All activity of a man, all spectrum his feelings and deeds, his emotions — joy and sorrow, love and hate, mad flights of fancy, knowledge and experience — all are controlled by brain. But the trouble comes when in the debugged mechanism malfunction occurs. It is not necessary to speak about complexity and importance of “refurbishment works” in this area. It is apparent enough.

In neurosurgery the cryodestruction is effectively used for destruction of subcortical structures in treatment of patients with various extrapyramidal hyperkinesias, epilepsy, and for destruction of brain tumours and vascular malformations.

more than 2,500 stereotaxic operations with cryodestructive method were performed

In Kyiv Scientific and Research Institute of Neurosurgery more than 2,500 stereotaxic operations with cryodestructive method were performed.

The destruction was carried out as in pathological formations themselves (intracerebral tumours, pituitary adenomas, arterial-venous aneurysms) so intact cerebral structures mainly thalamic nuclei responsible for formation of extrapyramidal hyperkinesias, epileptic attacks. The destruction of separate thalamic nuclei or their complexes leads to stoppage of affect impulses that was clinically manifested by elimination or decrease volume of involuntary movements.

Tumour cryodestruction was made with using of both stereotaxic method and open access. If necessary, some cryodestruction centers were made. In open access, external parts of tumour were removed and medial areas were destructed by cryosurgery that considerably increase surgery efficacy.

For parkinsonism, 2,200 cryosurgeries were performed. Indications were expressed and persisted tremor, muscle tone disturbance. Moreover, expression of the other signs due to hyperfunction of cerebral structures with pathological impulses was considered. The most frequent surgery was destruction of oral ventral nuclei and subthalamic nuclei. It resulted in complete and stable elimination of tremor and rigidity in 92% of observations.

Indications to cryosurgical treatment of epilepsy are high frequency of attacks and inefficient conservative therapy. The choice of operative measure first of all depends on localization of epileptic focus. If the focus is located in functionally important zones, the one-stage stereotaxic destruction directed to disintegration of bonds inside focus is appropriate. Positive results in treatment of patients with epileptic syndrome were obtained and in integrated effect as well, namely in focus destruction with using of drug therapy.

Along with decreasing of frequency and changing of epileptic attacks character in 2/3 of patients, apparent decrease in effect on psychomotor activity was noted, as well as reduced anxiety, malice.

For treatment of locomotive disturbances in 560 patients with nursery cerebral paralysis, breaking of complex of various nuclear formations and conduction paths was used. Obligatory destruction were performed for structures disintegration of which targeted spasticity — dentate cerebellum nuclei, talamic cushions, internal capsule, and structures (ventral group of talamic nuclei) disintegration of which promotes elimination of hyperkinesias. As a whole, operative intervention has allowed to reduce spasticity in 70% of patients.

Now it is established, that cold can result in destructions of all building blocks of cerebral tissue. Based on our and literary data we consider that cryodestruction of cerebral tissue meets the most fully requirements for “ideal” method of destruction, namely:

• allows precise dosing of volumes for tissue destruction;
• causes minimum perifocal response of cerebral tissue around of the focus of destruction;
• no harmful injuring effect on brain in whole;
• enables performing of functional switching off subcortical structure to control hit accuracy and predict operation results;
• precisely doses the shape and size of freezing area that is important for decrease of possible complications;
• provides gradual increase of cryodestruction focus.

VITALIY IVANOVICH TSYMBALYUK
Doctor of Medicine, Professor
The Head of Reconstructive Neurosurgery Clinic of
Ukrainian Scientific and Research Institute of Neurosurgery,
Corresponding Member АМS of Ukraine.