecular hydrogen and oxygen.
Discussion: Our findings regarding the potential implication of QIAPI-1 as a melanin precursor that has bioenergetics capabilities.
Conclusion: Specifically, we reported its promising application as a means for treating retinopathy of prematurity (ROP). The instant report focuses on the long-term treatment medical effects of melanin in treating ROP.
Proceedings of the conference "Molecular basis of epidemiology, diagnosis, prevention and treatment of current infections" 4-6 December 2018
Patent foramen ovale (PFO) is an important cause of embolic cryptogenic stroke (ECS) in young patients. The main mechanism in this case is paradoxical embolism (PE), the basis for which is a right-to-left (R-L) shunt. Objective: to comparatively characterize patients who have undergone ECS, with and without an R-L shunt, as evidenced by transcranial Doppler with the bubble test (TCD-BT).
The study of clinical terminology has always occupied a significant place in the discipline "Latin language and outlines of medical terminology." Undoubtedly, surgical terminology is one of the most voluminous terminology in the clinical block. Moreover, there are a lot of terms used in it in other departments of the clinical direction, so-called "common" terms.
Background: Sleep disorders have emerged as potential cancer risk factors.
Objective: This review discusses the relationships between sleep, obesity, and breathing disorders with concomitant risks of developing cancer.
Results: Sleep disorders result in an abnormal expression of clock genes, decreased immunity, and melatonin release disruption. Therefore, these disorders may contribute to cancer development. Moreover, in sleep breathing disorder, which are frequently experienced by the obese persons, the sufferer experiences intermittent hypoxia that may stimulate cancer cell proliferation.
Discussion: During short- or long- duration sleep, sleep-wake rhythm disruption may occur. Insomnia and obstructive sleep apnea increase cancer risks. In short sleepers, an increased risk of stomach cancer, esophageal squamous cell cancer, and breast cancer were observed. Among long sleepers (>9 hours), the risk of some hematologic malignancies is elevated.
Conclusion: Several factors including insomnia, circadian disruption, obesity, and intermittent hypoxia in obstructive sleep apnea are contributing risk factors for increased risk of several types of cancers. However, further studies are needed to determine the more significant of these risk factors and their interactions.
The series “Advances in Intelligent Systems and Computing” contains publications on theory, applications, and design methods of Intelligent Systems and Intelligent Computing. Virtually all disciplines such as engineering, natural sciences, computer and information science, ICT, economics, business, e-commerce, environment, healthcare, life science are covered. The list of topics spans all the areas of modern intelligent systems and computing such as: computational intelligence, soft computing including neural networks, fuzzy systems, evolutionary computing and the fusion of these paradigms, social intelligence, ambient intelligence, computational neuroscience, artificial life, virtual worlds and society, cognitive science and systems, Perception and Vision, DNA and immune based systems, self-organizing and adaptive systems, e-Learning and teaching, human-centered and human-centric computing, recommender systems, intelligent control, robotics and mechatronics including human-machine teaming, knowledge-based paradigms, learning paradigms, machine ethics, intelligent data analysis, knowledge management, intelligent agents, intelligent decision making and support, intelligent network security, trust management, interactive entertainment, Web intelligence and multimedia.
The publications within “Advances in Intelligent Systems and Computing” are primarily proceedings of important conferences, symposia and congresses. They cover significant recent developments in the field, both of a foundational and applicable character. An important characteristic feature of the series is the short publication time and world-wide distribution. This permits a rapid and broad dissemination of research results.
This book contains a selection of papers accepted for the presentation and discussion at the 2018 International Conference on Digital Science (DSIC’18). This Conference had the support of the Institute of Certified Specialists, Russia, AISTI (Iberian Association for Information Systems and Technologies), and Springer. It will take place at Convention Centre, Budva, Montenegro, October 19–21, 2018. DSIC’18 is an international forum for researchers and practitioners to present and discuss the most recent innovations, trends, results, experiences, and concerns in the several perspectives of Digital Science. The main idea of this Conference is that the world of science is unified and united allowing all scientists/practitioners to be able to think, analyze, and generalize their thoughts. DSIC aims efficiently to disseminate original research results in natural, social, art, and humanities sciences. An important characteristic feature of the Conference should be the short publication time and worldwide distribution. This Conference enables fast dissemination, so conference participants can publish their papers in print and electronic format, which is then made available worldwide and accessible by numerous researchers. The Scientific Committee of DSIC’18 was composed of a multidisciplinary group of 26 experts. One hundred and seven invited reviewers who are intimately concerned with Digital Science have had the responsibility for evaluating, in a “double-blind review” process, the papers received for each of the main themes proposed for the Conference: Digital Art and Humanities; Digital Economics; Digital Education; Digital Engineering; Digital Environmental Sciences; Digital Finance, Business and Banking; Digital Media; Digital Medicine, Pharma and Public Health; Digital Public Administration; Digital Technology and Applied Sciences.
DSIC’18 received 88 contributions from 16 countries around the world. The papers accepted for the presentation and discussion at the Conference are published by Springer (this book) and will be submitted for indexing by ISI, SCOPUS, among others.