NTRODUCTION. In recent years, there has been an increase in the frequency of nonspecific infectious diseases of the spine both in Russia and around the world. In modern conditions, in addition to surgical treatment of degenerative-dystrophic diseases of the spine, minimally invasive spinal surgery technologies have become actively introduced into the surgical treatment of infectious processes in the spine. Despite the widespread use of MISS technologies over the past decade, there are very few publications on this topic, most of the works describe small samples of patients (up to 10 patients), and there is no comparison of various minimally invasive surgical methods among themselves. AIM. The article deals with a review of the literature data and an analysis of results of the use of minimally invasive technologies in the surgical treatment of patients with infectious spondylitis. MATERIALS AND METHODS. During the period from 2019 to 2022, 28 patients with infectious lumbar spine spondylitis were operated on. The clinical picture was dominated by pain vertebrogenic syndrome and systemic inflammatory reaction syndrome. Patients underwent surgery using minimally invasive technologies (MISS): in group 1, 20 (71.4 %) patients underwent drainage of the infectious focus and decompression of the spinal canal by minimally invasive access using Caspar dilators and minilaminectomy, in group 2, 8 (28.6 %) patients underwent a set of tubes and a rigid endoscope through interlaminar or transforaminal access. RESULTS. Treatment results were evaluated dynamically using pain syndrome and quality of life assessment scales (NPS, ODI, MacNab), neuroimaging data, clinical and laboratory parameters. The results of surgical treatment in the first (MIS) group of patients were better than in the second (p<0.05). In 2 (25 %) patients of the 2 nd group who underwent endoscopic rehabilitation, the progression of the infectious process in the spine was revealed, which required repeated operations in this segment in the amount of decompression, rehabilitation and stabilization. CONCLUSION. The use of minimally invasive technologies in the surgical treatment of infectious spondylitis was not accompanied by the development of instability of the operated segment and the progression of neurological disorders in patients.

AIM. Assessment of immediate and long-term results, quality of life and return to work after microsurgical treatment of ruptured cerebral aneurysms in patients using the Hunt – Hess 3–5 scale. MATERIALS AND METHODS. The study included 455 patients with aneurysmal hemorrhage (AH) in the acute period after microsurgical clipping, who were treated at the Vladimirsky Moscow Regional Research Clinical Institute from 2019 to 2022. The condition was assessed using the Hunt – Hess scale; the study included patients with a severity of the Hunt – Hess condition of 3–5. An assessment was made of the prevalence of hemorrhage and the prognosis of the development of angiospasm according to the Fisher scale. RESULTS. Assessment of the clinical condition of patients and functional outcomes was carried out immediately after surgery and after 1, 3, 6 and 12 months. We used the Modified Glasgow Outcome Scale, the Modified Rankin Scale, the EQ-5D-3L Quality of Life Inventory, the MMSE Mini-Mental Status Scale, and the Hamilton Anxiety Scale. CONCLUSION. The patient’s age, the severity of the condition according to the Hunt – Hess grade, and functional impairments in the delayed period are the most significant factors in the return of patients to their previous working capacity. According to the results of our work, 50.3 % of patients returned to their previous working conditions on a full working day. In our opinion, the analysis of functional outcomes should be the basis for creating a functional scale for assessing functional outcomes and return to work, which determines the relevance of further research on this problem.

INTRODUCTION. High-grade gliomas are known as therapeutically resistant tumors. Over the past 35 years, their number has doubled. The processes occurring in the peritumoral zone directly affect the progression of the tumor process. The life expectancy of patients is the result of the work of a large number of specialists working in neurosurgery and for the needs of neurosurgery. These include, along with neurosurgeons, doctors of radiation diagnostics, neuromorphologists, geneticists, rehabilitation specialists, specialists working in the field of studying and assessing the contribution of oncogenic factors to the development of malignant gliomas. MATERIALS AND METHODS. The study material was current biopsies of 72 highly malignant glial tumors. Astrocytoma, with a mutation in the IDH genes, was classified as Grade IV (42 cases), glioblastoma, without mutations in the IDH genes (30   cases). The peritumorous zone of the tumors was studied, where inflammation was detected, which, when aggravated, accelerates the proliferation processes. RESULTS. Glioblastoma without mutations in the IDH genes in the studied material accounted for 41.7 %, astrocytoma with mutations in the IDH genes, respectively, accounted for 58.3 %. A detailed study of the peritumorous zone made it possible to   carry out etiotropic therapy using antiviral drugs aimed at combating exacerbation of chronic inflammation. With this approach, survival without continued growth was 17.2 months for glioblastoma, while in the control group, where antiviral treatment was not used – 6.1 months. Overall survival up to 1 year in the group of patients who received antiviral treatment in the early postoperative period was 95.8%, in the control group 43.5 %. The obtained results of complex treatment of patients with   glioblastomas as well as with astrocytomas, with a mutation in the IDH genes classified as Grade IV. Showed a significant improvement in one-year survival in this group. The emergence of mutations leading to the development of glioblastoma is usually spontaneous and has no proven association with most external factors. Risk estimates are calculated for a group of people, determined by gender, year of birth, ethnicity, occupation, lifestyle or other characteristics, as well as for specific exposure conditions. In accordance with the Law of the Republic of Belarus dated 26.05.2012 No. 385-Z «On the legal regime of territories subjected to radioactive contamination as a result of the Chernobyl disaster» it is approved to develop and implement new approaches to reduce the level of radioactive contamination of the territory and its harmful effects on people (taking into account other harmful factors, development of programs to overcome the consequences of the disaster, distribution of material and technical resources and finances allocated for these purposes, financing of scientific and technical programs covering various aspects of research to assess the long-term impact of the radiation factor).The use of rehabilitation to prolong the comfort of life for patients with glioblastoma, taking into account the individual characteristics of patients who have lost functions related to the surgical intervention area, cannot be underestimated. CONCLUSION. Methods of surgical interventions on the brain are constantly being improved, new methods are constantly being proposed for specific localizations taking into account many factors that have not yet received a clear classification. Unification of various approaches taking into account clinical, morphological and genetic characteristics will significantly improve treatment results patients of this category. In addition, existing methods of treating highly malignant gliomas often require multiple surgical interventions, which should also be worked out in detail with a possible individual approach. This will allow for the introduction of a systemic approach to surgical interventions along with consideration of general practices for specific localizations. Systematization of the multifactorial approach with the help of legal support will facilitate the work of specialists, facilitating their work in basic areas with patients.

INTRODUCTION. Surgical treatment of dumbbell tumors of the lumbar spine remains a discussible topic due to its complex location, affecting three conventional anatomical zones: the spinal canal, retroperitoneal space and foraminal canal. Many publications on the advantages and disadvantages of various treatment methods prove the need to develop a personalized approach to solving this issue. MATERIALS AND METHODS. The data of 47 (100 %) patients operated on for dumbbell tumors of the lumbosacral spine at the Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre in the period from 2015 to 2020 were analyzed, divided into 3 study groups operated using: tubular retractor – 16 (34.4 %), Kaspar wound expander – 15   (31.2 %), Quadrant® wound expander – 16 (34.4 %). The average age of the patients was 48.7 (19–76 years), among them 27 (57.45 %) women and 20 (42.55 %) men. Access to the tumor and its resection were performed using a tubular retractor or a Kaspar wound expander by one surgical team. Patients were observed both face-to-face, with an assessment of neurological status, after 6 and 12 months, and remotely – an analysis of MRI studies after 3, 6, 12, 24 and 36 months. RESULTS. The average surgical intervention time in the tubular retractor group was 125 min, in the Kaspar wound dilator group – 148 min, in the Quadrant® wound dilator group – 134 min, the average blood loss was comparable in both groups and amounted to 210 (80–400 ml). Total tumor resection was achieved in 100 % of cases. The average duration of hospitalization was 6 days. Histological verification of the tumor tissue revealed a 3-to-1 ratio of schwannomas to neurofibromas (35 (74.47 %) schwannomas and 12 (25.53 %) neurofibromas). There was no recurrence of the tumor during the follow-up period. CONCLUSION. Dumbbell tumors of the lumbosacral region can be removed in one step, completely and safely for the patient using minimally invasive methods, regardless of the surgical access technique used.

INTRODUCTION. Improving the efficiency of diagnostics of neurological complications of degenerative-dystrophic diseases of the cervical spine is one of the most pressing problems of neurology and neurosurgery. One of the most significant and frequently encountered among these complications is pain syndrome. Observation of patients with this spinal pathology allows us to conclude that the currently used diagnostic methods for assessing pain syndrome are not always reliable. One of the more reliable methods for assessing pain syndrome is the method of “Quantitative localization reflection of the intensity of pain syndrome in DDDCS”. The use of this method for assessing the severity of pain syndrome creates conditions for studying the   nature and identifying the specifics of pain syndrome. AIM. Based on follow-up observation data, analyze the nature of manifestations of pain syndrome of degenerative-dystrophic diseases of the cervical spine to identify its various specific features. MATERIALS AND METHODS. The work is based on a follow-up study of data on the intensity, structure and manifestations of pain syndrome in 457 patients at various stages of the disease aged 22 to 64 years. Men – 186 (40.7 %), women – 271 (59.3 %). RESULTS. The obtained data allowed us to separate and designate the intensity of multicomponent pain syndrome and subjective data of patients about the process of treating the disease within the range of 0–40 units, as a functionally acceptable pain syndrome, 40–60 units, as a functionally maximum acceptable pain syndrome, 60–100 units, as a functionally unacceptable pain syndrome.

INTRODUCTION. Glioblastoma (GB) is one of the most lethal human brain tumors. AIM. To study the effect of a preparation of autologous immunocytes with activated TLR/NF-k signaling on the microenvironment of tumor cells (TC) and the survival of rats with C6 glioma. MATERIALS AND METHODS. C6 glioma cells, bone marrow mononuclear cells (BMMC), and outbred Wistar rats were used. Methods: experimental modeling in vivo and in vivo, morphological, immunohistochemical, and enzyme immunoassay. Survival was assessed according to Kaplan – Meier. RESULTS. Ex vivo treatment of mononuclear cells with LPS + dsRNA allows obtaining a high-tech medicinal product (HTMP) characterized by the expression of CD3+ antigens of early activation of B lymphocytes (97.9±7.1 vs. 80.1±6.1 %, P<0.05) and NK cells (91.8±11.1 vs. 72.2±7.7 %, P<0.05), an increase in the number of T-killers in relation to T-suppressor cells (42.8±4.4 vs. 30.5±3.1 %, P<0.05), expression of the early lymphocyte activation antigen CD69 (82.2±18.8 vs. 11.2±2.2, P<0.05), an increase in the content of CD45+ cells (66.3 vs. 42.1%, ) and a decrease in the content of stem cells CD90+ cells (3.3 versus 21.5 %). Transplantation of HTMP into the body of rats with C6 glioma enriches the tumor with markers of CD86+ cells, which is accompanied by an increase in the content of proinflammatory cytokines IL-1, B – IL 6, B – IL18, TNF1. The combination of HTMP and plerixafor increases the survival of experimental animals (74,5 versus 60 days, P<0,0001). CONCLUSION. The complex use of HTMP and plerixafor modifies the OC microenvironment and increases the survival of experimental animals with C6 glioma

INTRODUCTION. The majority of unruptured internal carotid artery aneurysms in the USA, Europe and Asia are treated using endovascular techniques. However, in clinical practice, there are still situations in which clipping of ICA aneurysms remains the only possible method of treatment. We focused on such situations in this study. MATERIALS AND METHODS. We retrospectively analyzed the results of microsurgical treatment of 38 patients with cerebral aneurysms of the internal carotid artery for the period from 2018 to 2024 at the Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre. Gender distribution: 28 (73.7 %) women, 10 (26.3 %) men. The average age of the patients was 59±12.4 years. Distribution by segments of the internal carotid artery: 26 (68.4.2 %) patients – communicant segment, 5 (13.2 %) patients – choroidal segment, 3 (7.9 %) patients – ophthalmic segment, 4 (10.5 %) patients – internal carotid artery fork region. RESULTS. All patients underwent internal carotid artery aneurysm clipping. Postoperative complications of varying severity were observed in 5 (13.2 %) patients out of 38 . In the group of aneurysms of the ophthalmic segment of the internal carotid artery, 1 out of 3 patients had vision loss in the ipsilateral eye. In the group of aneurysms of the communicating segment of the internal carotid artery, 2 (7.7 %) patients out of 26 had postoperative complications associated with compromise of the anterior choroidal artery orifice. Out of 5 patients in the group of the choroidal segment of the internal carotid artery, 2 (40 %) patients had complications. CONCLUSION. The technology of microsurgical treatment of internal carotid artery aneurysms should not fade away against the background of intravascular treatment, but on the contrary it should develop in step with time and absorb modern technologies that improve the quality of patient treatment.

INTRODUCTION. Breast cancer is the leading oncological pathology in the female population. Active treatment, including surgery, chemo and radiation therapy, forms a set of disorders. Such complex of disorders is called postmastectomy syndrome. One of the neurological manifestations is the cerebral variant, characterized by impaired memory, attention, a feeling of “unclear” head, in some cases the development of fainting, balance disorders, strokes. Such manifestations reduce the quality of life and require early diagnosis and adequate correction. AIM. Assessment of the brain condition of patients with cerebral manifestations of postmastectomy syndrome using a battery of neurocognitive tests and magnetic resonance morphometry MATERIALS AND METHODS. An open single-center controlled trial was conducted with 86 patients with postmastectomy syndrome and 28 healthy female volunteers. A comprehensive assessment of the patients’ condition was carried out: neurological examination, neurocognitive testing, magnetic resonance morphometry. RESULTS. In women with postmastectomy syndrome, there was a statistically significant decrease in the speed of neurocognitive tests, as well as a decrease in the number of correct answers compared with the group of healthy volunteers. There was also a decrease in the volume of such brain structures as the cerebral cortex, cerebellar cortex, frontal, occipital, parietal lobes, thalamuses, and precentral gyri. CONCLUSION. In patients with the cerebral variant of postmastectomy syndrome, clinical and instrumental signs of damage to the central nervous system are determined. Good survival rates, as well as the high prevalence of neurological manifestations, create the need to create effective and accessible diagnostic strategies, as well as adequate and timely treatment.

INTRODUCTION. Understanding the nonlinear process of progression of low grade gliomas (LGG) necessitates the identification of factors that influence their biological behavior and the revision of commonly accepted recommendations regarding their MR monitoring. Early detection of continued tumor growth, including malignant transformation, before the first symptoms appear and neurological deficits develop is the main goal of surveillance after tumor resection. At present, the optimal frequency of follow-up MR examinations for patients with LGG has not been clearly defined. MATERIALS AND METHODS. The study group consisted of 52 patients with LGG of supratentorial localization who underwent reoperation for advanced LGG between 2019 and 2023. Inclusion criteria: age at the time of diagnosis older than 18 years; histologically and molecularly genetically verified LGG; no tumor contrast accumulation according to MRI before the first surgery; radiopharmaceutical accumulation index according to PET-CT with methionine less than 1.7; Ki-67 expression level less than 6 %; no vascular proliferation and endothelial swelling. To identify the factors influencing the recurrence-free survival of LGG, the peri- and postoperative treatment was analyzed. Comparative data analysis and statistical processing was performed using x 2 test and proportional hazards model in patients with progression. RESULTS. Based on the findings, MRI follow-up schedules for patients after initial treatment are proposed. After surgical resection without adjuvant treatment, the recommended interval of MRI studies for patients with LGG is every 3–4 months until its progression, while in patients with oligodendroglioma who underwent total resection or received a combination of radiation therapy and chemotherapy, it is preferable to perform MRI every 6–9 months after surgery until tumor progression. For patients with astrocytoma it is recommended to perform MRI control every 3–4 months regardless of the degree of resection and every six months for patients who have received a combination of radiation therapy and chemotherapy. CONCLUSION. The MR monitoring schedule used should take into account the individual characteristics of both the patient with LGG and the tumor itself. Determination of optimal timing of MR studies is crucial in early detection of malignant   transformation and/or tumor progression.

INTRODUCTION. Arteriovenous malformations of Spetzler – Martin grades III–V are characterized by complex angioarchitecture, deep localization, and a higher incidence of epileptic syndrome compared to grade I–II AVMs. These features complicate both the technical execution of the intervention and the objective assessment of its impact on seizure control. In the present study, special attention is given to the analysis of seizure dynamics following endovascular treatment in patients with high-grade AVMs in order to clarify its effectiveness in this clinical cohort. AIM. To identify prognostic factors for epileptic seizure control following embolization of arteriovenous malformations (AVMs), with a focus on the degree of vascular occlusion and its correlation with clinico-radiological parameters. MATERIALS AND METHODS. A retrospective study included 60 patients divided into two groups: group 1 (n=30) underwent total/subtotal embolization (>95 % occlusion), and group 2 (n=30) underwent partial embolization (<95 %). Efficacy was assessed using the Engel scale with a minimum follow-up period of 12 months. Statistical analysis utilized the 2 test, Fisher’s exact test, Mann – Whitney U test, and odds ratio (OR) calculation. RESULTS. In the total embolization group, complete seizure cessation (Engel Ia) was achieved in 56,7 % of patients compared to 23,3 % in the partial embolization group. The rate of unfavorable outcomes (Engel IVb+IVc) was 16,6 and 36,7 %, respectively. Complications were reported only in the total embolization group. In patients with partial embolization, a baseline low seizure frequency (<1/year) was a significant predictor of success (p=0,0008; OR=55,0). CONCLUSION. Total embolization of AVMs provides a higher rate of complete epilepsy control but is associated with   procedural risks. Partial embolization demonstrates satisfactory outcomes in patients with rare seizures, suggesting its potential as a first-line therapeutic strategy for carefully selected cases.

INTRODUCTION. Focal drug-resistant epilepsy, particularly mesial temporal lobe epilepsy, often necessitates surgical intervention when pharmacological treatment is ineffective. MATERIALS AND METHODS. A retrospective analysis was conducted on 46 patients who underwent surgery for focal epilepsy at the Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre between 2015 and 2023. All patients received preoperative neuroimaging and neurophysiological monitoring. Outcomes were assessed using the ILAE classification at 1, 2, and 3 years postoperatively. Patients were grouped by surgery type and etiology (structural or posttraumatic). RESULTS. At one year post-surgery, favorable outcomes (ILAE classes 1–2) were observed in 63 % of patients; at two years – in 69 %, and at three years – in 69 %. No statistically significant differences were found in outcomes based on surgical technique, side of resection, or etiology (p>0.05). CONCLUSION. Surgical treatment of focal drug-resistant epilepsy provides stable seizure control over three years. Neither the side of the lesion nor the surgical method significantly influenced the long-term outcome, underscoring the importance of timely surgical intervention.

INTRODUCTION. Epilepsy is a prevalent chronic neurological disorder, characterised by a high frequency of comorbid pathologies. The disease has a significant negative impact on the quality of life of patients, and the development of pharmacoresistant forms necessitates the use of surgical methods of treatment and a comprehensive multidisciplinary approach. The key unsolved problem is the absence of a unified system of rehabilitation care for this category of patients. AIM. To explore the impact of the aforementioned factors on the subject’s performance. The objective of this study is to ascertain the primary directions and requirements for rehabilitation in patients diagnosed with pharmacoresistant epilepsy (PRE) during the preparatory phase preceding surgical intervention. MATERIALS AND METHODS. A single-centre, non-randomised, prospective-retrospective study in parallel groups was conducted in 2025 within the framework of State task No. 123021000127-7. The focal point of this study is pharmacoresistant epilepsy. The subject of the study is the rehabilitation needs of individuals. Patients from the “Register of neurosurgical patients with FRE” were included in the study. An investigation was conducted into demographic, clinical and social status factors, with specially designed questionnaires being utilised for the purpose of data collection. RESULTS. Cognitive habilitation in the preoperative period is required in 76 % of patients, and the level of need in this respect is comparable with the need in postoperative rehabilitation. The prevalence of depression was observed to be 32 % among the patient cohort. Concurrently, there was an escalation in anxiety levels, with the proportion of patients experiencing anxiety rising from 74 % to 78 %. Psychogenic non-epileptic seizures (PNES) were detected in 4.3 % of cases. The correction of   fatigue was necessary in 62 % of cases, and increased physical activity was required in 42 % of observations. It is evident that a significant proportion of patients require labour rehabilitation, with 57 % of cases being attributable to non-working and non-disabled patients, 46 % to patients with II–III disability groups, and 49 % to patients with I disability groups. Somatic comorbid   pathologies require observation and correction in 38.5 % of cases. CONCLUSION. The study revealed a significant need for rehabilitation of patients with FRE from the position of biopsychosocial approach.

INTRODUCTION. The human immunodeficiency virus (HIV) is a global health problem. It makes the central nervous system susceptible to infectious and non-communicable diseases. HIV-infected individuals can contact neurosurgical services not only with brain damage, but also with conditions unrelated to their HIV status. MATERIALS AND METHODS. Out of 6,000 medical records of patients operated on for degenerative spinal pathology from 2012 to 2022, 12 medical records of patients with a positive HIV test were selected. RESULTS. Significantly later terms of admission to surgical treatment were revealed in this group of patients: 33.6 days, while in HIV-negative patients this period averaged 15.2 days, while the level of quality of life and severity of pain syndrome were comparable with the group of HIV-negative patients. In addition, the average age of patients admitted with HIV for surgical treatment was 10.3 years less. There were no infectious wound complications in the group of HIV-positive patients, with a follow-up period of 1 year. CONCLUSION. HIV-infected patients undergo surgery for degenerative stenosis much later. The number of operations for degenerative pathology in patients with HIV infection in Russia is significantly lower than it should be statistically. More extensive research is needed to obtain more accurate data on this issue. The number of complications in patients with HIV infection operated on for degenerative stenosis does not exceed the same data in patients operated on with HIV-negative status.

Magnetic resonance tractography is a modern method of visualizing the white matter of the brain in vivo. This method allows for a lifetime assessment of the microstructure of the pathways of the central nervous system normally and under the influence of various pathological processes in the form of compression, violation of integrity, breakage. The conductive tracts can change in acute, chronic cerebral circulatory disorders, injuries, demyelinating processes, neurodegenerative diseases, brain tumors and other diseases. Magnetic resonance tractography is widely used in scientific fields of medicine. For several decades, the patterns of changes in the structure of the pathways in certain diseases have been studied. This article provides a review and systematization of data on magnetic resonance tractography in ischemic stroke and Alzheimer’s disease. In particular, the regularities of morphological changes and diffusion characteristics of the white matter of the brain in these diseases are considered. In neurodegenerative pathology, magnetic resonance tractography makes it possible to diagnose chronic progressive brain dis eases in the early stages, which makes it possible to start treatment in a timely manner and reduce the rate of disease progression. In the case of an acute cerebrovascular event, with the help of this diagnostic method, it is possible to determine the degree of damage to the nerve fibers of the white matter, on the basis of which the reversibility of the pathological process is judged, a prognosis for the restoration of lost function is established, an individual rehabilitation treatment program is selected.

A rare clinical observation is presented, which combines spontaneous ventriculostomy that occurred in a patient in adolescence and tectal glioma of the posterior parts of the third ventricle, followed for 30 years. The history of the patient’s symptoms development, as well as the dynamics of the neoplasm of the pineal region and ventricular system of the brain according to neuroim aging methods from 1995 to 2025 are demonstrated. After the formation of spontaneous ventriculostomy, the patient’s condition remains stable, without the appearance of new symptoms and an increase in the tumor size.