Department of surgical treatment of CNS trauma

Head of the Department - Honored Doctor of the Russian Federation, Doctor of Medical Science, Prof. Kasumov Rauf Dzhabbarovich

The Department was founded in 1946. It was headed by Lubensky E.G., a Candidate of Medical Science (1952-1965), Prof. Zotov Yu.V. (1965-1985), Shchedrenok V.V., a Doctor of Medical Science (1986-1988) and Prof. Kasumov R.D. (since 1988).

The main trends of research are:

- improvement of diagnosis and differential surgical treatment of focal cerebral lesions;
- development of new methods of complex (nonsurgical) treatment of severe craniocerebral trauma;
- developing methods of prevention and treatment of craniocerebral trauma sequelae;
- study of pathogenesis, a clinical picture and dynamics of epilepsy and development of methods of its differential surgical treatment.

The Department personnel has worked out a system of early diagnosis and differential surgical treatment in severe craniocerebral trauma and hemispheric crush foci with taking into account types of a clinical course and a degree of severity of hypertension-dislocation syndrome. The most typical forms of brain destruction foci and their clinical course have been studied from the clinical-surgical point of view. Four degrees of hypertension-dislocation syndrome have been described, their importance in examination and surgical treatment of patients with severe craniocerebral trauma as well as indications and contraindications for an operation, an intervention extent and its terms have been clarified. A method of complex treatment of hemispheric crush foci has been worked out.

It has been proved that irreversible pathologic changes in perifocal areas of a destruction focus are dependent on a degree to which brain edema and dislocation syndrome are marked. Thus, differential tactics of removal of crush foci has been developed. A modified surgical approach for treatment of multiple foci of the brain crush with marked manifestations of dislocation syndrome has been offered.

New methods of intensive care (regional intra-arterial infusions of drugs and HBO) allow to prevent development of secondary circulation disorders and hypoxia around a destruction focus and spread of necrosis of cerebral tissue.

A new means of reduction of intracranial hypertension (the so-called reinfusion or delayed autohemotransfusion) used in complex treatment of severe craniocerebral trauma has been developed. This method, as well as reduction of intracranial pressure, prevents secondary disorders of cerebral circulation and hypoxia.

A clinical-morphologic classification of focal lesions of the brain has been created. It has been used as a basis for development of the system of differential treatment of severe craniocerebral trauma.

The improved system of diagnosis and complex treatment of severe craniocerebral trauma has led to reduction of mortality and invalidism by 12% and 22% respectively. The research work carried out during the last 10 years has resulted in publication of 5 monographs, more than 300 articles and defense of theses for a degree of a Doctor (5) and Candidate (12) of Medical Science.

Today the staff of the Department is working at development and introduction of new diagnostic methods and means of treatment of craniocerebral trauma. Among them one can mention:

- diagnosis and treatment of post-dislocation disorders of circulation in the brain stem;
- further improvement of surgical treatment of crush foci of the brain with application of ultrasound and cryoextirpation;
- development of new methods of treatment of posttraumatic epilepsy (ultrasonic sounding of epileptic zones, dissection of corpus callosum in generalized fits).

The prospects of investigation are as follows:

- further study of epidemiology of craniocerebral trauma and improvement of organization of neurotraumatologic care;
- terminology clarification and creating a unified classification of severity of cerebral lesions;
- more precise estimation of a role of venous circulation disorders in genesis of intracranial hypertension and development of methods of their treatment in patients with severe craniocerebral trauma;
- analysis of errors of diagnosis and surgical treatment of patients with severe craniocerebral trauma;
- study of the nearest and long-term results of treatment of patients with severe craniocerebral trauma, development of methods preventing negative sequelae;
- development of new methods of nonsurgical treatment aimed at prevention of necrosis, edema and dislocation of the brain.