Vol. 3 No. 3 (2024): EUROASIAN HEALTH JOURNAL

Fast Track Surgery (fast track in surgery) or ERAS (enhanced recovery after surgery, accelerated recovery after surgery) is a modern multimodal and interdisciplinary strategy for the perioperative management of surgical patients, based on the use of scientifically proven medical treatment and preventive components. Purpose of the study: to analyze the clinical implementation of the adapted Fast Track Surgery protocol in the perioperative management of patients with acute calculous cholecystitis. Study design: single-center, prospective, non-randomized. This article analyzes the implementation of the components of the developed clinical protocol Fast Track Surgery in the surgical treatment of 109 patients with acute calculous cholecystitis. Of all the patients studied, 27 (24.8%) were men, and 82 (75.2%) were women. The median age of patients was 47 years (25- 65). All patients, depending on the method of cholecystectomy, were divided into 2 groups. The first group consisted of 56 (51.4%) patients who underwent laparoscopic cholecystectomy. The second group consisted of 53 (48.6%) patients who underwent cholecystectomy from a mini-access. Patients in both groups were comparable by gender and age. 16 components were adapted and included in the developed Fast Track Surgery protocol. The analysis shows a high degree of clinical implementation of the Fast Track Surgery protocol, which is due to the adaptation and selection of available and implementable components.

Purpose of the study: to evaluate the effectiveness of the method of preemptive analgesia on the degree of postoperative pain syndrome in patients after laparoscopic cholecystectomy. Material and methods: a single-center randomized prospective study was conducted, which included 109 patients with acute calculous cholecystitis. All patients were divided into 2 groups: the main group (n=56), in which the developed method of preemptive analgesia was used, and the control group (n=53), where preemptive analgesia was not performed. The intensity of postoperative pain syndrome was recorded at 2, 6, 12, 24, 36 and 48 hours after surgery. Results and discussion. Postoperative pain syndrome was significantly (p<0.001) minimal in the group where preemptiveanalgesia was used. A significant reduction in postoperative pain syndrome was recorded 12 hours after surgery in all groups. The International Association for the Study of Pain indicates the adequacy of the degree of analgesia after surgery for pain levels less than 3 mm on VAS, which was achieved in the first group within 12 hours after laparoscopic cholecystectomy. In the second group, VAS values of less than 3 mm were recorded 48 hours after surgery. Conclusions. The developed method of intraoperative preemptive analgesia during laparoscopic cholecystectomy allows us to reliably minimize the degree of postoperative pain syndrome, and reduce the frequency of postoperative analgesia and abandon opioid analgesia.

Purpose of the study: to study the results of surgical treatment and quality of life of children with congenital spina bifida.
Materials and methods. The study examined the results of treatment of 191 patients with congenital spina bifida. To assess the quality of life of children, the nonspecific Lansky scale and a new developed scale “Assessing the quality of life of children with spina bifida” were used, which made it possible to objectively assess the results of treatment. The presence of hydrocephalus in patients with spina bifida aggravated the clinical picture of the disease, resulting in increasing neurological symptoms and retardation in psychomotor and physical development.
Results. The use of a diagnostic and treatment algorithm also led to an improvement in the results of surgical treatment, which was reflected in the regression of neurological deficits and an increase in the quality of life of patients. The developed algorithm for the management of patients with spina
bifida allowed us to differentiate the approach to surgical treatment, and as a result, improve treatment results and the quality of life of patients. The choice of method and stages of surgical treatment for combined neural tube anomalies significantly improved the results of surgical treatment in the form of regression of neurological deficit and improved quality of life.
Conclusions. An objective method for quantitative assessment of the quality of life before surgery and in the postoperative period is a scale developed by us, which helps evaluate the results of treatment. The use of a diagnostic and treatment algorithm led to improved results of surgical treatment, manifested in the regression of neurological deficits and an increase in the quality of life of patients.

Objective. Improving the results of treatment of patients with severe traumatic brain injury by improving and determining the optimal technique of decompressive trepanation of the skull, substantiating differentiated indications for its use and studying postoperative dynamics.
Material and methods. The analysis of management results of 107 patients (89 men, 18 women) with severe traumatic brain injury was presented. The age of the victims ranged from 16 to 84 years. The average age of the patients was 42.7±5.8 years. Decompressive trepanation of the skull was performed in all patients.
Results. For the first time in the Kyrgyz Republic, a prospective randomized study was conducted on the use of the method of decompressive trepanation of the skull in victims with traumatic intracranial hematomas and foci of brain injury. The indications and contraindications to the use of decompressive trepanation of the skull in patients with severe TBI in the presence of cerebral edema have been clarified. Risk factors for the development of an unfavorable outcome in patients with severe TBI after decompressive trepanation of the skull were determined.

The lack of an objectively based treatment strategy to guide spinal surgeons when treating professional athletes prompted us to study the experience of treating such patients. Purpose. To analyze the results of neurosurgical treatment of professional athletes and those with degenerative disease of the lumbar spine, to develop a clinical and instrumental algorithm for differentiated surgical tactics.
Material and methods. An analysis was made of the results of neurosurgical treatment of 114 professional athletes and those with degenerative disease of the lumbar spine, who underwent: (1) microsurgical/endoscopic discectomy (n=35); (2) PRP therapy of the facet joints (FJ) (n=41); total arthroplasty of intervertebral discs (IVD) (n=11); rigid decompressive and stabilizing interventions (n=27). Postoperative clinical outcomes and preoperative instrumental results were assessed.
Results. A correlation was established between the method of surgical treatment and preoperative clinical symptoms, the severity of degenerative changes in the IVD and DS, the timing of return to sports, the long-term level of pain, quality of life according to SF-36 and the degree of tolerance to physical activity. To optimize the results of surgical treatment of the analyzed patients, an algorithm for planning neurosurgical treatment tactics was developed, based on individual preoperative neurological manifestations and morphological changes in the lumbar segments.
Conclusion. The use of a personalized method of neurosurgical treatment in a group of patients who are professionally involved in sports can ensure: rapid restoration of preoperative sports activity, reduce the risk of perioperative complications, and reduce financial costs for non-core treatment.

Meningiomas are stratified depending on the extent of the tumor and the degree of resection, often in isolation from other clinical variables. The aim of the work is to integrate demographic, clinical, radiological and pathological data for the development of prognostic models of meningioma outcomes.
Material and methods. Authors have developed a comprehensive database containing information on 235 patients who underwent surgery for 257 meningiomas in one facility from 2013 to 2023. The median follow-up was 4.3 years, and the resection samples were re-evaluated in accordance with modern diagnostic criteria, resulting in 128 grade II meningiomas and 25 grade III meningiomas according to WHO. A series of machine learning algorithms have been trained and configured using nested resampling to create models based on preoperative functions, conventional postoperative functions, or both.
Results. Authors compared the accuracy of different algorithms, as well as the unique information they provided in the data. Machine learning models limited to preoperative information such as patient demographics and radiological characteristics had the same accuracy in predicting local insufficiency or overall survival as models based on the degree of meningioma and the degree of resection. Integrated models, including all available demographic, clinical, radiological and pathological data, allowed us to obtain the most accurate estimates. Based on these models, authors have developed decision trees and nomograms to assess the risks of local insufficiency or overall survival in meningioma patients.
Conclusion. Clinical information has historically been underused in predicting meningioma outcomes. Prognostic models trained on the basis of preoperative clinical data work comparably with conventional models in terms of the degree of meningioma and the degree of resection. Combining all the available information can help to more accurately stratify meningioma patients. 

Moyamoya disease (MMD) is a chronic, occlusive cerebrovascular disease with an uncertain etiology characterized by bilateral steno-occlusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. In view of the abnormal pathology of this progressive cerebral vasculopathy, it is not difficult to understand the recurrent and stereotyped symptoms in MMD, such as transient ischemic attack (TIA), ischemic, or hemorrhagic stroke. Seizure is another prominent transient event in MMD, with a prevalence of 30% in adults. Therefore, diagnostic and therapeutic dilemma arises from these transient neurological events.
Electroencephalography (EEG) is not commonly used as a diagnostic tool in MMD. However, it can play a relatively role in the differential diagnosis of TIA-like symptoms.

The diagnosis of traumatic orbital injuries presents certain difficulties for radiologists, it becomes even more difficult if the injury of the orbit is combined with injuries to the brain and skull. In cranio-orbital injuries, anterior chamber injuries, lens injuries, eyeball injuries, retinal detachment, foreign bodies in the intraorbital region, carotid-cavernous anastomoses and damage to the optic nerve are most common. Vehicle collisions and sports-related injuries are common causesof orbital injury. Fortunately, both of these causes can be prevented to some extent. Seat belts have been shown to reduce the prevalence of eye injuries by more than 50%; the prevalence is further reduced when using airbags. Preventive measures have also led to a significant reduction in sports-
related eye injuries. For example, in Canadian youth hockey, eye injuries decreased by 68% after players were required to wear face visors. Unfortunately, trauma is still the cause of significant orbital morbidity. In 1990, it was estimated that 40% of cases of monocular blindness in the United States were caused by trauma.

Research into carnioplasty methods began in ancient times; according to archaeological research, the use of cranioplasty dates back to 7000 BC. Thus, cranioplasty was used by many ancient civilizations, including the Incas, Britons, Asians, North Africans and Polynesians.
Indications for cranioplasty are the protection of the underlying brain parenchyma, since the absence of a bone flap and deformation of the brain in the postoperative period can lead to the development of post-trepanation syndrome, including various manifestations such as headache, occurrence of convulsive syndrome, behavioral disorders, weather dependence. Closing skull bone defects through reconstruction leads to normalization of intracranial pressure, restoring cerebrospinal fluid and hemodynamics, and improves cerebral metabolism. Cranioplasty has a significant impact on the quality of life of patients,
Authors came to the conclusion that today it remains relevant, despite the development of new techniques and the use of new materials for cranioplasty, there are no specific algorithms and recommendations for the selection of materials.

Recently, there has been a significant trend in the views of researchers and practitioners on the pathogenesis, course, and biochemical changes in the elements of the spinal cord and ligamentous apparatus that occur in osteochondrosis. This is due to the new opportunities that have opened up thanks to the advent of computed tomography (CT) and magnetic resonance imaging (MRI) in the arsenal of diagnostic tools. With the introduction of CT and MRI, the reliability of information increased to 82-93%.
The aim of the study: to improve the diagnosis and increase the effectiveness of surgical treatment of patients with disc hernias in the lumbar spine by studying the relationship of clinical manifestations and the results of the applied research and treatment methods.
Materials and methods. The work includes the results of data analysis of a complex of clinical, diagnostic examinations and surgical treatment of 120 patients with neurological complications of herniated lumbar intervertebral discs and received inpatient (operative - 97 (80,8%) and conservative – 23 (19,2) patients) in neurosurgery departments.
Results. By using a highly informative MRI method, the dependence of the severity of pain syndrome and sensitive disorders on the number of levels of disc damage, their localization in the diameter of the spinal canal and their size was determined. The severity of pain and sensory disorders depended on the number of prolapsed discs. Moreover, the greater the number of intervertebral discs affected by the degenerative-dystrophic process, the greater the likelihood of a pronounced and pronounced pain syndrome.
Conclusion. The most informative method of radiation diagnosis of degenerative-dystrophic processes in the intervertebral discs of the lumbar spine is magnetic resonance imaging, which allows you to identify the number, location and size of herniated protrusions. The optimal algorithm for examining patients before deciding on neurosurgical intervention for herniated lumbar intervertebral discs includes radiography of the lumbar spine, MRI of the spinal cord and spinal column, and, if indicated, magnetic resonance myelography.

Purpose: to enlighten about first Uzbek aphasia testing system that helps to assess the speech disorders in patients who had surgical resection of the tumors of eloquent brain areas of the brain, furthermore in patients with various pathological conditions, including ischemic stroke of eloquent areas.
Materials and methods. The linguistic protocol was tested on 25 healthy individuals, and on patients of the institution's skull base surgery department.
Results. Uzbek Aphasia Test has been validated by testing on 25 healthy individuals and recommended to use in neurological clinical examinations on patients in republican scientific center of neurosurgery.
Conclusion. The Uzbek Aphasia Test System serves as a convenient speech assessment protocol not only for intraoperative settings but also postoperatively, helping to functionally evaluate the degree of damage on language cortex and subcortical language networks. Utilizing this protocol, it is possible to monitor the neurological status of patients also in the postoperative period, this, in turn, reduces chances of disabilities caused by intraoperative damage to eloquent language areas.

Objective: improvement of hemorrhagic stroke management by perfecting of mini- invasive punction method and revealing of optimal technique for open removal of intracerebral hematomas, by using of differentiated indications for them and by investigating postoperative dynamics.
Material and methods. An analysis of management results of 140 patients (men - 82, women - 58) with hemorrhagic stroke was presented.
Results. Surgical treatment for non-traumatic supratentorial intracerebral bleeding indicated in lobar and lateral locations more than 40 cm3 and in miscellaneous locations more than 30 cm3. Methods for the prevention of repeated postoperative hemorrhages and intracranial dislocation disorders have been developed. The technique of surgical treatment of intracerebral hemorrhages by puncture removal has been improved, which is a promising direction in the treatment of this type of cerebral vascular pathology.

The paper presents the results of surgical treatment of 186 patients with stroke intracerebral hematomas (ICH) who were hospitalized at the National Hospital over 5 years, from 2019 to 2023. The purpose of the study was to create a prediction scale for postoperative mortality to select treatment tactics. Of the 186 operated patients, 46 died. The results of surgical treatment with removal of stroke intracerebral hematomas were analyzed depending on the size, location of the hematoma, degree of transverse dislocation, timing of surgical treatment, age, severity of consciousness and the presence of intraventricular hemorrhage. Taking into account the above criteria, a scale of postoperative risk of mortality of patients was developed, which makes it possible to determine the prediction of the risk of surgery when choosing treatment tactics for patients with IIMG. In surviving patients, according to the scale, the postoperative risk of mortality averaged 7.2 points, and in patients who died, it averaged 11.1 points. The analysis showed that the higher the scores on the postoperative mortality risk scale, the higher the mortality rate after surgery. Based on the results of the study, 4 degrees of postoperative mortality risk were identified, which makes it possible to predict the outcomes of surgical treatment.

Despite improvements in diagnostic methods and microsurgical techniques for treating arterial aneurysms of the cerebral vessels, there remains a high probability of mortality and persistent disability among the working population. This scientific work presents the results of examination and surgical treatment of 86 patients operated on from 2017 to 2023 y. at the Neurosurgery Clinic of the National Hospital. The age of the patients ranged from 23 to 78 years (average age - 47±1.7 years), among them there were 48 (55.8%) men, 38 (44.2%) women. All patients underwent MRI or CT angiography of cerebral vessels; in 47 (54.6%) patients, cerebral aneurysm was confirmed by selective cerebral angiography. The size of the aneurysms ranged from miliary (3.0 mm to giant sizes 25.0-30.0 mm). All patients were subjected to surgical treatment. The tactics of administration, the results of surgical treatment and complications of patients with this pathology are described in detail.

The authors conducted an epidemiological study of 2,750 patients who were treated in Bishkek hospitals for the period 2017-2022. The distribution of focal brain injuries by lobular localization was as follows: frontal lobe – 47.1%, temporal lobe – 40.6%; parietal lobe – 12.6%; occipital lobe and cerebellum – 2.1%. Of these, 72 patients underwent surgical treatment, and 44 patients were treated conservatively, including intensive therapy. They studied the clinical and
computed tomographic transformation of focal lesions – bruises, fractures and hematomas of the brain substance, which can be represented as follows: an increase in perifocal and lobar edema – 2-6 days; expansion of the foci of bruising and softening to 7-9 days; regression of intracranial hypertension – 3-4 weeks; regression of meningeal symptoms and rehabilitation of cerebrospinal fluid – 2-3 weeks; complete or significant normalization of neurological and mental status – 5-7 weeks; the transition from the hyperdensive phase of a hematoma or hemorrhagic lesion to an isodensive one – 3-4 weeks; their transition from an isodensive phase to a hypodensive one – 4-5 weeks; resorption of a hematoma followed by a change to the cystic cavity – 2-3 months. A new differentiated approach is proposed in choosing the method and type of treatment for brain injuries.

The aim of this work was to improve the simple and rational method of cranioplastic surgery using grafts and to prove using objective methods of investigation that applying titanium meshes as grafts provides favorable effect to the brain and helps to significant improvement of destroyed functions.
This work based on comparative results analysis of cranioplastic surgery using different plastic grafts for 98 patients with posttraumatic skull vault defects. Out of 98 patients with skull vault defects, in 50 patients plastic surgery for skull vault defects was performed using protacryl plates, and 48 patients were operated on using titanium meshes.
There were investigared 98 patients with skull vault defects. The age of patients was from 17 to 82 years. Males are 92 (93,9±5,4%) and females - 6 (6,1±2,3%).
Direct and remote results of cranioplastic surgery for skull vault defects have showed that using of titanium meshes to be the most effective and convenient method.

Neurosurgery is one of the most complex and delicate fields of medicine. Errors in this specialty can lead to devastating consequences, including permanent disability or death. This work is based on the analysis of fatal outcomes according to the data from the Mandatory Health Insurance Fund (MHIF) of the Republic of Kazakhstan (RK). It examines the types of neurosurgical errors and possible solutions for preventing these errors. In everyday practice, the term "medical error" implies the absence of signs of intent and negligence, and instead refers to errors associated with various causes leading to adverse outcomes. The problem of adverse outcomes depends on the quality of the diagnostic and therapeutic process, as well as factors such as gender, age, nosological forms, timing of hospitalization, and more.
An analysis of fatal cases in certain regions of the RK regarding neurosurgical services was conducted. The sample was carried out comprehensively using data from the MHIF of the RK. The sample included fatal outcomes of patients with neurosurgical pathology who were treated in various clinics across the republic. The quality of treatment was assessed using the MHIF's tabular form, which includes passport data, objective status, clinical examination methods, and treatment methods. The treatment outcome was evaluated on a three-point scale of compliance or non-compliance with standards and treatment protocols. The analysis determined the presence of treatment defects, the presence or absence of "medical errors," and more. Conducting such studies will help prevent adverse outcomes in neurosurgery.

Magnetic resonance imaging (MRI) of the brain and neurosonography are informative methods for detecting subdural hematomas and important for determining treatment tactics. In young children with subdural hematomas, the most acceptable method of neurosurgical treatment is percutaneous subdural puncture.
Material and methods. During investigation in admission compression of the brain by subdural hematoma was found in 7 children. Among them, 3 children had a history of perinatal CNS lesions. And four victims were injured when they fell from a low height – from a stroller and a bed, in 3 cases the cause of the injury was a traffic accident.
Results. MRI of the brain revealed sickle-shaped zones of altered density (increased in the zone of the acute phase of the process, reduced in the chronic course) located between the bones of the skull and the brain substance. There was marked swelling of the brain. The displacement of the average structures was in all cases. Along with traumatic changes in children with perinatal CNS damage, atrophic changes in the frontal lobes in 3 children and an increase in the size of the ventricular system in 4 children were revealed.
Conclusion. In young children with subdural hematomas, in addition to bone-plastic trepanation of the skull, effective methods of surgical treatment are the imposition of milling holes with the establishment of supply and exhaust drains, through which subsequent sanitation of the subdural space and percutaneous puncture of the subdural hematoma is carried out under the control of neurosonography followed by drainage of the subdural space.

In almost all cases of lesions of the osteoarticular apparatus at the level of the elbow joint, the ulnar nerve is affected too nedegree or another. The results of surgical treatment of 71 patients with ulnar nerve damage at the level of the joint of the same name, operated on in the period from 2017 to 2024, were analyzed. The majority of patients – 59 (83%) were men, 12 (17%) were women. The patients ranged in age from 20 to 66 years, mainly in the range of 30-59years, making up 55 (77.4%) patients. Household and street trauma prevailed in 55 (77.4%). The majority of patients – 42 (59.1%) – had closed lesions. In 16 (22.5%) cases, ulnar nerve injury occurred with open injury, 13 (18.3%) injuries were of iatrogenic etiology. Neurolysis and anterior subcutaneous ulnar nerve transposition for tunnel neuropathy were performed in 45 patients, suture was applied in 10 patients, and autoplasty was performed in three patients. Anterior subcutaneous nerve transposition was performed in all operated patients in order to reduce diastasis between the ends of the nerve. The result safter the operations performed on the international six-point scale MS0-5 allowed to raise the indicators M4-M5 from19.7% to 67.6%, S4–S5-from 19.7% to 60.6%. Anterior transposition of the ulnar nerve with its closure with a soft tissue-fatflapis the optimal solution for compression neuropathy and nerve suture. In case of intraarticular fractures with both bone fragments and iatrogenic causes, it is recommended to simultaneously perform anterior subcutaneous nerve transposition during osteosynthesis surgery.

Metastatic damage to organs and tissues is one of the main problems in the treatment of oncological diseases. Along with traditional metastasis to regional lymph nodes, metastatic lesions in distant organs and systems can be detected. Of crucial importance is the metastatic involvement of the skeleton, which is the third organ in terms of the frequency of lesion localization, after the lungs and liver. The purpose of the work is to analyze the results of diagnosis and treatment of patients with metastatic spinal lesions.
Material and methods. The paper presents an analysis of research materials conducted from 2008 to 2023 in the Osh region. Based on the data obtained, the frequency of metastatic spinal lesions in cancer of various localizations, the timing of their detection depending on the detection of the primary tumor, and the features of clinical manifestations were analyzed. The frequency of localization of metastases in various parts of the spine, methods of their diagnosis and treatment explored.
Results. In patients with identified primary tumors (n=66), signs of metastatic spinal lesions were diagnosed at various times after the diagnosis of the primary tumor. Thus, in 16 patients (24.2%), they were detected within 6 months, in 18 patients (27.3%) – from 1 to 3 years, in 7 patients (10.6%) – after 4-5 years.
Conclusion. For early and timely detection of metastatic spinal lesions, the most optimal algorithm for examining patients is needed. Mandatory magnetic resonance imaging of the spine in order to detect changes in soft tissues, computed tomography of the spine to identify pathological changes in the bone structure.

The work examines the features of the clinical and neurological symptoms of spinal cord injury, a comparative analysis of the effectiveness of various diagnostic methods is carried out, the structure of postoperative complications and ways of their prevention are studied.
Material and methods. An analysis of the results of surgical treatment in a total of 102 subjects showed that improvement was noted in 49 (48.0%) patients, while 53 (52.0%) of the victims had no improvement. The highest percentage of improvement was observed in patients under the age of 20 - 4 (80.0%), and the highest percentage of poor results was observed in the older age group (60 years and older) - 6 (66.7%).
Results. An analysis of the results of surgical treatment and the outcomes of various levels of damage showed the following data: among 38 patients with cervical injury, 11 (28.9%) improved, 22 (57.9%) remained unchanged, 5 (13.2%) victims died. In 12 patients with thoracic injury, 8 (66.7%) improved, 4 (33.3%) remained unchanged, and no mortality was noted. Improvement among 40 patients with damage to the thoracolumbar region was noted in 21 (52.5%), without changes - 19 (47.5%), there were no deaths. Among patients with lumbar injury, improvement was noted in 7 (58.3%) cases, in 5 (41.7%) – without changes, there were no fatal cases.

In this paper, the issue of a creative approach to the formulation of a neurosurgical diagnosis is revealed. Modern theoretical and methodological approaches to the study of the brain in its various lesions are analyzed. It is shown how diagnosis and surgical treatment are practically implemented through clinical thinking. A special place is occupied by the problems of proper diagnosis of neurosurgical diseases. The exceptional importance of a creative approach in diagnosis and the role of a neurosurgeon as a creator in deciding on the expediency and timeliness of surgical treatment of a patient, and not as a disease, is substantiated.