Brain surgery is a frightening performance for every person. Is such fear justified? Is intervention in the brain really associated with a higher risk than, for example, heart surgery?

brain operations

The risk of neurosurgical therapy does not depend on the type of organ, but on the severity, type and stage of the disease. Even today, for example, advanced inflammation of the appendix can lead to death. On the other hand, well prepared complex operation on his brain deep structures, where the "millimeter error" popular among ignorant people can lead to life-long consequences, usually passes quite normally.

brain injury

This is a serious socio-economic problem, the increase in traumatic brain injuries requires the improvement of both diagnostic and therapeutic procedures. This is a group of diseases that includes both fatal injuries and damage to the nervous system, suggesting immediate surgical intervention. Most often, brain injuries are caused by a high-energy mechanism (traffic accidents, falls, dangerous species sports, etc.). To prevent head injuries, we recommend using protective equipment (helmets, seat belts, child seats).

Types and related types of brain operations:

• Concussion. The mildest type of TBI, characterized by a short-term disorder of consciousness, the inability to remember events during trauma. Vomiting is often associated with a concentration disorder. State does not require surgical intervention.
• Skull fracture. Fracture is divided into 2 types:
  • a simple fracture that usually does not cause serious problems;
  • a depressed fracture requiring surgical intervention, the purpose of which is to straighten the cranial bone.
• Epidural and subdural bleeding. These are serious and life-threatening conditions. Bleeding under or over the cerebral sheath causes pressure on the brain, disruption of its function. The purpose of the operation is to eliminate high blood pressure, treat the site of bleeding (often from damaged blood vessels or bones). The procedure must be carried out immediately, a delay means a risk to the health or life of the patient.
• Brain contusion. The brain, moving at high speed in the cranial cavity, can get hurt on the bone. Edema appears in the affected area, therefore, an increase in volume. The goal of treatment (medical or surgical) is to relieve pressure within the brain.
• Fracture of the base of the skull. These fractures are most common in facial trauma. There is a risk of infection in the intracranial space, so surgery is necessary.

brain tumors

(lat.: tumor), tumors, arise from a population of cells that have lost control over their division and growth. Tumors are divided into:

• benign - meningiomas, low-grade glial tumors, cysts, etc.;
• malignant - anaplastic astrocytoma, glioblastoma.

- complex, requiring cooperation between a neurosurgeon, oncologist, histologist, neurologist, rehabilitation specialist.

The first step is to remove part of the skull bone. It is necessary to remove all or part of the tumor. Today, for this purpose, modern methods(magnetic resonance, neuronavigation, modern surgical microscopy), argon coagulation is used to stop bleeding. For some - deeply rooted - tumors, a biopsy is performed (taking a sample of tumor tissue for histological examination, which is important for determining the correct oncological treatment). Malignant tumors after the work of the surgeon require treatment by an oncologist. Subsequent chemotherapy reduces the risk of developing new growths.

The purpose of the operation is to reduce or remove the tumor, causing pressure on the brain. On the morning of the operation, the head is shaved (you can do a partial shave). During the procedure, part of the bone is exposed; the hole serves as a way of penetration into the area of ​​the tumor. After its removal, the surgical wound is restored. The procedure takes about 4 hours.

There is a risk of cerebral edema, bleeding (about 3%), rarely - inflammation. These complications may be associated with limb movement disorders or common complications(eg, pneumonia, bleeding disorder). After the intervention, the patient is treated in the department intensive care. After discharge from the hospital, the patient undergoes outpatient and home treatment.

An alternative to surgical treatment is, in exceptional cases, irradiation of the tumor.

Metastases

Metastases, as a secondary type of tumor, are the most common intracranial tumor. They occur in 20-40% of adult patients with malignant diseases, in sectional material their share is up to 50%. About 20% of cancer patients die because of metastases. Mostly, breast cancer, lung cancer, melanoma, Gravitz tumor metastasize to the brain.

The management of patients with metastases is complex and multidisciplinary. Neurosurgical operations on the head are an important part of it. Proper technical implementation is essential for the success of surgical therapy. Important role plays the clinical condition of the patient, the prognosis of the underlying disease, the type of primary tumor, radiological data.

Surgical resection is recommended in patients with solitary brain metastases in an accessible site, especially if the tumor is larger causing significant environmental pressure or if extracranial disease is controlled.

The therapeutic procedure for patients with multiple metastases is individual, and treatment is usually controversial. Surgical therapy is being considered in patients with radiosensitive primary tumors. The advantage of resection is cytoreduction or even complete removal tumors, lowering ICP, obtaining material for histological and molecular diagnostics, the possibility of additional targeted treatment.

Resection of brain metastases is performed using an operating microscope with proper MRI-based preoperative planning of the procedure. In these cases, standard procedures are supplemented by functional magnetic resonance or diffusion tensors. Intraoperative electrophysiology is also used to monitor important structures, or preoperative imaging such as ultrasound.

Hydrocephalus

The brain chambers are usually filled with cerebrospinal fluid. Cerebrospinal fluid (CSF) circulates in the brain chambers and spinal canal and is constantly updated. Under certain conditions, a barrier to fluid flow may arise, and its production itself may be increased. This leads to an increase in the volume of the brain chambers, the appearance of symptoms of high intracranial pressure (headache, vomiting, confusion).

Brain surgery is aimed at eliminating the cause of the block. One of the options is artificial drainage (the introduction of a drainage tube into the brain chambers with an outlet in the abdominal cavity).

The type of drainage depends on the cause and magnitude of hydrocephalus (obstruction in the natural flow of fluid, impaired intracranial absorption). In children, most often (in 98% of cases) fluid from the intracranial region into the abdominal cavity is removed using various types of ventriculoperitoneal drainage. In obstructive types of hydrocephalus, minimally invasive endoscopic surgery can be used.

The operation is performed under general anesthesia and takes about 1 hour. Complications may be biological or technical in nature.

• The most serious biological complications are infections (3-20%), which are divided into several types according to severity - from local to general septic condition. Other complications include epilepsy, subdural hematoma (4-20% in adults, 3-6% in children).
• Technical complications of drainage are represented by obstruction, disconnection of the connector, kinking or rupture of catheters, etc.

The success of therapy depends on the correct diagnosis and indications (especially in adult normotensive hydrocephalus).

With active types of hydrocephalus conservative treatment ineffective, drainage surgery is the only possible and often life-saving solution.

Surgical treatment does not have an equally effective alternative replacement.

Transnasal surgery for pituitary adenoma

The transnasal approach used in most pituitary adenoma operations aims to eliminate or at least reduce the process in the area. Intervention in the brain is carried out from the right nostril. After the procedure, a tampon is inserted into the patient's nose for 48 hours (you have to breathe through your mouth). Sometimes a spinal tap is needed. After treatment, the patient usually spends 1 day in the intensive care unit.

Transnasal surgery is considered a relatively safe intervention, the most acceptable for a person in terms of time and cosmetics. Possible complications that occur in a minimal percentage (up to 5%) of cases include inflammation of the nasal cavity, postoperative bleeding, or leakage of cerebrospinal fluid from the nose. In addition, hormonal disturbances in the function of the pituitary gland may occur. Less often, the eyes are damaged (impaired vision).

An alternative to surgical treatment is, in exceptional cases, irradiation of the pituitary adenoma.

Plastic surgery of the damaged meninges

The purpose of the intervention is to prevent the risk of post-traumatic inflammation of the meninges in the future. During the procedure, a part is removed bone tissue skull to ensure penetration into the affected area. The operation takes approximately 4 hours.

Risks include swelling, bleeding, inflammation, olfactory disorder. Surgical treatment has no alternative equally effective replacement.

Surgery for aneurysms, malformations and other vascular problems

Procedure vascular operations on the brain depends on the type of problem.

Bulge in a vessel (aneurysm)

Wall cerebral vessel may be influenced by external or internal factors loosen up. The site of weakness is prone to bulges (aneurysms). The risk of an aneurysm is that it can burst, becoming a source of intracranial bleeding (hemorrhagic stroke). This creates a condition that poses a direct threat to human life. It is necessary to quickly determine the location and size of the bulge, to choose the optimal treatment.

The principle of therapy is to eliminate the bulge from the circulation, i.e. to prevent further bleeding. This can be done in 2 ways.

• 1st method - surgical installation of the clip. This is a kind of "clothespin" located at the base of the aneurysm, so that it cannot burst.
• The 2nd method - endovascular - includes filling the bulge with spirals that ensure its closure. This method is suitable for the treatment of aneurysms, the location of which is inaccessible for direct surgical intervention. The spirals enter the bulge with a special device inserted into vascular system through a vessel in the groin.

Arteriovenous malformations

This is an abnormal accumulation of blood vessels between a cerebral artery and a vein. Its danger lies in the risk of bleeding, which can have serious consequences for a person. The goal of surgical and endovascular treatment is to eliminate abnormal blood vessels from the bloodstream.

During the intervention, the skull is opened, penetration into the area of ​​the vascular anomaly is closed or the vascular anomaly is removed, thereby preventing possible bleeding. After the procedure, the surgical wound is restored. The operation lasts about 4-6 hours.

An alternative to surgical treatment is an endovascular procedure.

Carotid endarterectomy

During a person's life, atherosclerotic deposits and plaques form in the blood vessels, gradually closing the vessels. If this occurs in the region of the cervical (carotid) artery, the blood supply to the brain is at risk. The next complication is the risk of detachment of part of the plaque that clogs the arteries of the brain, which causes an ischemic stroke.

Carotid endarterectomy consists in opening the artery, removing the plaque and restoring its patency. It is recommended not only for patients with a history of stroke, but also as a preventive measure. The procedure is performed using a microscope under local anesthesia, i.e. the patient is conscious. In some cases it is appropriate general anesthesia; in this case, continuous monitoring of the patient's neurological function (also called electrophysiological evoked potential monitoring) and the patency of the cerebral artery is necessary.

Carotid endarterectomy can be performed as emergency help in case of sudden occlusion of the cranial artery. This will help prevent serious injury or death.

Microvascular decompression of the head nerves

Vessel pressure on the brain nerves can cause problems that develop with age. As a rule, we are talking about trigeminal neuralgia (acute pain in the center of the face) or facial hemispasm (uncontrolled jerks in half of the face). Microvascular decompression of the head nerves consists in removing the nerve contact with the vessel, which is deflected, fixed in a new position with a special adhesive.

Extra-intracranial anastomoses

This is a microsurgical procedure aimed at improving the blood supply to the brain, usually by closing the cervical artery, with subsequent insufficient supply of blood to the GM. The indications are based on a study of the cerebrovascular reserve. The intervention itself consists in connecting the artery supplying the soft tissues of the head with the cerebral artery, providing a "new" blood flow to the organ.

Endoscopic brain therapy

Brain endoscopy is an intervention in which an endoscope is inserted into the brain - an instrument with a camera that allows you to see structures and perform therapeutic procedures. Purpose of endoscopy:

• visualization of the state inside the brain;
• performing a biopsy - taking a tissue sample for further examination;
• creating a drain hole cerebrospinal fluid.

The endoscope is inserted through a drilled hole in the skull. The intervention lasts about 2 hours and is performed under general anesthesia. The head is usually not completely shaved; shaving near the insertion site of the endoscope is sufficient.

Complications are rare and are mainly represented by bleeding at the insertion site of the endoscope. After surgery, you may experience a headache that responds to pain medication. Sometimes there is dizziness. The hospital stay after the procedure is 7 days, usually until the stitches are removed.

Surgical treatment has no effective alternative replacement.

Stereotactic brain surgery

Stereotaxis is a therapeutic method when the doctor does not directly see the structures on which the operation is performed. The structure of the brain is pre-focused, mainly in accordance with the planning magnetic resonance; the exact target is achieved with the help of a computer and a stereotaxic device.

The purpose of stereotaxis is to perform a biopsy, drain fluid (blood, pus), introduce an electrode or a therapeutic substance into the brain. In the case of treatment of movement disorders by inserting an electrode, the operation is performed with local anesthesia, because. the patient must cooperate. It takes 1-2 hours. A full head shave is not required, just shave around the insertion point of the electrode.

Complications may include unsuccessful sample collection (i.e. no diagnosis can be made) or bleeding at the time of lead insertion. After the intervention, a headache that responds to analgesics is possible. Postoperative hospitalization is about 7 days, usually until the stitches are removed or until the results of the biopsy are obtained.

Brain surgery for epilepsy

Approximately 30% of patients with epilepsy continue to suffer from seizures despite taking medication due to the so-called. pharmacoresistance. In these cases, consideration should be given to the advisability of neurosurgery.

During surgery, the part of the brain where seizures occur is removed without affecting the surrounding areas. The success of the therapeutic method depends on the operated site. After the procedure in the temporal region, up to 70% of patients get rid of seizures, with surgery in other areas, the success rate is lower.

There are patients whose illness is severe and whose attacks are severe, often associated with falls and injuries. However, sometimes it is not possible to perform an operation to eliminate them. In other cases, a surgical method can be used to interrupt the pathways that spread seizures from one hemisphere of the brain to the other, which can change the course of seizures.

In particularly severe cases of epilepsy, where there is no hope of controlling the disease with antiepileptic drugs or surgery, vagus nerve stimulation can be used. This is the 10th brain nerve, affecting several organs in the abdominal and chest cavities, transmitting sensations from the intestines to the brain. The vagus nerve is stimulated using a device similar to a pacemaker. It is placed under the skin under the left collarbone.

Vagus nerve stimulation is only effective for some patients whose disease is not treatable. The method helps to reduce the number of seizures or shorten their duration.

Unique stereotaxic surgery

A unique treatment option for epilepsy is the treatment of medial temporal epilepsy (seizures spreading from the internal structures of the temporal lobe) in a stereotactic manner. The most common cause of this type of epilepsy is hippocampal sclerosis. The disease occurs as a result of brain damage in childhood, for example, with long periods of fever, meningitis.

Stereotactic surgery is intended for patients with a well-defined, limited epileptic localization, where the removal of the lesion means the treatment of the disease. This is an intervention using a special electrode, through which the surgeon performs targeted thermal destruction of the tissue that causes epilepsy. The results of this method are comparable to the results of an open neurosurgical operation, but with minimal burden on the patient.

Is a brain transplant possible?

Various brain injuries lead to serious illnesses person, because its natural regeneration is very difficult. Current regenerative medicine is trying to replace or heal damaged or dead cells in the brain tissue with stem cells that can replace some of the missing parts of the tissue, produce substances that are important for the restoration of the whole organism. Attempts at brain transplantation have so far failed. Barriers include the time-consuming nature of the procedure, the inability to natural recovery brain nerve fibers, which stands in the way of restoring neural connections during implantation of foreign tissue.

One of the main problems is the lack of donors or organs of sufficient quality for transplantation, the limited survival of organs after transplantation. A brain transplant

The content of the article

brain tumors make up about 9% of the total number of all human neoplasms (I. Ya. Razdolsky, 1954) and occupy the fifth place among tumors of other localizations. According to A.P. Romodanov and N.N. Mosiychuk (1990), patients with brain tumors account for about 2% of patients with organic diseases nervous system. Every year, one case of a brain tumor is registered for every 15-20 thousand people. Men and women suffer about the same. The incidence in children is slightly lower than in adults. Most tumors are observed between the ages of 20 and 50 years.

Etiology and pathogenesis of brain tumors

The nature of brain tumors is polyetiological, and today it has not been finally elucidated. Among the theories explaining the mechanism of tumor occurrence, the most popular are those that associate the appearance of uncontrolled growth with changes in the genetic information of cells. An important role here is played by hyperplasia, which occurs under the influence of various unfavorable exogenous and endogenous factors (intoxication, inflammatory processes, ionizing radiation, carcinogens, hormonal disorders, prolonged trauma, and others). Violations of embryonic development, dysontogenetic heterotopia and atypia in the structure of the brain can cause the development of the blastomatous process. The final decision of this question belongs to the future.

Classification of brain tumors

I. By localization:
- supratentorial
-subtentorial
- double localization:
craniospinal
suprasubtentorial
-convexitals
-basal
II. For brain tissue:
extracerebral
intracerebral
III. Origin:
-Primary
Neuroectodermal (from nerve cells- astrocytoma, glioma, glioblastoma, ependymoma, medulloblastoma, papilloma, pinealoma, neurinoma)
-Secondary
3 mesenchyme derivatives (metastatic) (meningioma, angioreticuloma, sarcoma)
3 pituitary cells (adenoma)
From the remnants of the pituitary passage (craniopharyngioma)
Metastatic (in 80% of lung and breast cancer metastases)
Teratomas and teratoid tumors
Heterotopic tumors of ectodermal origin (dermoids)

Clinic of brain tumors

The clinical picture of brain tumors is due to the specifics of tumor growth, which is characterized by:
1) general effect on the whole organism,
2) a constant increase in the clinic - the progression of the disease,
3) local impact on brain structures. Tumors of the brain.
The clinical picture depends on the size, localization, growth rate of the tumor and the severity of perifocal edema. AT clinical picture brain tumors allocate cerebral and focal symptoms.
Cerebral symptoms indicate the presence of a tumor, focal (primary and secondary) are important in topical diagnosis.

Cerebral symptoms

The occurrence of cerebral symptoms is primarily due to an increase in intracranial pressure as a result of a gradual increase in the tumor, the development of concomitant edema - swelling of the brain, impaired CSF circulation and venous outflow. In the occurrence of cerebral symptoms, a certain role is played by intoxication of the body, associated both with the direct toxic effect of the tumor, and with dysfunctions. internal organs arising from a disorder of central regulation through tumor growth.
Venous congestion leads to extravasation of the liquid part of the blood and increased production of cerebrospinal fluid by the vascular plexuses of the ventricles while reducing its absorption by overflowing veins.
The most typical cerebral symptoms in hypertensive syndrome are headache, vomiting, dizziness, impaired consciousness.
Headache with tumors more often of hypertensive origin, characterized by bilaterality and diffuseness, it worries mainly in the morning, may be accompanied by vomiting, after which relief is possible. For meningiomas, a headache of a shell, vascular nature is more common - periodic, mainly localized, aggravated after physical and psycho-emotional stress.
Vomiting of the central character, not associated with eating, occurs at the height of the headache. After vomiting, the patient's condition often improves, the severity of the headache decreases. Vomiting with a change in the position of the head is characteristic of tumors of the IV ventricle.
Dizziness manifested by a feeling that resembles a state of slight intoxication, lightheadedness, unsure coordination of movements. It is believed that the basis of this sensation is stagnation in the labyrinth.
Disturbance of consciousness manifest as stunning, the degree of which increases with an increase in intracranial pressure. Lability of the psyche, disorders of memory, thinking, perception, concentration are possible, delirium, hallucinations occur. Mental disorders may appear paroxysmally in the form of seizures, but more often develop gradually, when stunning turns into stupor, and later into a coma. The pathogenesis of mental disorders in brain tumors is very complex. In some cases, they are caused by inhibition of the activity of the cerebral cortex as a result of hypertensive syndrome, in others, mental disorders are a focal symptom of damage mainly to the frontal lobe.
For brain tumors severe hypertension visual disturbances are:
- Deterioration of visual acuity,
- Narrowing of the visual fields, primarily to the red color (an early symptom of hypertension),
- Obnubilations (temporary periodic visual disturbances).
In the fundus, retinal vein expansion, stagnation are found, and on more late stages~ disc atrophy optic nerves, hemorrhages in the navcolodisk regions of the retina. The final stage of stagnant discs is their secondary atrophy. In brain tumors, atrophy of the optic discs can also be primary, associated not so much with increased intracranial pressure, but with direct compression of the optic nerves, or their tumor decussation. A peculiar phenomenon is observed when the tumor is localized in the region of the base of the anterior cranial fossa - Foster-Kennedy syndrome - simple atrophy is observed on the side of the focus, a decrease in visual acuity to complete blindness with the development of a congestive optic disc on the opposite side.
In addition to the listed main signs of increased intracranial pressure, meningeal symptoms, bradycardia, decreased pressure, especially diastole, circulatory disorders, epileptic syndrome, which can be both local and hypertensive, are possible.

Focal symptoms

Focal symptoms are divided into primary focal symptoms and secondary focal symptoms - in the neighborhood and at a distance.
Primary focal due to the direct action of tumors on the brain structures at the site of localization. Secondary focal due to displacement (dislocation) of the brain and ischemic disorders.
Primary focal symptoms are manifested by functional disorders of those parts of the brain on which the tumor has a direct effect: these are motor, sensory, olfactory, auditory, visual, and speech disorders. So, with damage to the frontal lobe (the posterior sections of the lower frontal gyrus - Broca's center), motor aphasia is characteristic.
With damage to the temporal lobe - auditory hallucinations, sensory aphasia (posterior superior temporal gyrus of the dominant hemisphere - Wernicke's center).
Amnestic aphasia occurs when the lower and posterior parts of the parietal and temporal lobes are affected. It is difficult for patients to name an object, although they understand its purpose well.
Semantic or semantic aphasia develops when the process is localized at the junction of the parietal, temporal and occipital lobes of the left hemisphere in right-handers.
epileptic seizures(convulsions, seizures) are most characteristic when the tumor is localized in the temporal lobe. Quite often, seizures for a long time is the first and only clinical sign of the disease, so their appearance should always raise the suspicion of the presence of a tumor. Seizures can be small (petit mal), local (Jacksonian epilepsy), generalized convulsions with loss of consciousness. Some features of the attacks make it possible to judge the localization of the process. So, seizures preceded by hallucinations or auras of a motor nature are observed with a tumor of the frontal lobe, sensitive hallucinations - in the parietal, olfactory, auditory, complex visual - in the temporal, simple visual - in the occipital lobe.
Secondary focal symptoms are divided into symptoms "neighborhood" and at a distance.
Secondary focal symptoms are caused by displacement, compression (dislocation) of parts of the brain or its trunk to the protrusions of the skull, cerebellum, crescent process, or impaired blood supply when the brain vessels are compressed by the tumor.
The most life-threatening with volumetric processes of the brain (tumor, hematoma, abscess, etc.). Are dislocation syndromes, which may be due to such types of herniation of the brain:
1) semilunar wedging under the falx;
2) temporo-tentorial;
3) cerebellar-tentorial;
4) herniation of the tonsils of the cerebellum into the cervical-occipital-dural funnel.
At the same time, against the background of a progressive impairment of consciousness, an increase in headache, vomiting, bradycardia, arterial hypertension, an increase in oculomotor disorders, vegetative disorders, an increase in pyramidal disorders, tonic convulsions, arrhythmia, an increase in respiratory rate with a violation of its rhythm up to a stop, a decrease in blood pressure, clinical death.

Diagnosis of brain tumors

Based on neurological examination data and additional research methods.

craniography

Craniography (overview in 2 projections and sighting) reveals a number of changes:
1) Craniographic signs (symptoms) are caused by increased intracranial pressure (intracranial hypertension):
a) osteoporosis of the back of the Turkish saddle;
b) thinning of the bones of the skull, deepening of the finger impressions - in older children, young people;
c) divergence of seams - in young children.
With a long course of the hypertensive syndrome, thinning of the Blumenbach clivus (clivus os occipitalis), an increase in the vascular pattern, and the threshold of the wings of the main bone can be observed.
2) Direct focal craniographic symptoms:
a) calcification (echinococcus, cysticercus, toxoplasmosis, planar hematomas, brain tumors can be called);
b) thinning and destruction of the bones of the skull (complete and incomplete destruction) - as a result of the action of dermoid tumors;
c) hyperostosis (thickening of the bone: needle-like, planar, mushroom-shaped - characteristic of benign tumors of the skull bones and meningiomas);
d) strengthening of the vascular pattern as a result of:
- Increase in the caliber of existing vessels,
- The appearance of newly formed vessels with an atypical course and branching.
3) Indirect focal craniographic symptoms are the result of displacement by a volumetric process of "physiological" signs:
a) the pineal gland;
b) the dura mater, including the falciform process;
c) vascular plexuses;
d) vessels.
4) Craniographic symptoms of endocrine disorders, which are characteristic of tumors of the diencephalic region (changes in the bones of the skull with symptoms of acromegaly).

Echoencephalography

Echoencephalography (EchoEG) allows you to detect displacement middle structures brain when the tumor is located in the cerebral hemispheres. The displacement of the M-echo in such cases can reach 10 or more millimeters. In tumors of subtentorial localization, M-echo displacement, as a rule, does not occur, however, other indirect signs of the tumor can be detected on echoencephalograms, namely, signs of increasing hypertension, as indicated by an increase in the size of the ventricles.
In electroencephalography (EEG), the main characteristic feature of brain tumors is the appearance of foci bioelectric activity, which often correspond to the localization of the tumor. sometimes, zones of epiactivity are revealed near these foci. With a pronounced hypertensive syndrome, general changes in bioelectric activity may prevail over focal ones.

Pseumoencephalography and pneumoventriculography

Pseumoencephalography and pneumoventriculography can detect displacement (dislocation) of the ventricles of the brain and cisterns, a change in their shape (deformation), an increase in the size (hydrocephalus) of the ventricles of the brain and subarachnoid space.

Lumbar puncture

Lumbar puncture for brain tumors can be of little information. With certain localizations of tumors (subtentorial) there is a real danger of causing herniation of brain structures. Lumbar puncture reveals predominantly an increase in cerebrospinal fluid pressure. Protein-cell dissociation (an increase in the amount of protein with normal cytosis) is more characteristic of neurinomas auditory nerve and basal meningiomas, although it is also observed in other types of brain tumors. In malignant tumors, pleocytosis can reach several hundred cells. sometimes tumor cells can be found in the cerebrospinal fluid.

Angiography

With angiography the most important features brain tumor is the displacement of vessels and their main branches, the appearance of new vessels, also note a change in the duration of the phases of angiography. Angiography is crucial for identifying the sources of blood supply to the tumor, helps in making a topical diagnosis and determining the histostructure of the tumor.

CT scan

The most informative in the diagnosis of brain tumors is computed tomography (CT) - a method of layer-by-layer examination of brain structures based on the different ability to absorb X-rays and magnetic resonance imaging (MRI). The latter method is based on the phenomenon of nuclear magnetic resonance, for the discovery of which in 1946 and. Parzell and F. Bloch received the Nobel Prize.
These methods make it possible to obtain an image that can be compared in quality with a histological section, while studies can be carried out in any plane of the brain. The sections show not only structural and pathological changes, but also physicochemical and pathophysiological processes of both the whole brain and its individual structures. With MRI, it is possible to conduct not only a functional study of the brain itself, but also perform magnetic resonance angiography, which does not require arterial puncture. MRI allows you to build a three-dimensional reconstruction of the area under study, highlight vasculature and even individual nerves passing in the subarachnoid space, all this creates optimal conditions for early detection brain tumors, planning the volume and features of surgical intervention and postoperative control.

radioisotope scanning

Radioisotope scanning - the method is based on the ability of radioactive isotopes introduced into the body to accumulate in the tumor in greater quantities than in the surrounding tissues, which is recorded using special counters. The method allows in about half of the cases to identify (the tumor and clarify its location.

Treatment of brain tumors

The treatment of brain tumors is predominantly surgical. At benign tumors microsurgical treatment is performed. For malignant cases, combined treatment is used - surgical in combination with chemotherapy, radiation and immunotherapy.

Surgery

In most extracerebral tumors (meningiomas, schwanoma, pituitary adenomas), it is possible to completely remove the tumor and avoid relapses. Operational risk depends on the patient's condition, comorbidities, size and location of the tumor, the complexity of the operation. Resection of large tumors is associated with significant damage to healthy areas of the brain, which affects the neurological status and the final result of treatment. A high risk is characteristic for the localization of tumors located in the cavity III ventricle, areas of the hypothalamus, trunk, foramen magnum and tumors closely connected to the main vessels - the carotid artery or the sinuses of the brain.
To remove brain tumors, various approaches to the affected areas of the brain are used, mainly using craniotomy. Pituitary tumors are in most cases removed by transsphenoidal access. In connection with the advent of endoscopic technology, it became possible to remove an intraventricular tumor through a special tube inserted into ventricular system through a small cut hole. In cases of inoperable tumors in order to reduce clinical manifestations tumors and removal of the severity of the hypertensive syndrome, decompressive trepanation is performed. In cases of occlusive hydrocephalus and the inability to eliminate the cause of its occurrence, use different types bypass operations (ventriculoperitoneal shunting, ventriculocysternal shunting (Thorkildsen operation), etc. The use of magnifying optics and microsurgical instruments made it possible to visualize previously inaccessible structures and dramatically reduce the incidence of surgical complications and postoperative mortality. The optimal result surgical treatment tumor is its complete removal. In cases of an unfavorable location of the tumor, in order to prevent trauma to the vital structures of the brain or the appearance of a gross neurological deficit, subtotal removal is used, when the tumor is removed almost completely, leaving only a part of it in the functionally important areas of the brain. With intracerebral tumors, which are characterized by predominantly infiltrative growth, complete removal is impossible without significant trauma to intact brain structures and the appearance of a pronounced neurological deficit. In such cases, partial removal is possible, since this significantly reduces intracranial pressure, which increases the effectiveness of subsequent radiation and chemotherapy.

Radiation therapy

Irradiation of tumor tissues with X-rays in doses of more than 50 Gy stops the continuous growth of tumors such as medulloblastomas, ependymomas, breast and lung cancer metastases. Serious attention is paid to the use of telecobalt therapy "gamma knife". Radiation therapy is indicated for partial removal of tumors. However, most tumors are insensitive to radiation therapy.

Chemotherapy

For drug exposure On the growth of tumors, various drugs are used that have the ability to penetrate the blood-brain barrier, concentrate in tumor tissues and suppress their growth. In the treatment of malignant gliomas, the highest efficiency was observed in nitrosourea derivatives (carmustine, lomustine, etc.). After the administration of the drug, leukopenia and thrombocytopenia are observed, the blood picture returns to normal within 3-4 weeks after the administration of the drug. Re-introduction of the drug is carried out only with the normalization of blood counts. Today, combined radiation therapy is used with frequent intraventricular administration of chemotherapy drugs (methotrexate, cytarabine) using an Ommaya reservoir placed in the subgaleal and connected to the lateral ventricle (intrathecal chemotherapy

Neurosurgery is a very exciting, but at the same time difficult branch of medicine. As you know, all diseases are from the nerves. There is truth in this statement, given that the brain controls all processes in human body. In adults, only 10-15% of all brain capabilities are used. Work on the elimination of ailments of the central nervous system (CNS) is complex, scrupulous and very responsible. After all, any mistake in the operation can ruin a human life.

Who is a neurosurgeon

A neurosurgeon is a highly qualified specialist who diagnoses and treats diseases of the brain, spinal cord, and peripheral nervous system. In total, training in such a craft takes 8-10 years. To prepare a good operating neurosurgeon, you need to spend another 10 years, and the doctor himself must have the following qualities:

• high erudition in the field of pathology of the nervous system;
• deep knowledge in anatomy, histology, physiology, pathological human physiology;
• resistance to stress;
• thoroughness;
• the ability to think soberly, quickly weigh all the pros and cons;
• purposefulness;
• responsiveness;
• sympathy;
• ability to work even with unpromising patients;
• thirst for constant self-development, because neurosurgery has not been studied at all;
• high accuracy in hand movements;
• common sense should outstrip the movements of the fingers, because the cost of error is very high.

In addition to such qualities of character, a neurosurgeon must have excellent health, vision and constantly maintain physical fitness.

In neurosurgery, the following subsections are distinguished:

• neurooncology;
• pediatric neurosurgery;
• neurotraumatology;
• vascular diseases of the central nervous system;
• functional neurosurgery;
• psychosurgery;
• spinal cord surgery;
• surgery of the peripheral nervous system;
• purulent-septic surgery.

A neurosurgeon treats both acute and chronic conditions.

What complaints are addressed to a neurosurgeon

Headache and dizziness - common symptoms with CNS pathology (photo: www.gohealth.com.ua)

Important! The spectrum of CNS diseases is quite wide, and not every person can independently determine which specialist can help in case of complaints.

Appearance the following symptoms requires immediate consultation with a neurosurgeon:

• a headache that does not go away after taking painkillers, is constantly disturbing, has a bursting character;
• persistent nausea;
• indomitable and causeless vomiting, which is not stopped by the use of antiemetic drugs;
• dizziness in the supine and standing position, not amenable to treatment;
• sharp deterioration vision. The person complains that he cannot see everything to his right or left;
• nystagmus (pendulum and involuntary movements of the eyeballs);
• strabismus that appeared in full health;
• protrusion of one eyeball outward;
• sudden loss of speech, memory, articulation;
• gait disorders;
• severe pain in the spine, which hinder movement in the limbs, torso;
• feeling of numbness of the legs and arms;
• back pain and the appearance of disorders in the genital area;
• the appearance of sudden convulsions;
• various injuries that are accompanied by damage to the brain or spinal cord.

Important! Many patients do not pay attention to a constant headache. But quite often such a banal symptom, if it lasts for weeks or months, indicates a serious organic pathology brain.

It should be noted that people need to take into account three main symptoms, the simultaneous occurrence of which requires the consultation of a neurosurgeon: severe headache, vomiting and sudden loss of consciousness.

What diseases does a neurosurgeon treat?

An experienced physician should deal with the treatment of diseases of the nervous system. Neurosurgeons treat conservatively or perform surgical interventions with such diseases:

• CNS tumors. Any brain tumor, even a benign one, is considered malignant. This is because with all neoplasms, intracranial pressure increases. Symptoms depend on the affected area;
• tumors of the peripheral nervous system appear anywhere - abdominal and pleural cavity, limbs, retroperitoneal space;
• consequences of the infectious diseases. Meningitis, encephalitis, neuritis can leave behind an adhesive process between the meninges. At the same time, the circulation of spinal fluid is disturbed, and pain syndrome and neurological symptoms are added;
• skull injuries occur after an accident, blows with a blunt or sharp object. This is fraught with the development of hemorrhage in the meninges and brain tissue. Headaches, vomiting, loss of consciousness, nystagmus, gait disturbances appear;
• injuries of the spinal cord, peripheral nerves with injuries of the extremities. Falls from a height, jumping into water, hits with sharp objects often damage the vertebrae, while compressing the nervous tissue. Paresis or paralysis may occur lower extremities, persistent dysfunction of the pelvic organs;
• epilepsy is characterized sudden convulsions that the patient does not remember. Attacks are so strong that respiratory arrest may occur;
• cerebral aneurysms are characterized by suddenness. When an aneurysm ruptures, the patient suddenly loses consciousness, falls into a coma. The outcome in most cases is lethal;
• intervertebral hernias of different departments. The cervical region is considered life-threatening, because squeezing medulla oblongata leads to respiratory and cardiac arrest;
• brain abscesses after infectious diseases. Symptoms depend on the affected area.

In pediatric neurosurgery, diseases are similar to adults, but in addition, a pediatrician treats congenital anomalies: neural tube nonunion, vertebral hernia, hydrocephalus (excessive accumulation of fluid in the membranes of the brain), brain cysts. Such ailments are difficult to treat, and the rehabilitation period lasts for the rest of your life.

How is an appointment with a neurosurgeon

After the appearance of problems with the nervous system, a person should immediately seek help from a neurosurgeon.

The doctor adheres to the sequence in examining the patient:

• collection of complaints;
• medical history;
• finding out the causes of the disease;
• local examination of the patient using a neurological hammer;
• examination for the presence or absence of reflexes: knee, elbow, in the area of ​​the Achilles tendon, radiocarpal joint;
• checking for symptoms of inflammation of the spinal membranes if there are signs of infectious meningitis, especially in children;
• study of the stability of the patient in the Romberg position (arms are straightened in front of him, palms down, legs together), if a person begins to stagger or leans to the side, then there is definitely a pathology of the brain;
• a test for walking in a straight line, if an adult cannot walk straight along the line, this indicates a problem with the cerebellum.

Examination of the patient and the results obtained functional tests help the doctor make a correct diagnosis. If twofold conclusions are obtained, then it is necessary to resort to more precise instrumental studies.

Researches prescribed by a neurosurgeon

In addition to the tests performed, the neurosurgeon must prescribe the following studies to exclude or confirm the pathology of the nervous system:

• general analysis of blood and urine;
• magnetic resonance imaging (MRI) or computed tomography (CT) of the skull, spine, areas of damage to peripheral nerves;
• encephalography - film recording of electrical impulses that occur in the brain;
• puncture of the membranes of the spinal cord (spinal puncture) in case of hemorrhage or suspicion of infectious meningitis;
• angiography - X-ray examination of the vessels of the brain using a contrast agent;
• ultrasound examination (ultrasound) of the vessels of the brain;
• myelography - x-ray examination spine and spinal cord with a contrast agent., which is injected during spinal puncture.

After receiving the results of the studies, the neurosurgeon determines the treatment and approximately sets the terms of rehabilitation.

Operations performed by a neurosurgeon

Different branches of neurosurgery require specific approaches to treatment. For example, radicalism in the removal of tumors is embedded in the system of work of neurooncology. However, it is very important that a person after the operation be able to take care of himself, avoid paralysis or loss of social qualities (changes in behavior, memory, consciousness).

Depending on the cause of the disease, neurosurgeons perform the following surgical interventions:

• trepanation of the skull. After detecting a pathological focus, the doctor “cuts out” a part of the skull bone with special tools. The operation is performed with hematomas, bone fractures, brain tumors;
• shunting. Often, neurosurgeons connect the subarachnoid space (the ball of blood vessels that covers the spinal cord) with a drain tube. abdominal cavity in children who suffer from hydrocephalus (excessive accumulation of fluid in the brain). So you can relieve increased intracranial pressure;
• removal of the hemisphere (one half) of the brain is indicated for gunshot wounds, large tumors. This is a desperation operation, but there are cases where patients survive and have minor neurological changes;
• reconstructive surgery on the skull is performed after trepanation, after 6-12 months. The hole is closed with a titanium plate to avoid damage to the brain tissue;
• removal intervertebral hernia endoscopically, laser, coagulator;
• osteosynthesis (comparison of bone fragments) with a metal structure of the vertebrae in case of fractures, dislocations;
• restorative microsurgery at the intersection of nerve trunks, bundles and plexuses - neurorhaphy;
• stereotaxic radiosurgery is a branch of neurosurgery that requires complex mechanical head stabilizers to use radiation. After mathematical calculations, a beam of gamma rays acts on a hard-to-reach brain tumor, which destroys the neoplasm.

Brain surgery is very dangerous for the patient's life. Therefore, neurosurgeons are required to have high accuracy in movements, accurate diagnosis and extensive experience in the treatment of such diseases.

Problems with the spine or nervous system can appear suddenly, and the person must be aware of the correct behavior in such situations.

• with a severe headache, you need to take an anesthetic (Nimesil, Nimid) 1 sachet per 100 ml of water inside. If it does not help, you should immediately call a doctor;
• if it starts to spin in the head, you should immediately lie down on the floor, turning on any side;
• if repeated vomiting occurs at home, Osetron 4 ml can be injected intramuscularly, and if it does not get easier after 30 minutes, call ambulance;
• in no case should you "reset" the vertebrae when intervertebral hernias even if the doctor suggests doing it;
• sharp turns of the neck during massage are fraught with torn ligaments and damage to the spinal cord;
• frequent pressure surges up to 200/100 mm Hg. Art., persistent headaches may indicate a brain tumor. In this case, you need to consult a neurosurgeon;
• it is strictly forbidden to jump into the water with your head if a person does not know the reservoir. Otherwise, you can get stranded and break the cervical vertebrae;
• in a car, you must use head restraints, because in any accident without a head restraint, a dislocation of the cervical vertebrae and compression of the spinal cord may occur;
• When performing heavy physical exertion, you must first do a warm-up to warm up the muscles and warn yourself from injury.

The advice of a neurosurgeon is useful for people who lead an active lifestyle, use a car, play sports. A careful attitude to the nervous system will reciprocate a person in old age.

brain surgery

Brain and brain tumors - brain neurosurgery

The brain is the most important part of the human central nervous system. Together with the spinal cord, which is located in the spinal column, they control all the organs and systems of our body. Both brains - the brain and spinal cord - are connected with the rest of the body through nerves - cranial and spinal. The brain is responsible for functions such as sight, touch, smell and hearing.

The human brain consists of nerve cells - neurons, which are interconnected by special processes. The brain itself consists of two hemispheres - the right and left, the cerebellum and the brain stem. Each of these parts has its own functions, for example, the cerebellum is responsible for the coordination of movements, and the vital centers of respiration and cardiac activity are located in the brain stem. The brain stem then passes into the spinal cord, which is located in the spinal canal.

The brain tissue consists of the so-called. gray and white matter. white matter represents nerve fibers - processes of neurons. They make up most of brain. The gray matter is the neurons themselves. Gray matter is represented by the cerebral cortex.

The hemispheres of the brain are responsible for mental functions - receiving, processing and storing information. Note that the presence of a decussation of nerve fibers in the brain is the reason that the right hemisphere is responsible for the left half of the body, and the left - for the right half. That is why, in any pathological conditions, such as tumors or hemorrhages, in the right side of the brain, the symptoms take place in the left side of the body, and vice versa.

The cerebellum, as already mentioned, is responsible for the coordination of movements and balance. It is located in the posterior cranial fossa, behind the cerebral hemispheres.

Between the brain and spinal cord is the so-called. brain stem. It contains centers that are responsible for functions such as heartbeat and breathing, as well as some others.

The nutrition of the brain is carried out both through blood vessels and cerebrospinal fluid - a clear liquid with a certain composition. Liquor washes the brain and circulates in its cavities - the so-called. ventricles of the brain. In addition, the brain seems to float in it, which ensures its depreciation. The brain and spinal cord itself is covered with meninges - soft and hard.

The brain is a fragile and delicate structure, therefore, nature has reliably enclosed it completely in the bone frame - the skull, protecting it from injury and impact. external environment. However, the disadvantage of such protection is that any pathological process in the brain - infections, hemorrhages or tumors - leads to compression of the brain tissue. That is why the nature of the brain tumor - benign or malignant - is not as important as the area in which it is located and how much it compresses the brain.

The hemispheres of the brain perform many functions, and each type of function is responsible for the so-called. parts of the hemispheres. Each hemisphere of the brain has six lobes:

• frontal lobe,
• parietal lobe,
• temporal lobe,
• occipital lobe,
• central lobe,
• limbic lobe.

When the brain is damaged by tumors or with cerebral hemorrhage, the symptoms may depend on the localization of the pathological process, that is, on which part of the brain is affected.

The number of newly diagnosed brain tumors is 10-15 cases per 100,000 people per year
Brain tumors account for 6% of all neoplasms in the body.

To risk factors, contributing to the emergence of tumors of the nervous system include a traumatic brain injury, some industrial intoxications, a history of x-ray exposure of the head, exposure to high frequency currents.

Tumors of the nervous system are characterized by sexual dimorphism. Medulloblastomas and germline tumors are more common in men, while meningiomas and neurinomas are more common in women.

The basis of tumor growth is damage to the genetic material of the cell, leading to a violation of the control of its growth. The nature of the genetic defect (or defects) determines the type of tumor.

Histological classification of tumors.

1. Neuroepithelial tumors (ependymoma, glioma, oligodendroglioma).
2. Shell tumors (meningiomas).
3. Metastatic tumors.
4. Pituitary tumors (pituitary adenomas).
5. Tumors of the cranial nerves (acoustic neuroma, etc.).
6. Vascular tumors.
7. Disembryogenic.

The concept of malignancy in relation to brain tumors.

1. According to the nature of the clinical course, all brain tumors are malignant., because they lead to death due to hypertension and dislocation of the brain. There are fast-growing tumors (gliomas, metastases, glioblastomas, adenocarcinomas, etc.) and relatively slow-growing ones (meningiomas, adenomas, etc.). This division of brain tumors is rather arbitrary, because. The site of tumor growth is also important.
2. By histological structure - depending on the histological features detected by microscopy.

Clinic of brain tumors.

One of the main features of brain tumors is that they develop in a strictly limited space of the cranial cavity, which sooner or later leads to the defeat of both adjacent to the tumor and parts of the brain remote from it.

Compression or destruction due to tumor infiltration of adjacent brain tissue causes the appearance primary(the so-called focal, local, local, nested) symptoms. Dysfunction relatively close to the tumor brain structures, which occurs due to edema, local hemodynamic disturbances, certain types of dislocations and other causes, leads to the appearance of additional groups of local symptoms.

As the disease progresses, there may be general symptoms, developing as a result of diffuse cerebral edema, generalization of hemodynamic disorders and the appearance of intracranial hypertension (intracranial pressure in an adult is normal with a lumbar puncture in the supine position is approximately 10-15 mm Hg (120-190 mm of water column).

However, when the tumor is localized in a “silent”, functionally insignificant area of ​​the brain, such a sequence of symptoms may not occur, and the disease will debut with cerebral symptoms, while focal symptoms may be absent altogether. 1. Headache- more often it is a cerebral symptom, but it can also be focal in brain tumors associated with a richly innervated sensory fibers of the dura mater.
2. Vomiting- is often a general symptom.
3. Impaired vision- Common in pituitary adenomas.
4. Dysfunction of the cranial nerves- impaired sense of smell, impaired movement of the eyeballs, pain and / or numbness on the face, paresis of the facial muscles, hearing loss, impaired balance, impaired swallowing, taste, etc.
5. Focal symptoms- the severity and nature of focal symptoms is largely determined by the functional role of the affected area (disturbance of movement, paralysis, impaired sensitivity, epileptic seizures, speech disorder, intellectual and mental disorders, various hallucinations, visual impairment, hyperkinesis, pain, autonomic and hormonal disorders, impaired coordination ). All patients with new onset epileptic fit CT or MRI of the brain is indicated to rule out mass formation in the brain.

The clinical picture of intracranial hypertension with its slow increase is manifested indefinitely, more often "morning" headaches, often at the height of the headache is noted vomit. The earliest symptoms of slowly progressive intracranial hypertension in adults include prolongation of the venous phase of blood circulation during fluorescein angiography of the fundus (the capillary and arterial phases change only with a pronounced increase in pressure in the cranial cavity), venous plethora, initial edema of the optic nerve head.

With further progression of intracranial hypertension appear mental disorders, memory loss, changes in the fundus are growing- a pronounced stagnation is determined with prominence of the optic discs into the vitreous body, hemorrhages, plasmorrhagia and white foci (secondary atrophy) in the fundus. The symptoms of advanced intracranial hypertension include the appearance of vision obnubilations (periodic blurring of vision when the head position changes, slight physical exertion).
Decompensation of intracranial hypertension ends with symptoms of progressive disturbances of consciousness(up to coma) and vital disorders, one of the causes of which are dislocations and herniation of the brain.

Diagnosis of brain tumors.

1. Careful neurological examination, including a detailed ophthalmological study of acuity, visual fields and fundus.
2. Modern methods of neuroimaging are of primary importance for the detection of a tumor, its topics, and sometimes even histostructures - CT (computed tomography), MRI (magnetic resonance imaging), angiography, etc., as well as radioisotope methods and special neurosurgical operations - stereotactic biopsy, ventriculoscopy.
3. Electroencephalography(EEG) is used to detect focal disorders of brain biopotentials and / or assess the severity of brain disorders in general.
4. Radiography reveals secondary features intracranial hypertension and sometimes tumor-induced local changes in the bones of the skull. It has no significant diagnostic value and is rarely used in neurooncology.
6. Ultrasonography used in children with open fontanelles. Provides good quality diagnostics, including intrauterine. The possibilities of application are limited by the age of patients (usually up to 1 year).
7. Lumbar puncture. Used to measure pressure and laboratory analysis cerebrospinal fluid, but is currently practically not used for diagnostic purposes in neurooncology. It should be remembered that with many tumors and increased intracranial pressure, lumbar puncture can cause dislocation and herniation of the brain, and therefore, without special indications, it is better not to do it.