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Purpose: to evaluate the efficacy of surgical treatment for the non-tumorous diseases of the craniovertebral region. Patients and Methods. Forty five patients aged 4 - 63 years (mean age 27 years) with non-tumorous diseases of the craniovertebral region were operated on. Either one- or two-step surgical interventions for spinal cord decompression were performed. Early and long term results were evaluated by Frankel, JAO and River scales. In 5 cases the assessment of volumetric craniovertebral interrelationships (VCVI). Results. Good results were obtained in 43 (96%) patients at terms from 1 to 15 years. In 1 patient with mucopolysaccharidoses the aggravation of neurologic symptoms was observed and in 1 case a fatal outcome occurred. VCVI analysis showed a significant improvement of liquor dynamics right up to its normalization in the zone of decompression. Conclusion. Treatment of craniovertebral region diseases requires a differential approach. When necessary to eliminate ventral spinal cord compression it is expedient to perform either transoral or endoscopic transnasal decompression, or transoral spinal cord (myelencephalon) decompression with anterior stabilization by custom-made device (plate).

Purpose:to evaluate the efficacy of surgical treatment for the non-tumorous diseases of the craniovertebral region.Patients and Methods. Forty five patients aged 4 – 63 years (mean age 27 years) with non-tumorous diseases of the craniovertebral region were operated on. Either one- or two-step surgical interventions for spinal cord decompression were performed. Early and long term results were evaluated by Frankel, JAO and River scales. In 5 cases the assessment of volumetric craniovertebral interrelationships (VCVI).Results.Good results were obtained in 43 (96%) patients at terms from 1 to 15 years. In 1 patient with mucopolysaccharidoses the aggravation of neurologic symptoms was observed and in 1 case a fatal outcome occurred. VCVI analysis showed a significant improvement of liquor dynamics right up to its normalization in the zone of decompression.Conclusion.Treatment of craniovertebral region diseases requires a differential approach. When necessary to eliminate ventral spinal cord compression it is expedient to perform either transoral or endoscopic transnasal decompression, or transoral spinal cord (myelencephalon) decompression with anterior stabilization by custom-made device (plate).

Type I Chiari malformation is often accompanied by congenital developmental abnormalities such as platybasia, basilar impression and C2 odontoid process retroflexion that may cause anterior compression of brainstem structures and upper cervical segments of spinal cord. Formerly the conventional method was posterior decompression even in presence of anterior brainstem compression. This article presents on a kinetic example the tactics of one-step treatment of patients with type I Chiari malformation accompanied by basilar impression and C2 odontoid process retroflexion via transoral approach only that was used for both decompression and C1-C2 segment anterior stabilization. Surgical intervention enabled to achieve the decompression of brainstem structures and upper cervical segments of spinal cord, normalization liquor dynamics and subsequent redislocation of cerebellar tonsils to normal position (above the Chamberlain line).

Chiari malformation is characterized by herniation of the cerebellar tonsils into the foramen magnum, which leads to disturbance of CSF circulation through the craniovertebral junction. Orthostatic stress, which leads to the movement of SCF through the craniovertebral junction, is an adequate method to detect these disorders. It is accompanied by changes in the intracranial pressure, affecting the cerebrovenous orthostatic reactivity (CVOR), which is noninvasively assessed in patients with Chiari malformation.The study involved 35 patients with Chiari malformation (26 patients with Chiari I and 9 patients with Chiari II) aged 4 to 58 years (of them 12 males). Hydrocephalus was diagnosed in 4 examined patients and myelosyringosis was diagnosed in 6 patients. Transcranial Doppler sonography was used to record the venous blood flow in the tentorial sinus of the brain while changing body position on the fracture table from +90° to -30°.There is significant CVOR abnormality in most patients with Chiari malformation (more than 90%), which is characterized by either increased CVOR (sometimes 5-6-fold compared to the upper normal level (considerable hyperreactivity) or complete absence of any changes during the orthostatic load (areactivity). Before surgical treatment, CVOR of patients with Chiari malformation is often characterized by areactivity, as well as a moderate or significant hyperreactivity. After surgical treatment (decompression of the foramen magnum), patients with Chiari malformation demonstrate significant normalization of the craniovertebral volumetric ratios and CVOR if often characterized by normoreactivity (in 63%) or, more rarely, moderate hyperreactivity. The rate of venous blood flow in the tentorial sinus of the brain in patients with Chiari malformation can be increased before the surgery and normalizes after surgery.The high incidence of disturbance of CVOR (over 90%) in patients with Chiari malformation was revealed. After surgical treatment, complete normalization of CVOR was observed in more than half of these patients (63%).Мальформация Киари характеризуется вклинением миндалин мозжечка в большое затылочное отверстие, что приводит к нарушению циркуляции ликвора через краниовертебральный переход. Адекватным методом для выявления этих нарушений являются ортостатические нагрузки, которые приводят к перемещению ликвора через краниовертебральный переход. Возникающие при этом изменения внутричерепного давления оказывают влияние на церебровенозную ортостатическую реактивность (ЦВОР), которая оценивается неинвазивно при мальформации Киари. Материал и методы. Исследование проведено у 35 больных с мальформацией Киари (Киари I - 26 больных, Киари II - 9) в возрасте от 4 до 58 лет. Среди обследованных больных у 4 была выявлена гидроцефалия, у 6 - сирингомиелия. Методом транскраниальной допплерографии регистрировали венозный кровоток в прямом синусе мозга при изменении положения тела на ортостоле от +90° до –30°. Результаты. У больных с мальформацией Киари ЦВОР существенно отличается от нормы (более чем в 90% случаев) как ее увеличением (иногда в 5-6 раз по сравнению с верхней границей нормы - значительная гиперреактивность), так и полным отсутствием каких-либо изменений при ортостатической нагрузке (ареактивность). У больных c мальформацией Киари до хирургического лечения ЦВОР чаще всего характеризуется ареактивностью, а также умеренной или значительной гиперреактивностью. После хирургического лечения (декомпрессия большого затылочного отверстия) у больных с мальформацией Киари отмечается существенная нормализация краниовертебральных объемных соотношений, а ЦВОР чаще всего характеризуется нормореактивностью (63%), реже - умеренной гиперреактивностью. Скорость венозного кровотока в прямом синусе мозга при мальформации Киари до операции бывает повышена, а после хирургического лечения нормализуется. Выводы. Выявлена высокая частота нарушений ЦВОР (более 90% случаев) у больных с мальформацией Киари. После хирургического лечения этих больных больше чем в половине наблюдений (63%) отмечается полная нормализация ЦВОР.

Acyl peroxides react with aluminum triisopropylate at ordinary temperature with cleavage of an ester and formation of an alkoxyaluminum peracid salt which further oxidizes the isopropyl group to acetone and is converted into an alkoxyaluminum carboxylate.

1. The thermal decomposition of (C6H53Al, (C4H5Ga, (C6H5)3In, (C6H5)3 Tl in C14-labeled benzene solution is accompanied by the exchange of their phenyl radicals with the solvent. Triphenylaluminum shows the greatest ability to exchange. Triphenylgallium exchanges with benzene with much greater difficulty than does triphenylaluminum, and the ability to exchange increases in the order (C6H5Ga, (C6H5)3In, (C6H5)3Tl. 2. The exchange reaction is not observed in the photodecomposition of the organometallic compounds [(C6H5In]. 3. The phenyl radicals of the organometallic compounds react with benzene to yield biphenyl.