PATHOGENETIC PRINCIPLES OF SECONDARY NEUROPROTECTION IN PATIENTS WITH CLOSED CRANIOCEREBRAL INJURIES. (Review article)

Closed craniocerebral injury is the main cause of death and severe disability throughout the world. The treatment and rehabilitation of its victims inflict great damage on the budgets of various countries. The psychological and physical burden, the decline in the quality of life and the considerable expenditure can only underline the need for additional, more complex and effective options for managing these patients. The concept of neuroprotection, as a means of achieving a better outcome by making use of the complex pathophysiological changes provoked by ischaemia, has been and remains at the centre of many therapeutic and surgical strategies. Several types of complication that give rise to the various mechanisms of closed craniocerebral injury, from excitotoxicity, apoptosis and oxidative stress to inflammation, have been studied, and most of them have led to disappointment at the clinical stage; at every stage of damage, protection, that is neuroprotection, must be provided in order to prevent one or another pathway of damage or to minimise its consequences. This shows that neuroprotection remains an important treatment tactic. This review gives brief information on the clinically studied methods of neuroprotection, their mechanisms and results, the potential targets of neuroprotection and targeted methods of treatment.