Russian Research Neurosurgical Institute. prof. AL Polenov Russian Ministry of Health
Severo West State Medical University named after II Mechnikov
Research objective – studying of data of complex inspection of a dislocation at the craniocerebral injury (CСI) and primary brain tumors (BT) with a quantitative assessment of an index of cross shift.
Material and methods. Complex clinical and beam examination of 135 victims with CCI in the acute period conducted. Complex inspection included neurologic survey, an assessment of extent of violation of consciousness on the scale of a coma of Glasgow (SCG), ultrasonography of the head, chest and abdomen cavities, CT and MRI. Based on the conducted examination 92 victims, the most part (58.7%) from which – in the first 6 hours after an injury operated. Complex clinical and beam examination of 120 patients with primary BT conducted. Meningiomas revealed in 20.8% of cases, in other supervision glial tumors of 1-2 degrees of an anaplastic (19.2%) and the low-differentiated tumors of 3-4 degrees of an anaplastic (60.0%) took place. Surgical treatment depending on degree of a dislocation of a brain undertaken in various terms and the differentiated volume at all people. In all supervision calculated an index of a cross dislocation of a brain (ID) as follows. After neurologic survey and an assessment of level of violation of consciousness on SCG in points (G) carried out a tomography of a brain (CT or MPI), visualized the pathological substratum causing a cross dislocation. According to a morphometry determined the volume (V) pathological education in cm³, the size of shift of median structures (D) and the cross size of both lateral ventricles (L) at the level of the middle of a transparent partition in mm. After that calculated an index of a cross dislocation of ID on a formula ID = (V:3+3×D):(G+L).
Results. Retrospective studying of the obtained data at CCI allowed the following is established: at ID less than 0.6 operation isn't shown; at ID in the range from 0.7 to 1.2 it is possible to carry out miniinvasive operation with removal of the substratum causing a cross dislocation in an emergency order; at ID from 1.3 to 3.5 emergency operation with removal of the substratum causing a cross dislocation, in combination with a bone decompression with sizes of window not less 7×7 cm is expedient, and at ID more than 3.5 – emergency operation with removal of the substratum causing a cross dislocation, in combination with a bone decompression with sizes of a window the sizes not less 7×10 cm with a subtemporal decompression and expanded plasticity of a dura mater.
Retrospective studying of the obtained data at OGM allowed the following is established: at ID less than 1.2 operation of removal of a tumor it is possible carry out in a planned order; at ID in the range from 1.3 to 3.5 intervention should be carried out in urgent, and at ID more than 3.5 – in an emergency order.
Conclusions. The dislocation index presenting a derivative of parameters of volume of an intracranial supratentorial substratum in cm3, sizes of shift of ventricular system and its width of rather transparent partition in mm, and also a condition of consciousness on a scale of a coma of Glasgow adequately reflects extent of cross shift at CCI and BT. High diagnostic informational content of the developed and approved index of cross shift of a brain at various intracranial pathology allows to recommend it for universal broad application.