INTRODUCTION. When we conduct a microscopic examination of nervous tissue, our judgment can often lead to erroneous conclusions about its condition. The reasons for our erroneous judgments may be autolytic processes that simulate almost all intravital changes in nerve cells. Artificial changes in brain structures can also form during an autopsy. To achieve more accurate research results, simultaneous studies of histological and cytological preparations were carried out.

MATERIALS AND METHODS. Cytological and histological methods were used to study 17 stereotactic biopsies obtained during diagnostic brain surgeries and drug studies. Preparations, both cytological and histological, were stained with hematoxylin–eosin. Immunohistochemical techniques were used on both histological and cytological preparations. Monoclonal antibodies to vimentin, S-100, CD-34, CD-45 were used. Cytological preparations, like histological ones, were covered with a coverslip.

RESULTS. In all studied cases, clinicians diagnosed a tumor process or, in 2 cases, a space-occupying process. Using the cytological method, normal and pathological structures were identified in a negligible amount of material. When studying histological specimens, the diagnosis was confirmed. The accuracy, sensitivity and specificity of cytological examination are quite high and approach 95 % (in our study). However, the histological method has certain advantages, which are manifested in the ability to assess the histoarchitecture of the pathological process.

CONCLUSION. The problem associated with the diagnosis of repair and pathological processes of the central nervous system is key in neurosurgical pathology, since its understanding explains the features of the clinical course of injury, as well as neurosurgical pathology, including vascular pathology, inflammatory and tumor diseases. A deep understanding of the basic morphological processes characteristic of the central nervous system allows the clinician to most effectively solve problems that arise during treatment. For doctors who have dedicated their activities to examining and resolving issues related to disability, this problem is the most serious, since it is currently being solved without taking into account existing knowledge. Understanding the problem will significantly improve the efficiency of medical care and rehabilitation of patients. Without detracting from the effectiveness of genetic research, it should be emphasized that tumor processes in the central nervous system are just a small part of all pathological processes in the brain. We believe that when studying the pathology of the central nervous system, histological and cytological examination is paramount, which gives the most effective results in diagnosing repair and pathological processes of the central nervous system

INTRODUCTION. Acquired bone defects of the cranial vault occur after surgical treatment for traumatic brain injury, tumor and vascular pathology of the brain. Cranioplasty performed within one month after decompressive cranioctomy, known as ultra-early cranioplasty (ultra-early CP), can improve neurological function with a lower number of concomitant complications.

AIM. To analyze postoperative complications in patients after ultra-early cranioplasty after open and closed traumatic brain injury.

MATERIALS AND METHODS. The data of 19 patients with open traumatic brain injury (study group), aged 18 to 68 years (average age 35.3±1.4 years), who were treated for traumatic brain injury and 21 patients with closed traumatic brain injury (control group), in aged 18 to 69 years (average age 35.7±1.3 years), who underwent ultra-early cranioplasty with a titanium mesh within 4–5 weeks after decompressive craniectomy. In all cases, if the dura mater was damaged, it was hermetically repaired with artificial Xeno Dura TMO sealed with Glue Brain glue to prevent cerebrospinal fluid. In patients of the main and control groups, upon admission for ultra-early cranioplasty, on the tenth day of the postoperative period, and one month after cranioplasty, neurological functions were assessed using the National Stroke Institute of Health (NIHSS) Scale, and the level of consciousness was assessed using the Glasgow Coma Scale.

RESULTS. The obtained results of assessing the level of consciousness according to the SHG, cognitive functions according to the Montreal Cognitive Function Assessment Scale (MoCA), neurological functions according to the National Stroke Scale of the Institute of Health (NIHSS), general disability and the degree of dependence of the patient on outside help – according to the Rankin scale in patients of the study and control groups before ultra-early cranioplasty, by 10 – the 1st day of the postoperative period and a month after the ultra-early cranioplasty did not differ significantly (p>0.05). However, there was a significant improvement a month after the ultra-early cranioplasty, compared with the preoperative condition (p<0.05).

CONCLUSION. Ultra-early cranioplasty should be performed in patients after decompressive cranial trepanation for open and closed craniocerebral trauma as early as possible, subject to mandatory hermetization of the dura mater, since it leads to early recovery of cognitive functions, reduction of disability, restoration of the physiological shape of the cranial vault with the elimination of cosmetic defects and related psychological stress after injuries. Taking into account all the individual characteristics of the patient, ultra-early cranioplasty can be performed in patients with open traumatic brain injury.

INTRODUCTION. Myasthenia gravis is an autoimmune disorder characterized by pathological muscle weakness and fatigability. Patients with myasthenia often present with various comorbidities, including cardiovascular and thyroid diseases, systemic autoimmune disorders, as well as mental health conditions such as depression and anxiety disorders. The impact of these comorbidities on the severity of myasthenia remains ambiguous. AIM. To evaluate the structure and influence of comorbid conditions on the course of myasthenia gravis in patients with varying disease severity.

MATERIALS AND METHODS. A clinical analysis was conducted on 102 patients with myasthenia gravis who underwent treatment between 2020 and 2023 at the Almazov National Medical Research Centre and the City Multidisciplinary Hospital No. 2 at St. Petersburg. Demographic characteristics, comorbidities, and myasthenia severity (MGFA classification) were assessed. A comparative analysis was performed for groups with different disease severities.

RESULTS. The most common comorbid conditions were anxiety disorders, depression (40.2 %) and hypertension (37.3 %). Mental health disorders were more prevalent in patients younger than 40 years, whereas cardiovascular diseases dominated in patients over 60 years. No significant association was found between these comorbidities and the severity of myasthenia.

CONCLUSION. Despite the high prevalence of comorbid conditions, their impact on the severity of myasthenia gravis has not been identified. Further research is required to elucidate the mechanisms of interaction between myasthenia gravis and comorbidities.

INTRODUCTION. Traction injury is one of the main causes of unfavorable outcomes in the removal of deep-seated brain lesions. Port-assisted surgery has been developed to minimize traction impact. Despite its growing popularity, this technique has specific technical features and limitations that are insufficiently observed in the literature. Based on our experience, we present key aspects of tubular retractor application, their advantages, and the outcomes of surgeries performed for various types of deep-seated brain lesions.

AIM. To demonstrate the methodology of port-assisted surgery, its limitations, and effectiveness in the removal of deep-seated brain tumors.

MATERIALS AND METHODS. Port-assisted surgeries were performed on 26 patients with deep-seated lesions: 14 with diffuse gliomas and 12 with nodular tumors. The median tumor depth was 21 [15; 27] mm, and the median volume was 18.5 [5.9; 53.5] cm3. Port placement and trajectory planning were based on preoperative MR tractography and the relationship between the lesion and the internal capsule.

RESULTS. The choice of port size should account for the total length of the surgical corridor, from the skin surface to the medial edge of the tumor. This determines the area of craniotomy, dura opening, and the need for combining port-assisted surgery with conventional spatulas. EOR of surgeries using tubular retractors was 98.2 % [87.5; 100 %] for all tumors, being lower for gliomas (88.9 % [57.2; 96.0 %]) and higher for nodular tumors (100.0 % [100.0; 100.0 %]), with median volumes of 36.1 [19.8; 57.1] cm3 and 5.7 [2.8; 18.8] cm3, respectively. The median Karnofsky Performance Status score remained unchanged at 80 [70; 90]. Deterioration was observed in 4 (15.4 %) patients, but only in 1 (3.8 %) case it was persistent. No complications associated with port-assisted surgery were observed.

CONCLUSION. The high radicality and favorable functional outcomes of tubular surgery for deep-seated brain tumors support its recommendation for broader clinical use.

INTRODUCTION. Fatigue after stroke has attracted research attention, but there is still insufficient evidence to estimate its prevalence and identify factors for its variability. As this condition has multiple implications for stroke survivors and the lives of their families, there is a need to find evidence regarding the causal relationship of fatigue with other post-stroke conditions.

AIM. To evaluate the dependence of the degree of hypersomnolence and fatigue on the severity, volume, localisation of the lesion focus and subtype of ischemic stroke (IS) according to the TOAST classification and to study the influence of neurological deficit on the severity of fatigue in patients in the acute period of IS.

MATERIALS AND METHODS. 80 patients in the acute period of IS were included in the study. During the examination, the subtype, basin and volume of the ischaemic focus were recorded. Fatigue was assessed using FIS and FSS scales, sleepiness was assessed using a sleep diary, ESS and KSS scales, and stroke severity was assessed using NIHSS, Rankin, Bartel, and Rivermead scales. Statistical data processing was performed using StatPlus Mac software package (USA). The significance level for statistical hypothesis testing was taken as p 0.05.

RESULTS. Hypersomnolence was detected in 37 patients, predominantly with unspecified subtype of IS, without dependence on the volume of the focus and severity of IS. To a greater extent, drowsiness was demonstrated in patients with right-sided localisation of the ischemia focus. Fatigue was observed in 17 patients regardless of the subtype of IS, localisation and volume of IS. The level of fatigue was higher in patients with greater neurological deficit and less mobility. No association of fatigue with the presence or absence of hypersomnolence was found.

CONCLUSION. The established correlation of hypersomnolence with the subtype of IS, affected hemisphere can serve as a reference point for predicting the outcomes of IS and developing individual patient treatment tactics. The revealed regularities, the discrepancy of data on the dependence of fatigue and sleepiness severity on the subtype of IS and localisation of the lesion focus allow us to assert the possibility of differentiating the concepts of fatigue and sleepiness.

INTRODUCTION. The incidence of intracerebral hemorrhage is 9–35 per 100,000 population. Mortality in hypertensive intracerebral hemorrhage is the highest among all acute cerebrovascular disorders. While most intracerebral hemorrhages are treated conservatively, there are indications for surgical intervention. The choice between open and endoscopic surgical methods depends on the hematoma’s localization. Data on the distribution of hematomas of various localizations are essential to assess the appropriateness of using open or endoscopic interventions.

MATERIALS AND METHODS. A retrospective multicenter study was conducted, including data from patients with hypertensive intracerebral hemorrhages from 4 regional vascular centers and 14 primary vascular centers in the Republic of Tatarstan in 2022. Inclusion criteria: registered cases of hypertensive intracerebral hematoma from 01.01.2022 to 31.12.2022, age >18 years. Exclusion criteria: identification of non-traumatic intracerebral hematoma due to vascular anomalies (ruptured aneurysm, arteriovenous malformation, cavernous hemorrhage, etc.), hematoma within a tumor, coagulopathy, vasculopathy, hemorrhagic transformation.

RESULTS. The study included 1127 patients with hypertensive intracerebral hemorrhages. The median volume of intracerebral hematoma was 12 [4; 36] ml, with a maximum volume of 330 ml. Midline shift reached 27 mm. 56,1 % were male and 43,9 % were female. According to medical records among 1127 patients, putaminal hematomas were 33,1 %, thalamic 22,1 %, subcortical 22,8 %, mixed 6,3 %, cerebellar 6,8 %, brainstem 5,8 %, other 2,7 %, isolated intraventricular hemorrhage was 0,4 %. Neurovisualization data confirmed the localization in 786 patients, showing putaminal hematomas at 33,8%, thalamic 23,7 %, subcortical 18,8 %, mixed 7,6 %, cerebellar 7 %, brainstem 5,1 %, other 3,3 %, isolated intraventricular hemorrhage 0,6 % (*here in after sum of shares less than or more than 100 % due to rounding). Right-sided hematomas were 47 %, left-sided 46,2 %, bilateral 6,9 %. Blood breakthrough into the ventricular system occurred in 37,5 % of cases. In the surgical treatment group (87 patients), hematoma localization was putaminal 47,1 %, thalamic 6,9 %, subcortical 27,6 %, mixed 9,2 %, cerebellar 6,9 %, other 2,3 %. The highest hospital mortality (78 %) was in patients with mixed intracerebral hematoma localization. The lowest hospital mortality (17 %) was in patients with thalamic intracerebral hematomas. Different localization thresholds have been calculated, above which bad or lethal outcomes are predicted.

CONCLUSION. The structure of hypertensive intracerebral hematoma localization in the Republic of Tatarstan generally aligns with literature data, but thalamic hematomas occur slightly more frequently. More than half of the hematomas in the Republic of Tatarstan have deep localization, indicating that endoscopic methods of hematoma removal should dominate among surgical treatment options. The outcomes of the disease depend on the volume and localization of the intracerebral hematoma. Threshold values for the volume of intracerebral hematoma at various localizations have been calculated, exceeding which a poor or lethal outcome are predicted.

The problem of surgical complications is widely discussed among neurosurgeons. Despite the presence of a large number of studies, there is uncertainty both in terminology and in the classification of complications. Currently, neurosurgery uses various scales of complications, both general and specific. The review presents the main modern classifications of surgical complications, outlines the underlying approaches, as well as their advantages and disadvantages. The issues of systematization of intraoperative complications are considered separately.

INTRODUCTION. The relevance of neonatal neurosurgery is increasing due to the annual increase in the number of previous births. Children with very low and extremely low body weight are often in critical condition, which can be complicated by pathology that requires emergency intervention by cardiac surgeons, surgeons or neurosurgeons. Transportation of such infants from the neonatal intensive care unit to the operating room leads to huge risks of comlication (e.g., hypothermia, interruption of treatment of the underlying disease, accidental extubation, hypo/hyperventilation, accidental removal of the vascular access, inadequate monitoring etc.). To reduce these risks, “bedside” technologies for diagnosing and treating surgical pathology of newborns are being developed. The most complex and poorly studied is currently intracouveuse neurosurgery technologies, which include intracouveuse neuroimaging, intracouveuse invasive neurodiagnostics and intracouveuse operative neurosurgery (puncture and open operations). A key unresolved issue is the study of the neurosurgical risks of performing operations inside the incubator (inadequacy of surgical navigation and/or volume of surgery, as well as the possibility of increased infectious complications). Solving these problems is the basis for assessing the prospects for the development of intracouveuse neurosurgery.

AIM. Analysis of domestic and foreign literature to assess the possibilities and prospects for the use of intracouveuse neurosurgical technologies for neurosurgical pathology in newborns.

MATERIALS AND METHODS. Literature search was carried out using the detabases PubMed, eLibrary.ru using the keywords “bedside surgery”, “bedside neonatal neurosurgery”, “bedside surgery intensive care”, “intracоuveuse neurosurgery”, “intracоuveuse surgery”. A review of 56 messages published between 1977 and 2024 was carried out.

RESULTS. The concept of neonatal bedside surgery is widespread in world practice and has found its application in various fields of surgery. It eliminates many high risks that arise when transporting a newborn from the neonatal intensive care unit to the operating room. Analysis of the data confirms the absence of intra- and postoperative complications during bedside abdominal and cardiac surgical interventions, however, the possibility of safe use of bedside neurosurgical diagnostic and therapeutic manipulations in the world literature is described very few and needs further study.

INTRODUCTION. Surgical treatment of drug-resistant epilepsy does not always allow to completely get rid of epileptic seizures. Relapses of seizures can occur both early and late after surgery.

AIM. To analyze a clinical case of late relapse of epileptic seizures after surgical treatment of drug-resistant epilepsy.

MATERIALS AND METHODS. The results of surgical treatment of a patient with drug-resistant epilepsy, with the development of relapse of epileptic seizures after 2 years and the decision to repeat surgical treatment, thanks to which it was possible to achieve remission of epileptic seizures, were analyzed.

RESULTS. The recurrence of seizures may be caused by incomplete removal of the epileptogenic focus or postoperative changes. In any case, a patient with persistent epileptic seizures is shown a preoperative examination and a decision on the need for reoperation.

CONCLUSION. Surgical treatment of drug-resistant epilepsy is the most effective method for achieving freedom from seizures or significantly reducing their frequency in the long term. Control over seizures in the postoperative period is usually ensured by taking antiepileptic drugs. The question of antiepileptic drugs withdrawal is still open. A personalized approach is used in each specific case.

Epileptic seizures occur in 20–25 % of patients with cerebral arteriovenous malformations (AVMs) and are often resistant to both surgical and conservative treatment methods. This literature review provides an analysis of current data on the epidemiology, diagnosis, and treatment of epileptic syndrome in patients with cerebral arteriovenous malformations. Over 100 literature sources available in the PubMed, eLibrary.ru, Medscape, Cochrane Library, and Medical NDX databases were analyzed as part of the study. To reflect the most up-to-date information, primary focus was placed on data published between 2018 and 2023.

Special attention in the review is given to modern diagnostic approaches, including the use of neuroimaging and electroencephalography, as well as the latest treatment methods such as stereotactic radiosurgery, endovascular interventions, and combined therapeutic strategies. Factors influencing treatment effectiveness, including the location and size of the AVMs, as well as the clinical course of the epileptic syndrome, are discussed. The review highlights the prospects for further research in this field, aimed at improving patients’ quality of life and reducing the frequency of seizure recurrence. The review emphasizes the need for a multidisciplinary approach to managing patients with cerebral AVMs, as well as the importance of individualized treatment tailored to the specifics of each clinical case.

Combat gunshot wounds of the brain differ from injuries usual for neurosurgery in the presence of many traumatic factors: exposure to a blast wave, high temperature, flame, metal effect of an explosion, etc. The structure of a gunshot wound is determined by the type, size and number of wounding projectiles, their kinetic energy, localization and the trajectory of the injury.

As a result, many variants of injury are formed, which in some cases require modification of standard treatment and the application of the concept of “damage” control. This article describes a clinical case of a patient with a penetrating head injury with severe brain damage, complicated by total intraventricular hemorrhage. As one of the components of surgical treatment the removal of an intraventricular hematoma from the fourth ventricle using median trans-atlanto-occipital membrane microsurgical approach to the posterior cranial fossa without craniotomy. According to our data, this is the first case of using this approach in emergency neurosurgical practice, especially for traumatic brain injuries.