neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2022-24-4-111-117neurosurgery-1295Research ArticleОБЗОР ЛИТЕРАТУРЫLITERATURE REVIEWДиссекция базальных цистерн в лечении тяжелой черепно‑мозговой травмыDissection of basal cisterns for treatment of severe traumatic brain injuryhttps://orcid.org/0000-0002-2615-269XСтанишевскийА. В.StanishevskiyA. V.

Артём Вадимович Станишевский

105094 Москва, Госпитальная пл., 3

Artem Vadimovich Stanishevskiy

3 Gospitalnaya Sq., Moscow 105094

a-stan@mail.ruhttps://orcid.org/0000-0002-4797-2937БабичевК. Н.BabichevK. N.

105094 Москва, Госпитальная пл., 3

3 Gospitalnaya Sq., Moscow 105094

https://orcid.org/0000-0002-2953-9902ГизатуллинШ. Х.GizatullinSh. Kh.

105094 Москва, Госпитальная пл., 3

3 Gospitalnaya Sq., Moscow 105094

https://orcid.org/0000-0002-3922-9887СвистовД. В.SvistovD. V.

105094 Москва, Госпитальная пл., 3

3 Gospitalnaya Sq., Moscow 105094

https://orcid.org/0000-0002-3858-2371ОнницевИ. Е.OnnitsevI. E.

105094 Москва, Госпитальная пл., 3

3 Gospitalnaya Sq., Moscow 105094

https://orcid.org/0000-0001-5449-9394ДавыдовД. В.DavydovD. V.

105094 Москва, Госпитальная пл., 3

3 Gospitalnaya Sq., Moscow 105094

ФГБУ «Главный военный клинический госпиталь им. акад. Н. Н. Бурденко» Минобороны РоссииРоссияMain Military Clinical Hospital named after Academician N. N. Burdenko, Ministry of Defense of RussiaRussian Federation202227122022244111117Copyright © Станишевский А.В., Бабичев К.Н., Гизатуллин Ш.Х., Свистов Д.В., Онницев И.Е., Давыдов Д.В., 20222022Станишевский А.В., Бабичев К.Н., Гизатуллин Ш.Х., Свистов Д.В., Онницев И.Е., Давыдов Д.В.Stanishevskiy A.V., Babichev K.N., Gizatullin S.K., Svistov D.V., Onnitsev I.E., Davydov D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1295Введение

Введение. По данным ВОЗ, тяжелая черепно‑мозговая травма входит в десятку лидирующих причин смертности во всем мире. Несмотря на многовековую историю разработки методов оказания помощи пострадавшим с черепно‑мозговой травмой, результаты лечения, по данным крупных рандомизированных исследований, остаются неудовлетворительными: летальный исход и тяжелая инвалидизация наблюдаются более чем у 50 % пострадавших. Некоторые экспериментальные исследования указывают, что декомпрессивная трепанация черепа может усугублять выраженность отека головного мозга (ГМ) за счет создания условий для тракции нервных волокон и приводить к геморрагической трансформации очагов ушиба и ишемии. В последнее десятилетие экспериментальные исследования и технологический прогресс существенно расширили понимание нормальной и патологической физиологии ГМ и позволили разработать новые методики хирургических вмешательств. В частности, в ряде публикаций показаны значительные преимущества диссекции арахноидальных пространств основания ГМ при тяжелой черепно‑мозговой травме по сравнению с классической декомпрессивной трепанацией черепа.

Цель работы – анализ данных литературы о патофизиологическом обосновании, технике выполнения, результатах использования диссекции арахноидальных пространств основания ГМ при тяжелой черепно‑мозговой травме, преимуществах и недостатках метода по сравнению со стандартными методиками лечения таких пострадавших.

Материалы и методы

Материалы и методы. Проведен поиск научных публикаций в основных базах данных. Проанализированы методики вскрытия базальных субарахноидальных пространств при тяжелой черепно‑мозговой травме, патофизиологическое обоснование и техники выполнения, результаты клинических исследований применения методик.

Результаты

Результаты. Найдены, систематизированы и проанализированы сведения о патогенезе отека ГМ и патофизиологическом обосновании эффективности вскрытия цистерн основания ГМ в лечении черепно‑мозговой травмы, а также о технике выполнения цистерностомии и результатах клинических исследований ее применения. Публикации отдельных клинических случаев и серий наблюдений свидетельствуют о приемлемых результатах цистерностомии по сравнению с декомпрессивной трепанацией черепа в лечении черепно‑мозговой травмы.

Заключение

Заключение. Диссекция арахноидальных пространств основания ГМ с перфорацией терминальной пластинки и мембраны Лилиеквиста – перспективный метод хирургического лечения тяжелой черепно‑мозговой травмы.

Background

Background. According to WHO, severe traumatic brain injury is among the top ten leading causes of death worldwide. Despite the centuries‑old history of development of the treatment methods to patients with traumatic brain injury their results according to large randomized studies remain unsatisfactory – mortality and severe disability are observed in more than 50 % of patients. Some experimental studies indicate that decompressive craniectomy can aggravate the severity of cerebral edema by creating conditions for traction of nerve fibers and can lead to hemorrhagic transformation of injury foci and ischemia. During the last decade, experimental studies and technological progress have significantly expanded the understanding of brain normal and pathological physiology and made it possible to develop new methods of surgical interventions. In particular, a number of publications have shown significant advantages of dissection of arachnoid spaces of brain base in case of severe traumatic brain injury as compared with classical decompressive craniectomy.

Aim

Aim. To analyze the literature data on pathophysiological justification, surgery technique and results of dissection of arachnoid spaces of the brain base in case of severe traumatic brain injury as well as the advantages and disadvantages of the method as compared with standard treatment methods of such patients.

Materials and methods

Materials and methods. Literature search through in the main databases was carried out. The methods of opening of basal subarachnoid spaces in case of severe traumatic brain injury, pathophysiological justification and surgery techniques as well as results of clinical studies of the techniques employed are analyzed.

Results

Results. Information on pathogenesis of cerebral edema and pathophysiological justification of effectiveness of opening of brain base cisterns for treatment of traumatic brain injury, data on cisternostomy surgery technique and results were revealed, systematized and analyzed. Publications of individual clinical cases and series of observations indicate acceptable results of cisternostomy in comparison with decompressive craniectomy for treatment of traumatic brain injury.

Conclusions

Conclusions. Dissection of arachnoid spaces of the brain base with perforation of the terminal plate and the Liliequist membrane is a promising method of surgical treatment of severe traumatic brain injury.

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The authors declare that there are no conflicts of interest present.