bluuebunny/crossref_metadata_2025 huggingface dataset:
Invasive tumours of third ventricle
Authors: Teslenko Dmytro S. , Palamar Orest I. , Huk Andriy P. , Okonskyi Dmytro I. , Usatov Oleksandr S.
Published: September 2023

Despite the rapid development of neurosurgery in the 21st century, the invasive (secondary) tumours of the third ventricle have always presented a highly sophisticated challenge in terms of surgical treatment. The question of radical resection of these tumours remains debatable, considering the high risk associated with the possibility of disability, the expected duration and the postoperative quality of life. We conducted a retrospective study of patients with invasive third ventricular tumours that have been treated in our department from 2015 to 2020 reviewing pre-and postoperative clinical and radiological data for 21 cases. The treatment options in all 21 cases included an endoscopic frontal transcortical transventricular transforaminal-transchoroidal tumour removal, achieving gross total and subtotal resection in 86% of the interventions, followed by adjuvant treatment (radiation therapy in all cases, and chemotherapy – for high-grade tumours). An endoscopic third ventriculocisternostomy was performed in cases with partial tumour removal in order to improve the CSF flow. Neurological deficits included permanent hemiplegia – in 3 patients (15%), permanent hemianopia – in 2 patients (10%), transient short-term memory impairment – in 3 patients (15%) with regression in 2-4 weeks after surgery. There was no postoperative lethality. Maximal postoperative survival in our patients with high-grade tumours was 16 months; patients with low-grade tumours are still under supervision. Endoscopic frontal transcortical transventricular transforaminal-transchoroidal approach to resection of third ventricular tumours is an effective surgical modality, that maximizes the possible resection volume with minimal occurrence of postoperative complications, therefore can be recommended for the routine treatment of the aforementioned pathology.
Delayed cerebrospinal fluid ascites following ventriculoperitoneal shunt
Authors: Khizar Ahtesham , Zahid Soha
Published: September 2023

Background: Cerebrospinal fluid (CSF) ascites is an abnormal accumulation of CSF within the peritoneal cavity caused by the peritoneum's inability to absorb the CSF, following a ventriculoperitoneal (VP) shunt surgery. Excessive CSF production (e.g, choroid plexus papilloma and choroid plexus villous hypertrophy), high CSF protein secondary to chronic infection (e.g. tuberculosis), and brain tumours (e.g, optic gliomas and craniopharyngiomas) have all been suggested as contributing factors to the formation of CSF ascites. Peritoneal inflammation as a result of several shunt revisions or some non-specific inflammatory reaction to shunt material has also been explored.

Case Presentation: A 3-year-old girl with lumbar myelomeningocele and delayed CSF ascites following VP shunt is reported. Therapeutic paracentesis was employed to relieve abdominal distension, although recurring accumulation was common. The VP shunt was removed and instead of a Ventriculo-atrial shunt, she underwent Endoscopic Third Ventriculostomy (ETV). CSF ascites gradually disappeared after ETV over a two-week period.

Conclusions: Abdominal paracentesis to relieve ascites and conversion of a Ventriculoperitoneal shunt to a Ventriculo-atrial shunt are commonly used to treat CSF ascites, however Endoscopic Third Ventriculostomy, where feasible, is another alternative treatment that can be performed to treat this condition.
A comprehensive review on pituitary hydroscopy and the role of endoscopic diving techniques
Authors: Khizar Ahtesham , Khaliq Adnan , Haq Mian Iftikhar ul , Ahmad Sajjad
Published: September 2023

Pituitary hydroscopy is a new technique in skull base surgery that involves transnasal neuroendoscopy and gentle fluid distention of the sella turcica. Hydroscopy allows for a more thorough inspection of the sellar region and may make it easier to remove additional tumour cell foci. Endoscopic Diving Technique, on the other hand, uses a continuous water flow that is driven in front of the endoscope to aid explore the surgical cavity and improve image clarity. After tumour removal, a double-path aspirator is implanted inside the sella turcica and tumour cavity, providing a pressured flow with continuous irrigation in the Modified Endoscopic Diving Technique. Several groups' recent uses of diving techniques attest to the increased interest in these approaches. The development of dedicated surgical devices will improve the efficacy of diving procedures in the future. More research is needed right now to improve the effectiveness of diving techniques.
Flail bone flap in decompressive craniotomy for infants
Authors: Elshirbiny Mohammad Fekry , Amen Mohamed Mohsen , Ahmed Assem
Published: September 2023

Background: Subdural hematoma in infants is a challenging condition. Acute subdural hematomas can cause intracranial hypertension and a midline shift, but decompressive craniotomies in young patients have shown promising results with specific complications in this age group. Hinge craniotomy is an old technique used in many neurosurgical procedures associated with elevated intracranial pressure. The objective of this study is to report the usage of flail bone flap in the management of acute subdural hematoma in infants, its outcome, advantages, disadvantages and related complications.
Methods: This is a review of the medical records of 5 infants younger than one-year-old who underwent decompressive craniotomy as management of acute subdural hematoma at Mansoura university hospital.
Results: In this series, five babies were included. Operative time for decompressive craniotomy (DC) ranged from 1 h and 40 min to 3 h. Four infants survived. Three infants recovered with good outcomes and one infant developed hemiparesis.
Conclusion: The use of flail bone flap technique in decompressive craniotomy is associated with a high success rate and low incidence of complications. Large-based studies are still required for a better assessment of the results.
Personal experience in intramedullary lesions, in adults
Authors: Iacob G.
Published: September 2023

Background: Intramedullary spinal cord lesions (IMSCL) although they are rare, it generates invasion and destruction of the spinal cord. Such lesions must be diagnosed as early as possible, some have histological and genetic aggressiveness, generating severe functional neurological damage.

Objective: To identify the optimal strategy for diagnosis and treatment in IMSC, to improve prognosis.

Methods: A retrospective clinical study from 2001 to 2021, was performed on 33 adult patients (18 women, 15 men), diagnosed with magnetic resonance imaging with IMSCT. The most common topography was: thoracic 27 cases disposed between T2-T12, cervical 6 cases disposed between C2-C6, lumbar 2 cases at L1-L2. The most frequent symptoms in my cases were: unilateral radicular pain related to the tumour topography or bilateral diffuse burning pain, especially during the night; back and neck stiffness; paresthesia, motor disturbances with an ASIA score of 2-4, and severe atrophy especially in cervical topography, ataxia, initial retention, impotence and later loss of bowel and bladder function with incontinence. All patients were operated by the same senior neurosurgeon with at least 6 months of follow-up postoperatively. For functional outcome, the most important predictors are the preoperative neurological grade, and the high-grade IMSCT generating recurrence and reoperations.

Results: The patients addressed the clinic for pain and neurological deficits; the topography of the intramedullary lesion was confirmed by MRI native / with contrast, ultrasonography, and spinal arteriography. Several histologic entities were recorded: ependymomas - 12 cases, astrocytomas - 8 cases, hemangioblastomas - 3 cases, cavernomas - 6 cases, metastases - 2 cases, germ cell tumour - 1 case, malignant peripheral nerve sheath tumour - 1 case. Gross total excision was performed in 25 cases, with no mortality. In eight cases recurrences were recorded requiring the resumption of surgical treatment. In all cases physiotherapy-rehabilitation approach was used, and the outcome was correlated with pre-operatory motor deficits severity, 3 patients with thoracic high-grade astrocytoma underwent stereotactic spine radiosurgery (SSR) with Cyberknife abroad, stopping tumour growth one year after.

Conclusions: Intramedullary spinal cord lesions (IMSCL) are rare conditions, and MRI development allows an early diagnosis of these tumours. To adequately counselled patients, with minor preoperative deficits, real expectations concerning the functional outcomes, in benign tumours, and even anatomical healing should be based still on refinements of radical surgical excision. Actual radiotherapy techniques should be used in aggressive tumours.
Focal cerebritis with vasculitis mimicking a high-grade glioma
Authors: Vissa V. Shanthi , Nandyala Rukmangadha , Badiginchala Suguna , Bodagala Vijaya Lakshmi Devi , Chandra Ramesh , Ravikumar Thenmozhi
Published: September 2023

Cerebritis is an inflammatory reaction in the brain which can be localized or diffuse and can be secondary to various etiologies like granulomatous demyelinating infections, vasculitis or neoplastic. Identifying the aetiology is very essential for the proper treatment. We report a case of 24 years male patient, who came with a history of headaches for 3 months. CT scan revealed intra-axial hypodense lesion suggesting high-grade glioma, which on histopathological examination revealed reactive gliosis with diffuse lymphocytic infiltrate and perivascular lymphocyte collection.
The impact of coagulation profile derangements and their effect on the outcome of head injury patients
Authors: Sury Surendra Saini , Acharya Sushil , Yogi Ramsevak , Lal Echara Mohan , Vyas Shashin , Gehlot Deepika
Published: September 2023

Background: In traumatic brain injury patients, coagulation disorder causes secondary brain injury, thereby increasing mortality and morbidity.
Aim: This study aims to know the impact of coagulation profile derangements and their effect on the outcome of head injury patients.
Materials and methods: A total of 100 patients admitted with traumatic brain injury were included in the study. Samples of complete haemogram (CBC), prothrombin time (PT), partial thromboplastin time (PTTK), D-Dimers and fibrinogen were obtained. Coagulopathy was defined as platelet counts < 100,000 cells/mm2 and PTI >15 seconds or a DIC(Disseminated intravascular coagulation) score of more than 4. The outcome in each group was measured according to the Glasgow outcome score. The data were analysed with the Chi-square test and independent t-test.
Results: In patients with severe and moderate traumatic brain injury, there was no significant difference in the Haemoglobin, Fibrinogen and D-Dimer between the patients with and without coagulopathy. But, the platelet count was significantly lower in the patients with coagulopathy and the PT and PTTK were significantly higher in the patients with coagulopathy in comparison to the patients without coagulopathy (p<0.05). There was no significant difference in the Fibrinogen and D-Dimer between the expired and discharged patients. But, the platelet count was significantly higher in the discharged patients and the DIC score, PT and PTTK were significantly lower in the discharged patients (p<0.05).
Conclusion: Coagulation profile derangements are seen in patients with traumatic brain injury. Early diagnosis and prompt management can make remarkable improvements in the mortality of these patients.
Madjid Samii: Omagium
Authors: Grădinaru Ștefan-Octavian , Marinescu Andrei Alexandru , Gheorghe Cristiana-Ștefania , Bentia Dan , Ciurea Alexandru-Vlad
Published: September 2023

Prof. Madjid Samii is an internationally recognized neurosurgeon who has conquered the highest levels of 21st-century neurosurgery. Born in Iran, he decided to take medical courses at the University of Mainz, Hanover, Germany. He earned his medical degree in 1963, marking the highest achievable score, and started his residency, guided by Emeritus Professor Dr Kurt Schurmann. Numerous various surgeries and studies that reshaped the field of neurosurgery describe his career. Starting with a publication regarding a new technique, pneumencephalotomography, he has steadily been ascending, studying and writing about cranial nerves, developing the surgery of the skull base and proving that the transnasal approach is preferred in clivus chondromas. Prof. Madjid Samii founded, 1990, the Foundation of National and Continental Skull Base Societies, and since 2001, he has been the Honorary President of the World Federation of Neurosurgery Societies(WFNS). Not only was he successful in his scientific path, but he also gave an example for the future generation of what astonishing results can be obtained with hard work, commitment, and a leader's spirit. He wanted to take worldwide neurosurgery to a whole new level, so he came up with an idea, the concept of an international neuro-excellence centre, which quickly became the reality of the International Neuroscience Institute of Hanover.
The assessment of risk factors for brainstem injuries and supratentorial brain injuries in patients with traumatic brain injury
Authors: Pastor Iulia-Sevastiana , Dumbrava Lacrimioara Perju , Siserman Costel , Stan Horațiu , Para Ioana , Lupu Delia , Florian Ioan Ștefan
Published: September 2023

Traumatic brain injury (TBI) is an important cause of death with a significant worldwide percentage. In the United States, there are approximately 2.8 million TBIs yearly with 250,000 hospitalized patients and 50,000 TBI-related deaths. Every year, there are one million hospitalizations in the European Union, resulting in more than 50,000 deaths, most of which occur due to road traffic accidents. Needless to say, these estimations varied based on the different sources of data. The patient’s outcome is determined by the context of the trauma, the type of lesion, as well as other factors.
The aim of the study was to assess variables associated with brainstem injury and supra-tentorial brain injury in patients with TBI. This cohort included 70 consecutive TBI-related deaths from the Institute of Legal Medicine Cluj-Napoca. There was a significant difference in brainstem contusion (haemorrhage contusion) in patients younger than 60. According to the computed tomography (CT) data, brain contusion and laceration were observed in association with brainstem contusion in a significant percentage of TBI-related deaths (p=0.016). Neither the meningo-cerebral blood collections nor the intraparenchymal hematomas had a significant occurrence with brainstem contusion. The diffuse axonal injuries were detected on a CT scan in a significant number of cases with brainstem contusion (p=0.011). The mass effect with brain herniation in the posterior fossa was associated with the occurrence of brainstem contusion, possibly as an extensive process (p=0.041).
Analyzing the histopathological data, we observed the significant presence of intracranial haemorrhage in association with a hemorrhagic contusion in the brainstem (p=0.004), but not with meningeal haemorrhage. The poor neurological assessment evaluated by GCS was not an independent variable in relation to this brainstem lesion. That was probably caused by the complexity of the TBI. We did not include this variable in a multivariate analysis considering the poor outcome for all patients
PICA ischemic stroke
Authors: Covache-Busuioc Razvan Adrian , Costin Horia Petre , Saceleanu Vicentiu Mircea
Published: September 2023

The posterior inferior cerebellar artery (PICA) has a unique anatomical complexity, which is of great clinical importance and is involved in many pathologies, such as aneurysm, ischemic stroke, neurovascular compression syndrome (NVCS), arteriovenous malformation (AVM) and brain tumour (1).

PICA has a sinuous and variable trajectory, divided into 5 segments. PICA infarction usually manifests lateral bulbar syndrome and is more likely to cause mass effects. PICA frequently compresses the bulb and cranial nerves, resulting in various neurovascular compression syndromes (NVCS) (2).

The ischemic stroke caused by thromboembolism in the PICA segment is accounted for more than 2% of all cases of ischemic stroke (3). Moreover, it tends to be underdiagnosed due to the symptomatology, represented usually by vertigo which mimics a possible peripheral vestibulopathy (4).
Double curve linear incision approach in cases of sagittal craniosynostosis
Authors: Ozbek Muhammet Arif , Akşehirli Naci Emre , Tahta Alican , Akalan Nejat
Published: September 2023

Craniosynostosis is the premature fusion of one or more sutures in the cranial dome or anterior skull base, resulting in an abnormal head shape. This pathological process is observed less frequently in Eastern geography and approximately one in 2000 to 2500 births in Western countries. Isolated sagittal synostosis accounts for more than half of craniosynostosis cases. In our study, the duration of surgery, duration of anaesthesia, duration of hospital stay, estimated amount of bleeding during surgery and the months of surgery were examined in 16 patients. The performed craniotomy is not different from the four different craniotomies described in the literature. Strip craniectomy and barrel osteotomy were performed on each patient. According to the incisions described in the literature, the incision type and location are different. As the described incision provides less skin dissection, less bleeding and less dead space formation allows surgery in earlier months.
Penetrating head injury caused by a screwdriver
Authors: Ilić Jovan , Nikolov Vesna , Djordjević Marija , Kostić Aleksandar , Stojanović Miloš
Published: September 2023

Background: Penetrating head injuries (PHI) caused by sharp objects are associated with a high risk of potentially life-threatening complications and are estimated to account for approximately 0.4% of all head injuries. Since not many cases of PHI with a screwdriver have been described in the literature, the treatment of these patients is quite controversial and non-standardized. Therefore, the aim of this paper was to present our experience with treating a patient with a PHI caused by a screwdriver.
Case description: The authors present a three-year-old female patient who accidentally sustained a PHI with a screwdriver through the right orbit. A computed tomography scan of the head was performed, which demonstrated the presence of the metal end of a screwdriver in the anterior cranial fossa. The patient underwent emergency surgery and the foreign body was evacuated with the repair of dura and brain injury. The intervention was followed by a complete postoperative recovery without any gross neurological deficits. Follow-up examinations were performed up to three years after the injury, while the patient's condition remained unchanged. Our patient's case supports immediate neurosurgical intervention and removal of a foreign object from the endocranium.
Anterior approach arthrodesis - ALIF with use of a titanium cage for treatment of postoperative spondylodiscitis after lumbar microdiscectomy
Authors: Ramos Soares Sofia , Lacerda Alexandre , Richard Gondim Bezerra Cavalcanti Júlia , Gomes Martins Thiago , De Freitas Souza Giacomo , Umberto Cantisani Neto Jim
Published: September 2023

Introduction. Infectious spondylodiscitis has an incidence of 0.21-3.6%. The best intervention should be individualized, using antibiotics only or combining them with stabilizing surgeries.
Case presentation. A 38-year-old man presented with lumbosciatalgia, severe pain and inability to ambulate. Magnetic resonance imaging (MRI) of the lumbar spine showed L5-S1 extruded disc herniation and the patient underwent endoscopic microdiscectomy with complete remission of symptoms. After two weeks, he reported severe low back pain and a return of difficulty to walk. Laboratory tests showed an increase in CRP and ESR. MRI showed signs of lumbar spondylodiscitis. The patient started on broad-spectrum intravenous antibiotic therapy. He evolved with improvement in laboratory parameters and maintenance of low back pain. Due to the failure of conservative treatment, anterior approach arthrodesis (ALIF) was chosen, with the complete improvement of the low back pain and the return of the ability to walk.
Discussion. Postoperative spondylodiscitis’ frequency depends on the invasiveness of the operation and the type of surgery performed. The most likely source of infection is direct inoculation by virulent pathogens during surgery. A diagnosis delay of more than two months is considered a risk factor for generating adverse results. A Conservative approach is indicated for the patient who is neurologically intact and with minimal bone destruction. Surgical indications are the presence of neurological deficits, intraspinal abscesses, extensive bone destruction, and failure of conservative management. ALIF is supported in the literature because it allows wide exposure of the entire disc space through efficient access to the spine with the complete evacuation of the disc, avoiding dissection of perineural scar tissue and preserving the articular facets.
Conclusion. Early diagnosis and treatment are crucial, although there is still no consensus about the best treatment approach. The use of a titanium cage with a bioglass graft had a good response in pain and infection control in our case.
The efficacy of endoscopic endonasal duraplasty compared to transcranial duraplasty for post-traumatic CSF rhinorrhea in terms of CSF rhinorrhea recurrence and other complications
Authors: Regmi Pranab , Khizar Ahtesham , Yadav Pradhumna Kumar
Published: September 2023

Objectives. To determine the efficacy of endoscopic endonasal dura repair versus transcranial dura repair for post-traumatic CSF rhinorrhoea in terms of CSF rhinorrhea recurrence and other complications.
Materials and methods. A total of 92 patients (age 15-50 years, both genders) with an established diagnosis of CSF rhinorrhea following traumatic brain injury were enrolled in this prospective cohort study. Group A and Group B were formed from the patients. Group A received endoscopic endonasal duraplasty, while Group B received transcranial duraplasty. Recurrence of CSF rhinorrhea, as well as any other complications (meningitis, anosmia, hydrocephalus, and abscess), were noted and compared between the two groups one week, two weeks, and four weeks after the procedure.
Results. In Group A, the mean age was 28.6 ± 9.9 SD years and in Group B it was 29.9 ± 8.6 SD years. In group A, there were 63% (n=29/46) patients who had age between 15-30 years and 37% (n=17/46) had age between 31-50 years. In group B, 52.2% (n=24/46) patients had age between 15-30 years and 47.8% (n=22/46) had age between 31-50 years. In group A, there were 82.6% (n=38/46) males and 17.4% (n=8/46) were females and in group B there were 87% (n=40/46) males and 13% (n=6/46) females. At one month follow-up, overall recurrence of rhinorrhea was observed in 17.4% (n=8/46) patients in Group A, while it was 41.3% (n=19/46) patients in Group B (P=0.012). On the other hand, overall complications were 8.7% (n=21/46) in Group A patients, while they were 45.7% (n=21/46) in Group B patients (P=0.001).
Conclusions. During a one-month follow-up, patients who received endoscopic repair experienced fewer recurrences and other complications overall than patients who underwent transcranial duraplasty, and the difference was statistically significant. We advise conducting studies with a larger sample size and longer follow-up periods.
Combined endoscopic-microscopic trans-nasal trans-sphenoidal approach for pituitary adenomas
Authors: Kaif Mohd , Yadav Kuldeep , Upadhyay Amit , Singh Deepak Kumar , Singh Rakesh Kumar , Agarwal Ashish Chandra , Sinha Kshitij
Published: September 2023

Objective. To obtain evidence that the use of endoscopy along with a microscope in the surgical management of pituitary tumours improves intraoperative visualization and significantly impacts operative outcomes in the trans-nasal approach.
Material and methods. Each patient underwent endonasal transsphenoidal microscopic tumour resection. The procedure was modified by the use of intrasellar endoscopy as an adjunctive imaging modality. Following complete microscopic resection of tumour, rigid 0° and 30° 4.0-mm endoscopes were used to conduct a final survey of the sellar and parasellar spaces. Residual tumour fragments identified during this endoscopic examination were removed.
Results. In 50 patients with pituitary macroadenomas, the rigid 30 ° angled rigid endoscope was found to be highly beneficial. Hidden areas could be visualized and tumour residues were detected. In the majority of the patients with detected tumour residues, adenomatous remnants were safely removed by meticulous endoscopic dissection under optimum visual control after the main part of the tumour had been removed with the operating microscope.
Conclusions. Endoscopy provides distinct advantages over microscopy in imaging intrasellar and parasellar structures during pituitary tumour resection which are often missed by microscopy alone.
Mature cystic teratoma of spinal cord in an adult
Authors: Misra Rajneesh , Kumar Sushil , Sharma Sandeep
Published: September 2023

Aim: Reporting a rare case of mature cystic teratoma of spinal cord in an adult

Background: Teratomas of the central nervous system are rare lesions accounting for less than 0.5-2% of all CNS tumors. Most of these are found in pediatric age group and favor sellar - suprasellar, pineal and sacro-coccygeal regions. Their occurrence in spinal cord in an adult is incredibly rare.

Case presentation: A 22-year-old male presented with low back ache and weakness of both lower limbs. Clinical examination and radiological workup revealed presence of a cystic lesion causing diffuse enlargement of the cord from L1 to L5-S1. Histo-pathological examination of the excised lesion revealed it to be teratoma.

Conclusion and clinical significance: Mature teratoma of the spinal cord in adults is extremely rare occurrence. However, this diagnosis should be kept in mind when evaluating a cystic lesion of cord even in adults. Maximal safe resection of the lesion results in prolonged deficit-free survival.
Incomplete Currarino triad in an adult woman
Authors: Al-Youzbaki Rasha A. , Mahmoud Emad Hazim , Alsubaihawi Zahraa A. , Almeran Mohammed A. , Albanaa Saja A. , Hoz Samer S.
Published: September 2023

Introduction: Currarino Syndrome (CS) is a rare entity characterized by a triad of sacral agenesis, anorectal malformations, and pre-sacral masses. CS is typically diagnosed during the first decade of life.

Case Description: We present a rare case of incomplete Currarino syndrome manifesting in a 36-year-old lady who presented with back pain, urinary retention, anal paresthesia, and lower limb weakness. The patient underwent multiple laminectomies and partial resection of an epidermoid cyst and regained function.

Conclusion: Although rare, the possibility of Currarino syndrome should be entertained in adult patients with lower lumbosacral symptoms and a pre-sacral mass. A thorough physical examination and strategic pre-operative planning are mandatory to maximize patient outcomes.
Delayed intraoperative rupture of clipped aneurysm during the awaking from anaesthesia
Authors: Ismail Mustafa , Al-Hadeethi Bandar Mohammed , Moushib Amir Ibrahim , Algburi Hagar A. , Al-Khafaji Aktham O. , Al-Jehani Hosam , Hoz Samer S.
Published: September 2023

Introduction. Intraoperative rupture (IOR) of an aneurysm is a frightful complication that causes significant morbidity and mortality worldwide. IOR can be attributed to various parameters, including hypertension, increased intracranial pressure (ICP), fragility of the vessels, and inadequate anaesthesia. IOR due to insufficient anaesthesia is scarcely reported in the literature. Here, we describe a re-ruptured anterior communicating artery (ACoA) after incomplete clipping of the neck during craniotomy closure due to unintended early wake-up from anaesthesia with a discussion about the management.
Case description. A 38-year-old male suddenly developed a severe headache, a brief loss of consciousness, and vomiting. Computed tomography (CT) scan showed a subarachnoid haemorrhage in the basal cistern. CT angiography showed a bilobed right ACoA aneurysm with a wide neck and Murphy's teat. The patient was considered for surgery. Clipping of the aneurysm neck was done through two curved clips. During craniotomy closure, the patient started coughing and gagging then a huge IOR was encountered. These events can be mainly attributed to unintended inadequate anaesthesia, particularly muscle relaxants. The bleeding ceased after two suction catheters were inserted, temporary clips were applied, and the readjustment of permanent clips. After surgery, the patient showed a left-sided weakness. His postoperative CT scan showed a right distal anterior cerebral artery (ACA) territory infarction. The weakness improved in the follow-up period.
Conclusion. Delayed IOR due to early awaking from anaesthesia should be considered a potential source of complications and bad outcomes in aneurysm surgery.
Electroencephalographic findings in autistic non-epileptic children
Authors: Ibrahem Arwa K. , Shareef Hula , Shaker Kanar , Mohammed Dhay , Bader Hamdan Farqad
Published: September 2023

Despite the well-acknowledged link between autism spectrum disorders (ASDs) and epilepsy, the prevalence and significance of electroencephalogram (EEG) changes in epileptic children in the absence of clinical seizures remains underdetermined.
Aim. The primary goal of this study is to report the prevalence of EEG abnormalities in non-epileptic or pre-epileptic autistic children, investigate their association with a set of pre-determined risk factors, speculate on their significance, and direct future research efforts.
Methods. A case-based sampling for children diagnosed with autism was done. Only patients without a history of epilepsy and those under the age of 15 were included. All patients underwent an EEG study. Children with abnormal EEG findings (case group) were compared to age-matched controls with normal EEG findings using a set of pre-determined factors.
Results. A total of 38 patients were enrolled in our study, of whom 31.6% (n=12) had abnormal EEG readings. Of those, the presence of the following EEG abnormalities were noted – each being present in two patients: frontal sharp waves, frontal slowing, temporal slowing, bitemporal slowing, frontal sharp waves, and generalized sharp waves, Frontal intermittent rhythmic delta activity (FIRDA). Patients with abnormal EEG findings were more likely to have a positive family history of epilepsy and/or autism, with odd ratios of 28.05, and 12.62, accordingly.
Conclusion. Aberrant brain connectivity patterns have been observed in non-epileptic ASD patients, and our findings support these findings. Furthermore, we believe that gender, mother's age, mode of delivery, and speech abnormalities could all have an impact on the EEG results. However, more research is needed to expand on these findings.
Cerebellopontine angle tumours: clinico-radiological features and surgical outcome
Authors: Kankane Vivek Kumar , Gujral Ketan , Sharma Avinash , Shrivastava Aditya
Published: September 2023

Object. Our aim is to demonstrate the various aspects of clinical-Radiological presentation and surgical Outcome with association to the tumour size concerning cerebellopontine angle (CPA) tumours.

Materials and method. This is a prospective study of 40 patients at the Department of Neurosurgery, Jayarogya Group of Hospitals, GRMC Gwalior, M.P. India. All of the patients were pre-operatively evaluated with either non-enhanced and enhanced computerized tomography (CT) or Magnetic-resonance (MR) imaging or both.CPA tumours (predominantly acoustic neuroma) that underwent surgical removal using a suboccipital retro sigmoid approach over a 2-year period (June 2019 to May 2021).

Results. There was a female preponderance. The most common presentation was Sensorineural hearing loss (90%) followed by Headache (67.5%). The majority of cases of Vestibular Schwannoma have heterogenous enhancement with cystic component.65% of patients have large (26-40mm) size tumours and facial nerve preservation is 86.4% in medium size tumours (10-25 mm).and Incidence of post-postoperative of facial nerve palsy is more in Giant size tumour (> 40mm) so Positive association between size of lesion and Incidence of Post-operative facial nerve palsy. CSF leak occurs in 6 patients and postoperative Hydrocephalus occur in 2 patients and Mortality occurs in 3 patients.

Conclusion. CP angle Tumor was common in middle age group, with the incidence in females slightly more than in males. The majority of lesions were of large size (26-40mm). Most of the patients on admission had a non-serviceable hearing. Heterogeneous enhancement with cystic components was found in most of the lesions. Gross-total excision was one in the majority of cases and vestibular schwannoma was the most common histopathological lesion obtained. Facial nerve palsy was the most complication and as the size of the lesion increased, the possibility of facial nerve palsy also increased post-operatively. Overall mortality is 7.5%.
Teoría de la inteligencia emocional en la enseñanza de la contabilidad. Aportes conceptuales
Authors: Kwan Chung Chap Kau , Alegre Brítez Miguel Ángel
Published: September 2023

El objetivo de esta investigación fue explorar y analizar los aportes conceptuales de la teoría de la inteligencia emocional en la enseñanza de la contabilidad. Se realizó un análisis documental utilizando una metodología de revisión sistemática. Los resultados obtenidos muestran que la teoría de la inteligencia emocional puede ser aplicada con éxito en la enseñanza de la contabilidad para mejorar el desempeño académico de los estudiantes y prepararlos para enfrentar los desafíos del mundo laboral. Se recomienda a los docentes de contabilidad incluir la inteligencia emocional en sus planes de estudio y promover el desarrollo de habilidades emocionales en sus estudiantes.
ANALYSIS OF RISK FACTORS FOR PROLONGED AIR LEAK AFTER LOBECTOMY
Authors: Toneev Evgeniy Aleksandrovich , Martynov Aleksandr Aleksandrovich , Komarov Andrey Sergeevich , Midlenko Oleg Vladimirovich , Pikin Oleg Valentinovich , Zaripov Linar Ravil'evich , Zul'karnyaev Ayrat Shamil'evich , Chavkin Petr Mikhaylovich
Published: September 2023

The aim of the study is to identify risk factors for the development of prolonged air leak in patients after lobectomy and to construct a nomogram to predict such complications.
Materials and Methods. Between January 2019 and December 31, 2022, 417 lobectomies were performed in patients with non-small cell lung cancer at Regional Clinical Oncological Dispensary in Ulyanovsk. The study included 162 patients who were thoroughly examined. Statistically significant factors influencing the development of prolonged air leak were identified.
Results. Multivariate logistic regression analysis (results are presented as odds ratio (OR) and 95 % confidence interval) revealed the following parameters: blood loss (1.008; (1.003–1.013)), surgery duration (1.092; (1.029–1.158)), total protein (0.732; (0.598–0.898)), fissura intensity (0.100; (0.015–0.653)), adhesion process (75.505; (6.527–873.056)), and the number of devices (10.233; (1.883–55.590)), independently associated with prolonged air leak. According to this regression, a nomogram was constructed to calculate the probability of prolonged air leak using the model coefficients. The sensitivity and specificity of the developed nomogram for the studied patients were 97.0 % and 93.8 %, respectively.
Conclusion. The developed prognostic nomogram makes it possible to assess the probability of prolonged air leak development and to prevent it in high-risk patients.
CYTOMETRIC PARAMETERS OF CEREBRAL CORTEX NEURONS IN COVID-19
Authors: Kuznetsova Tat'yana Ivanovna , Slesareva Elena Vasil'evna , Nikishin Kirill Evgen'evich , Gadzhiarslanova Malikat Magomedalievna , Vlasova Alina Alekseevna
Published: September 2023

COVID-19 has recently been one of the greatest challenges of public health services worldwide. SARS-CoV-19 affects not only the respiratory, but also other systems, including the brain. It causes strokes, meningitis, encephalopathy, encephalitis, etc. Due to the multifactorial nature and complexity of COVID-19 pathogenesis, studying its impact on brain tissue is relevant.
The aim of the work is to study the cytometric parameters of neurons in the parietal-occipital lobe of the cerebral cortex in patients who died due to COVID-19.
Materials and Methods. For histomorphological examination, autopsies of the parietal-occipital lobe of the cerebral cortex were fixed in 10 % neutral formalin and embedded in paraffin. Cross sections (5–6 μm) were stained with hematoxylin-eosin. Histologic specimens were studied under a light microscope. Morphometric measurements of the nucleus and cytoplasm area of neurons of the parietal-occipital lobe of the cerebral cortex were performed on the images. The nuclear-cytoplasmic ratio was calculated. The results of the histomorphological study were analyzed along with the medical history. For comparison, autopsies of the parietal-occipital lobe of the cerebral cortex from patients who died from cerebral infarction were used.
Results. Nucleus and cytoplasm areas of neurons in the pyramidal and ganglionic layers of the cerebral cortex were measured. In the cerebral cortex, COVID-19 mainly affects the microvasculature vessels, disrupting their permeability and causing hemorrhages. Damage to the neurons of the cerebral cortex is less pronounced and does not have any specific pathomorphological picture, which corresponds to the pattern of long-term ischemic effects on the gray matter.
IMPACT OF WHOLE BLOOD DONATION ON BLOOD PRESSURE IN STAGE 1 HYPERTENSION
Authors: Razin Vladimir Aleksandrovich , Vorotnikov Il'ya Mikhaylovich , Gnoevykh Valeriy Viktorovich , Smirnova Anna Yur'evna , Sharafutdinova Rizida Rafaelevna
Published: September 2023

At present, blood donation and donors’ health are the imperatives of the healthcare system.
The aim of the paper is to study the impact of blood donation on blood pressure in hypertensive donors.
Materials and Methods. During 12 months, the authors examined and followed-up 100 frequent whole blood donors, aged 40.3±7.5, with stage 1 hypertension. The donors did not receive any drug treatment for hypertension. The authors also monitored erythrocyte and hemoglobin levels, and 24-hour blood pressure. Statistica 10 software was used for statistical data analysis.
Results. The study revealed that the dynamics of blood pressure depended on anemia, which could develop as a result of blood donations. Thus, one year after the 1st blood donation, we observed an increase in 24-hour mean SBP by 4.0 % (p<0.05), 24-hour mean DBP by 3.9 % (p<0.05), daytime SBP variability by 33 % (p<0.05), and daytime DBP variability by 28.8 % (p<0.05) in 17 blood donors with hypertension in case of anemia progression. Pathological BP rhythms also increased. We noted a statistically significant (p<0.05) decrease in SBP and DBP, as well as SBP and DBP variability in 83 donors with hypertension who did not develop anemia in 12 months.
Conclusion. Whole blood donors with stage 1 hypertension, who do not undergo antihypertensive therapy, demonstrate positive blood pressure dynamics, whereas those who develop anemia as a result of blood donations show negative blood pressure dynamics.
EXPRESSION OF PROGRAMMED CELL DEATH PROTEIN 1 (PD-1) AND ITS LIGAND PD-L1 IN HIGH-GRADE SEROUS OVARIAN CANCER
Authors: Zhurman Varvara Nikolaevna , Plekhova Natal'ya Gennad'evna
Published: September 2023

Recently, the immunotherapeutic treatment of ovarian cancer is of much concern. This is due to the discovery of the signaling pathway of the PD-1/PD-L1 immune checkpoints, which are capable of controlling autoimmune response severity and duration.
The aim of the study is to determine the dependence of PD-1/PD-L1 expression on the proliferative activity of high-grade serous ovarian cancer cells.
Materials and Methods. The study was performed at Central Research Laboratory, Pacific State Medical University, Ministry of Health of the Russian Federation. The material was collected at Primorsky Regional Oncological Dispensary, 2016–2021. The pathological and anatomical samples were analyzed by immunohistochemistry using p53, Ki-67, PD-L1, and Anti-Hu CD279 (PD-1). The main group included 74 patients with high-grade serous ovarian cancer, the comparative group consisted of 26 patients with benign ovarian tumors.
Results. PD-1/PD-L1 expression was observed in tumor tissues in ovarian cancer. There was also an increase in the positive reaction to Ki-67 and p53 according to grading and staging of cancer.
Conclusion. Despite the claimed immunomodulatory function, high PD-1/PD-L1 levels are favorable prognostic indicators in ovarian cancer. The obtained data show that PD-1/PD-L1 molecules are biologically significant regulators of the immune response in high-grade serous ovarian cancer, which is an argument in favor of immune checkpoint inhibitors. Thus, PD-L1 in the immune cells infiltrating the tumor is a favorable prognostic factor. A statistically significant direct correlation between Ki-67 and PD-L1 proves a direct dependence of PD-L1 expression on proliferative activity of the ovarian tumor. A statistically significant inverse correlation between p53 and PD-1 shows the dependence of PD-1 expression on apoptotic changes in the ovarian tumor.
La Loi dans la pensée d'Isaac Breuer (1883-1946)
Authors: Friedemann Charles
Published: September 2023

Juriste et théologien, Isaac Breuer a su donner une expression philosophique nouvelle à la doctrine de son grand-père, Samson Raphaël Hirsch (le fondateur de la néo-orthodoxie juive moderne), en lui donnant pour infrastructure la notion de Loi.

L'auteur (prématurément décédé) de V étude établit d'abord le lien entre les sources juridico-philosophiques générales et la notion spécifiquement juive de tōrāh dans la pensée d'Isaac Breuer. Puis il montre comment celle-ci est tributaire à la fois du système kantien et d'une critique de ce système, réfractaire à la notion d'hétéronomie qui seule permet d'arracher la Loi à l'arbitraire en la soumettant à une volonté qui la dépasse. Cette volonté «formatrice » de la loi n'est, en fin de compte, pas différente de la place qu'occupe la notion de «forme» dans la mystique juive et notamment celle du Maharal. L'étude éclaire ainsi, sous un jour entièrement nouveau, le canevas mystique d'une doctrine qui se veut essentiellement rationnelle.
Salomon Ibn Gabirol, sa vie et son œuvre poétique
Authors: Schirmann Hayyim
Published: September 2023

Les auteurs médiévaux ne nous ont pas légué de biographie d'Ibn Gabirol. Nous essayons de réunir ci-dessus les faits essentiels de sa vie en les puisant surtout à son œuvre poétique. Pourtant même une étude minutieuse de tous ces textes ne nous offre pas de biographie cohérente et de nombreux détails restent encore obscurs. Les mêmes poèmes nous donnent par contre une bonne idée de la personnalité d'Ibn Gabirol, de son attitude envers la société, de son caractère très étrange, de ses aspirations et de ses souffrances. Nous y joignons un aperçu de ses poèmes profanes en général, mais nous nous penchons surtout sur les textes qui expriment son pessimisme, son désir de pénétrer les mystères de la «connaissance du Seigneur», sa lutte acharnée contre le Destin. Dans ce contexte, nous analysons son grand poème symbolique «Je suis l'homme». La dernière partie de l'étude traite de la poésie sacrée d'Ibn Gabirol, en particulier des genres qu'il a introduits ou renouvelés, ainsi que de son célèbre hymne contemplatif et lyrique, connu sous le nom de La Couronne du Royaume. même une étude minutieuse de tous ces textes ne nous offre pas de biographie cohérente et de nombreux détails restent encore obscurs. Les mêmes poèmes nous donnent par contre une bonne idée de la personnalité d'Ibn Gabirol, de son attitude envers la société, de son caractère très étrange, de ses aspirations et de ses souffrances. Nous y joignons un aperçu de ses poèmes profanes en général, mais nous nous penchons surtout sur les textes qui expriment son pessimisme, son désir de pénétrer les mystères de la «connaissance du Seigneur », sa lutte acharnée contre le Destin. Dans ce contexte, nous analysons son grand poème symbolique «Je suis l'homme ». La dernière partie de l'étude traite de la poésie sacrée d'Ibn Gabirol, en particulier des genres qu'il a introduits ou renouvelés, ainsi que de son célèbre hymne contem¬ platif et lyrique, connu sous le nom de La Couronne du Royaume.
La Lex Orandi de la communauté karaïte d'après Lévi ben Yefet
Authors: Vajda Georges
Published: September 2023

Traduction commentée fondée sur une rédaction en judéo-arabe imparfaitement conservée et deux versions hébraïques, dont l'une reflète le fragment arabe, du chapitre concernant la liturgie dans le Livre des Préceptes de Lévi ben Yefet, Docteur karaïte delà première moitié du xie siècle. Comparaison de ce texte avec la liturgie mise au point, environ un siècle plus tôt, par al-Qirqisânï.
Intercultural and globalization factors in the development of multilingualism
Authors: Medynska Nataliia , Grytsenko Svitlana , Biriukova Diana , Karlova Nadiia , Kotienieva Iryna
Published: September 2023

The aim of the study was to determine multilingualism in Ukraine with the identification of intercultural and globalization factors. The study involved statistical methods and comparative analysis. It was established that the phenomenon of multilingualism is characteristic of the Ukrainian people. During the period of its establishment, Ukraine was constantly under the socio-cultural influence of neighbouring states, which showed elements of chauvinistic ascendancy. However, the typical combinations of languages that were characteristic of multilingual groups of the population of Ukraine are being transformed in accordance with the current requirements. In particular, an increased influence of the official languages of the international community is recorded. The phenomenon of multilingualism for the Ukrainian people is contradictory, as it is mostly artificial, caused by intercultural factors of foreign countries. However, technological development, globalization processes and Ukraine’s Euro-Atlantic aspirations form the basis for a fundamental change in attitudes towards this phenomenon and the use of multilingualism as an advantage of Ukrainian society. Further research is aimed at obtaining the concept of systemic solutions for the positive use of the multilingualism of the Ukrainian people, in particular through the implementation of language combinations using languages recognized by the international society.