Russian Research Neurosurgical Institute. prof. AL Polenov Russian Ministry of Health
Severo West State Medical University named after II Mechnikov
The research objective – studying of data of complex inspection at a longitudinal dislocation at the craniocerebral injury (CCI) and primary brain tumors (BT) with a quantitative assessment the degrees of infringement of a brainstem in the tentorium cerebelli (TC) and the foramen magnum (FM).
Material and methods. Complex clinical and beam examination of 135 victims with the 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 on. 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.
Results. The infringement of a brainstem in the TC visualized on MRI and CT in a frontal projection better. At uncus of hippocampus and parahippocampal gyrus under free edge of TC it mashed on 1-2 mm, the paramesencefal and the suprasellar of cisterns degree of a dislocation considered smoothness of moderate. Clinically this degree of a dislocation accompanied by consciousness violation to 8-9 points on SCG.
At the infringement of both medial departments of temporal gyrus on 3-4 mm, a full obliteration of the basal cisterns, and expansion of the pontocerebellaris cistern on the damage party degree of a dislocation considered the expressed. Consciousness violation to 6-7 points on SCG and existence of unilateral expansion of a pupil on the party of an intracranial compression clinically noted. At the infringement of both medial departments of temporal lobes on depth more than 5 mm and infringement of the last at the level of TC degree of a dislocation is mashed defined, how considerable. This degree of a dislocation accompanied by consciousness violation to 4-5 points on SCG and frequently pupil expansion on the party of an opposite intracranial compression.
On CT or MPI of a brain in the axial plane measured the area of a FM (S1). Further determined the total area of the tonsils of a cerebellum (S2) displaced in FM with the subsequent calculation of coefficient (Co) infringement of a brainstem in FM by a formula: Co=S2:S1×100%. At value of coefficient of infringement of a brainstem in FM to 20% degree of infringement counted moderate, at value of an indicator from 21 to 30% – expressed and at coefficient of infringement of a brainstem in FM more than 30% – considerable. Degree of the visualized dislocation formed the basis for terms and volume of surgical treatment.
Conclusions. Clinical and beam diagnostics at CCI and primary BT with application of CT and MRI-morphometry allows to allocate the moderated, expressed and considerable degrees longitudinal dislocation of a brain that predetermines a choice of terms and volume of surgical treatment. For each degree of the longitudinal dislocation, the clinical and neurologic symptomatology that important signs, the dissociation of deep reflexes and a muscular tone on a longitudinal axis of a body, a unilateral expansion of a pupil, and absence the corneal and oсuloсefalic of reflexes are is characteristic. СT as the method of emergency inspection, possesses high diagnostic information (within 81.8-87.1%).
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