Conceptual approaches to the treatment of neurosurgical pathology (based on examples of chronic subdural hematomas and severe brain contusions)

Leonid B. Likhterman , Vladimir A. Okhlopkov , Alexander D. Kravchuk , Boleslav L. Lichterman

For citation:

Abstract

Introduction. General development tendency for modern neurosurgery is characterized by neuroimaging of focal brain damage at an early stage, choice of conceptual approaches to treatment tactics and minimization of operative interventions themselves.

Objective: to develop new treatment paradigm for chronic subdural haematoma, severe focal brain damage.

Material and methods. Verified observations of chronic subdural haematoma (765 cases) and severe brain damage (170 cases) entered the study. The following neuroimaging modalities were used: MRI and CT in dynamics, including early and delayed periods.

Results. It was estimated that the main factor for existence and periodical development of CSH was hyperfibrinolysis of hematoma contents (which was 6–60 time higher than in the peripheral blood of similar patients), thus provoking (stimulating) hemorrhage from newly formed abnormal CSH capsule vessels. Considering that, minimally invasive surgery (short-term drainage) was proposed instead of radical surgery, thus ensuring complete resorption of haematoma and its capsule with good clinical recovery in 94.7% of cases and ten-fold decrease of lethal outcomes (up to 1.2%). The concept of sanogenesis was formulated for severe focal brain damage, based on which indications for conservative treatment of this group of patients were determined. The comparative analysis of treatment outcomes in groups of severe brain damage showed that good recovery was statistically more frequent in cases of conservative and not operative treatment (52.5% versus 28.2%). On the contrary, severe disability and lethality were statistically lower in the conservative group of patients than in the operative one (9% versus 20.6% and 5.1% versus 13.0% correspondingly).

Conclusion. In our opinion, our results seem convincing; we managed to achieve better results of treatment when acting by the developed conceptual approaches and not by common sense. We suppose that our experience is a good example to be used in other conflicting situations considering the choice of treatment tactics in patients with neurosurgical brain pathology.

Keywords: sanogenesis, medical ethics, head injury outcomes, conceptual approach, chronic subdural haematoma, focal brain damage.

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For citation:Likhterman L.B., Okhlopkov V.A., Kravchuk A.D., Lichterman B.L. Conceptual approaches to the treatment of neurosurgical pathology (based on examples of chronic subdural hematomas and severe brain contusions). Clinical review for general practice. 2025; 6 (12): 136–140 (In Russ.). DOI: 10.47407/kr2025.6.12.00741

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Clinical review for general practice