Method for morphologic prediction of children arachnoid brain cyst progression

FIELD: medicine.

SUBSTANCE: histologic examination of transverse section is performed through all the layers of arachnoid cyst walls with previous alignment of the piece in paraffin on the edge and study the state of lining and connective-tissue membrane. In case the wall of the cyst is covered in flat arachnoendothelium with hyperchromatic nucleus, the cyst is regarded the non-proliferating, the prognosis is favorable. In case the wall of the cyst is covered with round-shaped arachnoidendothelium with the zones of amplified proliferation of arachnoidendothelium in form of multirowed layer and/or vertical cells alignment, it is regarded as proliferating - the prognosis is unfavorable.

EFFECT: morphologic prediction of children arachnoid brain cyst progression.

1 dwg, 2 dwg, 1 tbl, 2 ex

 

The invention relates to medicine and can be used in forecasting the development of the clinical course and outcomes of surgical treatment arachnoidal cysts of the brain in children.

Possibilities of modern medicine and new ways of treatment (endoscopic surgery), as well as the introduction of new technologies in neurosurgery poses new challenges for morphologists, requires a deeper analysis of histostructure and evaluate the value of the morphological and functional transformations arachnoidal cysts for prediction of clinical course of the disease.

Normal arachnoidea shell consists of three layers - an inner arachnoidal layer, collagenolytic basics and outer arachnodactyly layer, also describes the expansion of the outer arachnodactyly layer normal arachnoid (Dobrovolsky GF ABOUT the role of the ultrastructure of the arachnoid of the human brain in the process of removal of erythrocytes subarachnoid streamed blood. - Matters. on neurosurgery. - 1974. No. 2. - P.32-37; Dobrovolsky GF / Ultrastructure of cell spots arachnoid brain of man (Genesis arachnoentomology of ottsepleny hard shell of the brain) // Questions of neurosurgery. - 1976. No. 4. P.47 - 53).

It is proved that cells arachnodactyly secreting have abilities that can affect the increase in the volume of the cyst (Go, K.G. Houthoff H.J Blaauw E.H et al. Arachnoid cysts of the sylvian fissure. Evidense of fluid secretion // J neurosurg. - 1984. - Vol.60. - P.803-813).

The known method pathological studies arachnoidal cysts, which were studied drugs brain two deceased patients by the arachnoid cysts. It is noted that the inner wall of the cyst adjacent to the brain, goes directly to the outside. Under the internal wall of the cyst is determined by the subarachnoid space. Thus, the cavity arachnoidal cysts limited duplicatory of the arachnoid. In addition, in the study of outer wall arachnoidal cysts revealed the presence of foci of proliferation (previously named Dobrovolsky GF cell spots) and the identification of blood capillaries that are absent in normal arachnoid membrane. But not assessed the effects of these findings in the clinical course arachnoidal cysts. (Gradirovskii, Tambient, Niihin et al. Arachnoidal cysts (postmortem examination). - // Ukr. neurol. and the psychiatrist. imasco. - 1990. - T. No. 10. - P.20-25).

The known method of histological examination in the outer wall of the cyst fibrous fibrous layer, which is highly developed, which is regarded as a cause of decompensation process and is a nonspecific response to stretching (Muhametzhanov X., Ivakina NI VRO is established intracranial arachnoidal cysts in children. - Alma-ATA, 1995. - S-134). In the way that no attention is paid to clinical and morphological comparisons, the effects of the characteristics of the functional state of the lining of the cyst on the development of clinical course and prognosis of this disease.

Methods of predicting the course of disease depending on morphological variant arachnoidal cysts are absent.

The invention is directed to a method of in vivo morphological predicting the course arachnoidal cysts of the brain in children.

This technical result in the implementation of the invention is achieved by the fact that the morphological method of predicting the course of arachnoidal cysts of the brain in children peculiarity lies in the fact that conduct histological examination of transverse sections through all layers of the wall arachnoidal cysts with a preliminary orientation of the piece on "the edge" and assess the condition of pavements and connective tissue membrane. If the cyst wall is covered with flattened arachnodactyly with hyperchromic nuclei, the cyst is referred to nephrolithotripsy - the prognosis is favorable, but if the cyst wall is covered with arachnodactyly, round shaped zones of proliferation of arachnodactyly in the form of the multiple layers and/or vertical arrangement of cells, it belongs to the cast new Araruama - the prognosis is poor.

The method is as follows.

The fence of the operational material then leaves the outer and inner walls arachnoidal cysts are immersed in different containers with saline 0.9% solution of sodium chloride and mark.

Preparation for commit - outer and inner wall arachnoidal cysts straighten and spread out on sheets of cardboard or paper outer surface up to the best of unfolding the cyst wall, which is necessary for accurate verification of the structures of its walls. Pieces fix bandages.

Fixation of drugs is carried out in 10% formalin not later than three hours after sampling to prevent autolytic processes. The material is carried out in alcohols by standard procedures. Then make the fill of drugs in paraffin in position "on the edge" for surveillance cross section and all layers of the cyst wall.

Histological study was conducted using dyed with hematoxylin and eosin according to van Gison, Ft to assess the condition of pavements arachnoidal of the cyst and its connective tissue membrane.

In preparations stained with hematoxylin and eosin, and studied the state arachnodactyly lining of the cyst. In preparations stained by van Gison, appreciate groovology what's connective tissue fibers in the wall of the cyst. On drugs, imprisioned method M, estimate the number of vessels and the presence of foci of angiomatosis in connective tissue membrane. If the wall arachnoidal cysts covered with a layer of flattened arachnodactyly with hyperchromic nuclei, the cyst is referred to nephrolithotripsy (Figure 1), if the cyst wall is covered with arachnodactyly, round shaped with zones of enhanced proliferation of arachnodactyly in the form of multi-layers (arachnodactyly kidney) and/or vertical arrangement of cells, the cyst is referred to as proliferating (Figure 2). If the cyst nephrolithotripsy - positive Outlook (uncomplicated clinical course of the disease), and if proliferating - the prognosis is poor (complicated, relapsing course of the disease).

The inventive method morphological predicting the course arachnoidal cysts of the brain in children was developed and clinically tested in the Polenov research neurosurgical Institute imageline the clinical-morphological study of 37 patients with by the arachnoid cysts of the brain.

In the study of complicated clinical course arachnoidal cysts in different functional groups revealed that this clinical course is typical of proliferating cysts at the level of statistical significance of difference p<0,01. The results of the research the Finance presented in the table.

Complicated clinical course depending on the functional group arachnoidal cysts (n=37)
Functional group arachnoidal cystsClinical course arachnoidal cystsOnly
UncomplicatedComplicated
or neproliferirute16117
proliferating11920
only271037

In the study of repeated interventions, due to complications and recurrence of the disease in different functional groups, it was found that in the group proliferating arachnoidal cysts often produced re-intervention at the level of statistical significance of difference p<0,01. While subsequent operations were carried out with the extension of its area of intervention, in the beam of the presence of epileptic syndrome of repeated surgical intervention was supplemented by resection of the epileptic focus, and in cases of hypertensive symptoms was performed a wide excision of the walls and the creation of anastomoses with the basal cisterns.

Examples of extracts from the histories.

Example 1. B-Naya K., age 15, IB. 713-99, suffered from the age of 7, when there are headaches with nausea, radiating to the left eyeball, and the deviation of the left eyeball medially, difficulty in understanding speech, irritability, neurologist prescribed dehydration and vascular therapy without effect, for the year prior to surgery headaches intensified, joined vomiting, CT scan revealed a cyst of the left pole of the temporal lobe dimensions of 2.5×3 cm, the patient was admitted to hospital for surgical treatment. Operation was performed - osteoplastic trepanation in the left temporal region - excision of the outer cyst wall. According to the claimed method was conducted histological examination. Wall arachnoidal cyst was covered with one layer of flattened arachnodactyly with hyperchromic nuclei, identified nephrolithotripsy arachnoidal cyst, on the basis of which he was made a favorable prognosis. Indeed, after 8 years after surgery, the child has graduated from secondary school, re-operation was not performed, socially adapted, no complaints.

Example 2. B-Neu Century, 15 years old, IB. 194-94, more than the t to 14 years, when did the headaches. Using CT detected arachnoidal cyst in the right temporal and frontal lobe size of 5.5×6 cm, in the dynamics of a detected displacement of the midline structures to the right to the left 6 mm, neurological symptoms presented left-sided pyramid failure, narrowing of the right eye slits. Operation was performed - osteoplastic trepanation in the right fronto-temporal region - partial excision of the outer cyst wall. According to the claimed method was conducted histological examination walls arachnoidal cysts. It is revealed that the wall is covered by arachnodactyly rounded with numerous foci of proliferation of arachnodactyly, connective tissue membrane had lots of different thickness with different density and arrangement of collagen fibers, with a significant number of vessels. Installed proliferating arachnoidal cyst, made a poor prognosis. The postoperative course was hard, with a complication in the form of hemorrhage into the cyst cavity, requiring repeated surgical intervention.

The morphological method of predicting the course of arachnoidal cysts of the brain in children, characterized in that conduct a histological study of transverse cut through all layers of the wall of arachno the long-cyst with a preliminary orientation of the piece on "the edge" and assess the condition of pavements and connective tissue membrane, if the cyst wall is covered with flattened arachnodactyly with hyperchromic nuclei, the cyst is referred to nephrolithotripsy - the prognosis is favorable, but if the cyst wall is covered with arachnodactyly, round shaped with zones of enhanced proliferation of arachnodactyly in the form of the multiple layers and/or vertical arrangement of cells, it is referred to proliferating - the prognosis is poor.



 

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