The article discusses the ethical and legal framework for working with personal data in relation to the medical field. Based on the analysis of the legal and ethical standards for the provision of medical care in the Republic of Belarus, it is stated that the problems in terms of working with personal data of patients, ensuring technical protection and digital hygiene at the legislative, moral, ethical and technological levels have not been resolved. It is concluded that it is necessary to develop a special regulation for working with personal data in medicine.

Craniosynostosis is a disease characterized by premature fusion of the cranial sutures, which leads to the development of a specific deformation of the skull. this deformation is associated with both local compression of various parts of the brain and the forming of intracranial hypertension syndrome. Both of these phenomena are a manifestation of craniocerebral disproportion, the progression of which can lead to craniostenosis.

OBJECTIVE: to analyze data from long-term monitoring of ICP in patients with craniosynostosis.

MATERIALS AND METHODS: monitoring of intracranial pressure was carried out in 9 patients with various non-syndromic forms of craniosynostosis. this analysis was made of the average values of ICP, ICP change curves and parameters of pulse fluctuations.

RESULTS: according to the monitoring data, the presence of a decompensated form of intracranial hypertension was noted in 7 out of 9 patients. there were characteristic changes in ICP curves, indicating decompensation of intracranial hypertension. In 2 patients with severe skull deformation, there were no signs of intracranial hypertension.

CONCLUSIONS: the progression of craniocerebral disproportion in craniosynostosis can lead to the decrease in intracranial compliance and the development of intracranial hypertension syndrome. the gold standard in assessing intracranial pressure and intracranial compliance is long-term invasive monitoring of intracranial pressure.

The purpose of this study shows how the choice of anesthesia affects the quality of the perioperative period after performing orthopaedic surgery on the distal segment of the lower limbs. The study included 60 patients in three groups depending on the type of anesthesia performed. Patients in the first group received general anesthesia via mechanical ventilation. The patients of the second group received spinal anesthesia with intravenous sedation. Patients of the third group received combined anesthesia based on a combination of peripheral nerve blockade and sedation with an inhalation anesthetic on a ventilator. The results showed that combined anesthesia based on nerve blockade and sedation with an inhalation anesthetic: reduces the severity of pain in the postoperative period, reduces the risk of developing postoperative nausea and vomiting syndrome, and contributes to earlier verticalization of patients.

Surgical treatment of ruptured tiny aneurysms (TA) is a significant problem of vascular neurosurgery due to the large number of technical difficulties, complications and high mortality.

THE PURPOSE OF THE STUDY: to substantiate the efficacy and safety of endovascular occlusion of ruptured MA in comparison with cerebral aneurysms (CA) of normal size.

MATERIALS AND METHODS: a retrospective analysis of the treatment of 639 patients with aneurysmal subarachnoid hemorrhage (SAH) due to CA rupture of proximal localization less than 3 mm (the first group) and aneurysms from 3 to 15 mm (the second group) was performed. The first group included 44 patients, and the second group, respectively, 491 patients. All patients underwent clinical, laboratory and instrumental examinations according to the current clinical guidelines. In all patients, endovascular occlusion with detachable coils was chosen as a method of surgical treatment. Assessment of the results of treatment was carried out at the time of discharge from the hospital and after 12 months.

RESULTS AND DISCUSSION: middle and severe severity of the condition was prevailed in the patients included in the study. Statistical analysis didn’t performed significant correlation between in the initial severity of the condition, the type of hemorrhage, the severity of cerebral angiospasm in the severity of the condition at admission, outcomes of treatment of patients with aneurysmal SAH with the size of the CA (in the nearest and delay periods). The survival analysis also didn’t determine statistically significant differences depending on the size of CA. However, the frequency of intraoperative complications and adverse outcomes in the near term in patients with TA was significantly higher. The survival analysis also did not determine statistically significant differences depending on the size of the CA.

CONCLUSIONS: endovascular occlusion of TA is an effective and safe method of surgical treatment, and the problem of ruptured TA remains an urgent and ambiguous issue of vascular neurosurgery. The frequency of TA rupture is probably somewhat underestimated, and a number of technical difficulties in surgical treatment once again prove the need for in depth research on this issue.

The current level of development of neurooncology, as well as achievements in anesthesiology, have significantly improved the results of operations with hypervascular tumors of the brain, however, surgical treatment of intracranial meningiomas remains one of the most actual issues of neurosurgery to this day.

PURPOSE OF THE STUDY: was to assess the effect of embolization of the vascular network of the tumor on the results of surgical treatment of intracranial meningiomas.

MATERIALS AND METHODS: a retrospective follow-up was carried out on 54 patients with hypervascular intracranial meningiomas who underwent hospital treatment in the neurosurgical department of the Stavropol regional clinical hospital from 2019 to 2021. The first group included 30 patients who underwent preoperative embolization of the tumor vascular network. The second group consisted of 24 patients who underwent microsurgical removal without preoperative embolization.

RESULTS AND DISCUSSION: the analysis of the results of treatment of patients with and without the use of preoperative embolization of the tumor network revealed the following key patterns: in the group of patients with PE, the average volume of blood loss was 322.41 ± 122.90 ml, in contrast to the second group, where this indicator reached 545.83 ± 147.38 ml (Student’s t–criterion, p < 0.001). Statistically significant differences were found when evaluating the results of treatment of patients according to the Glasgow Outcome Scale (GOS): in patients who underwent preoperative embolization, the median GOS score was higher than in patients of the second group (the median in the first group was 5 points, and in the second — 4 points, respectively (Mann-Whitney U-test, p < 0.001)).

CONCLUSIONS: preoperative embolization of the vascular network is an effective addition to classical microsurgical resection, which significantly improves treatment results by significantly reducing intraoperative blood loss, reducing the frequency of blood transfusions, and thereby improves treatment outcomes in patients with hypervascular meningiomas.

Glia plays a significant role in epileptogenesis. As a known, glial reactions occur in the epileptogenic focus. In this study we analyzed the glial proliferation in the cortex of two hemispheres of the brain of rodents.

PURPOSE OF THE STUDY: to analyze the glial reaction in the cerebral cortex of rats which occurs by electrical stimulation of epileptic seizures.

MATERIALS AND METHODS: 82 Wistar rats were included in experimental study. The first group (n=10) — intact control; the second group (n=20) — animals with intracerebral electrode implantation, without stimulation; the third group (n=20) — animals with partial epileptic seizures; the fourth group (n=20) — animals with generalized epileptic seizures. An immunohistochemical study was performed with markers of glial cell.

RESULTS. The proliferative activity of astrocytes and microglial cells in the both cerebral cortex of rodents after stimulation of partial and generalized seizures and also oligodendrocytes of the right cortex of the brain of rodents after stimulation of generalized seizures were detected.

CONCLUSION. Electrical stimulation of partial and generalized seizures is accompanied by reactive proliferation of astrocytes and microglial cells in the cortex of the right and left hemispheres of the brain of experimental animals and oligodendrocytes in the cortex of the right hemisphere of the brain of rodents during electrical stimulation of generalized seizures.

OBJECTIVE. Evaluation of the effectiveness and safety of the “skip corpectomy” method in the surgical treatment of cervical spondylotic myelopathy.

MATERIALS AND METHODS. The study included 7 patients with cervical myelopathy due to extended stenosis of the cervical spine, operated using the “skip corpectomy” method. The clinical examination included an assessment of the degree of neurological disorders according to the modified scale of the Japanese Orthopedic Association (JOA), followed by the calculation of the degree of recovery (recovery rate) and Nurick, pain syndrome — according to the visual analogue scale (VAS). Verification of the diagnosis was based on the data of spondylography, magnetic resonance and computed tomography. The indication for surgical treatment was the presence of conduction disorders, the spondylotic genesis of which was confirmed by neuroimaging methods.

RESULTS. In the late postoperative period, a decrease in the intensity of pain according to VAS was achieved by 2–4 points (average — 3.1). When assessing the degree of myelopathy in the postoperative period according to the JOA, Nurick scale and calculating the recovery index (the average recovery rate is 42.5 %), all patients showed significant changes in the neurological status for the better. In all cases, the follow-up examination confirmed the usefulness of decompression and completed spinal fusion.

CONCLUSION. The “skip corpectomy” method makes it possible to perform a complete decompression of the spinal cord in case of extended stenosis of the cervical spine and minimize the risk of complications typical for multilevel corporectomy. The recovery rate indicates the effectiveness of the method in the surgical treatment of cervical myelopathy caused by multilevel stenosis. However, for a reliable assessment of the method, further studies on sufficient clinical material are needed.

The analysis of the results of the implantation of a shunt system between the lateral ventricle and the transverse sinus in hydrocephalus in children, the treatment of which the use of other CSF-shunting operations proved ineffective or impractical.

MATERIALS AND METHODS. 54 patients aged from 4 months to 17 years, with decompensated hydrocephalus was performed anastomosis between the lateral ventricle and the transverse sinus, through the implantation of the valve low-pressure system or a programmable system with low values of the valve settings. The result of operations is determined by evaluating the dynamics of quantitative clinical and manifestations of hydrocephaly and hypertensive syndrome.

RESULTS. In all cases, it was a severe ventriculomegaly and hypertensive syndrome. In all cases, the use of ventriculoatriostomy and ventriculoperitoneostomy proved ineffective or impractical. As a result of the treatment, stabilization of the patients, and the manifestations of decompensated hydrocephalus regression was achieved in 90,7 % children.

CONCLUSION. Ventriculosinus transversal shunt may be the method of choice for the treatment of decompensated hydrocephalus in cases where the application of classical operations is not advisable. We consider it appropriate intraoperative assessment of venous pressure in the sinus, as well as the correlation with intraventricular pressure.

Considering the importance of genome methylation profile assessment in distinguishing molecular classes within different types of cancer, microarray-based DNA methylation analysis has become routine in modern pathomorphological diagnosis of CNS tumors.

The most recent version (5th edition) of the WHO classification of CNS tumors includes current consensus about DNA methylation-based molecular groups. It is advised that morphological diagnosis should take methylation studies into

account since this information is important for risk stratification, prognosis, treatment strategy, as well as for enrollment in clinical trials.

Novel computational tools — machine learning-based online tumor classifiers — were designed to facilitate easier interpretation of DNA methylation data and increase diagnostic precision. While being a valuable resource in many cases, the existing online classifiers still have limitations and are not always conclusive about tumor methylation classes due to individual sample features or lack of similar samples in the reference cohort. Addressing these limitations is possible by introducing additional graphical methods of methylation data analysis, which would confirm the correspondence between methylation profiles in tumor subgroups and support evidence for a particular diagnosis.

In this work, we demonstrate an interactive tool we developed to visualize the results of DNA methylation analysis, compare histological findings with molecular classes and check the similarities between various tumor types for 470 CNS tumor samples available in our database. This tool provides a beneficial option for a morphologist to achieve a better quality diagnosis in controversial cases where other methods are insufficient or misleading.

Indicators of the coxo-vertebral complex determine the orientation of the pelvis in the sagittal plane, and their correct ratio is the factor that reflects the spatial position of the pelvis and spinal column during the verticalization of the body. We have evaluated changes in these parameters of the spinal-pelvic balance in patients with spondylolisthesis of various degrees of displacement.

PURPOSE OF THE STUDY. Analysis of clinical and radiological results of surgical treatment of patients with spondylolytic spondylolisthesis of the L5 vertebra and spino-pelvic imbalance.

MATERIALS AND METHODS. The study analyzed the results of surgical treatment of 320 patients (146 men with an average age of 52.4 years, 174 women with an average age of 55.8 years) with spondylolytic spondylolisthesis of the L5 vertebra, who undergone operation in the period 2016–2020., using the method of repositioning-stabilizing spondylosynthesis with implantation of transpedicular screws and the formation of interbody fusion by implantation of a cage filled with autologous bone. Difficulties with the complete removal of the L5 vertebra were solved using angular osteotomy of the S 1 vertebra. The patients were divided into groups depending on the classification of J.M. Mac-Thiong, H. Labelle and Meyerding H.W. The pain syndrome was assessed according to the VAS, by the degree of dysfunction according to the Oswestry questionnaire in the presurgery and postsurgery examinations, the result of surgical treatment were assessed according to the MacNab subjective scale in the postsurgery examination. Measurement of the parameters of the spinal pelvic balance was performed using standard tools in the RadiAnt DICOM Viewer and WEASIS.

RESULTS. After surgical treatment, there is a decrease in sacral slope (SS), correction of global lumbar lordosis (GLL), and a decrease in the indices of pelvic tilt (PT) with reduction of the L5 vertebra. Changes in pelvic incidence (PI) after elimination of spondylolisthesis by reduction of the L5 vertebra is associated with sacral osteotomy and a change in the inclination of the upper endplate. Striving for a complete reduction of the displaced vertebra and bringing the coxovertebral indicators to normal, made it possible to achieve a significant reduction in pain in the lower back and lower extremities and improve the quality of life.

CONCLUSION. Surgical treatment of patients with spondylolytic spondylolisthesis of the L5 vertebra brings the coxo-vertebral parameters closer to normal, thereby making it possible to correct the sagittal balance and reduce the “mechanical conflict” between the spine and the pelvis.

One of the most significant problems in medical rehabilitation is therapy of posttraumatic musculoskeletal diseases and recurrent injury prevention. Recurrent musculoskeletal injuries can be caused by an underlying connective tissue failure, significantly aggravating the pain syndrome in the post-traumatic period and requiring special treatment.

AIM: to identify age-related markers of the aggravated pain syndrome in persons with post-traumatic musculoskeletal disease, resulting from recurrent injuries.

MATERIALS AND METHODS: A comprehensive clinico-instrumental examination of 117 subjects aged 22 to 47 with posttraumatic musculoskeletal disease, resulting from recurrent injuries, in which the leading clinical manifestation was pain syndrome, was carried out at Sechenov University and the Medical Academy of Osteopathic Education. A specially designed questionnaire including 66 characteristic morphometric signs of connective tissue dysmorphogenesis was used to screen connective tissue condition.

RESULTS. It was shown that at the age of 22–35, a special approach to the pain treatment in the post-traumatic period is required to persons with an asthenic physique, excessive joint mobility, thin skin, soft auricles and keloid scars. With age, such signs as spine kyphosis, feet valgus deformity, skin hyperpigmentation over the spine, atrophic striae, varicose veins, abdominal muscle diastasis and recurrent hernias acquire greater diagnostic value. Universal indicators that are relevant at any age include moderate or severe myopia, spine scoliosis, X- and O-shaped feet, gothic palate, and temporomandibular joint crunching on movement.

CONCLUSION. The identification of the established age-related and universal indicators of connective tissue failure dictates the need for of timely correction of rehabilitation treatment and inclusion of the measures aimed at strengthening the connective tissue, which will which will help prevent injury recurrence and pain syndrome chronicity.

New medicines for the treatment of epilepsy appear rather rarely, one of the reasons is the lack of reproducible experimental models of different types of seizures. The designs of experimental models for specific seizures are needed.

PURPOSE OF THE STUDY: to modify the experimental model of electrical stimulation of partial and generalized seizures.

MATERIALS AND METHODS: Wistar rats (n=40) were included in this experimental study. The rodents of the first (n=20) group after intracranial electrode implantation and were electrically stimulated for partial seizures; rats of the second group (n=20) were electrically stimulated for generalized seizures. The development of seizures was assessed using the five-point Racine scale.

RESULTS. Modification and adaptation of the experimental model of electrical stimulation of partial and generalized impulse-dependent seizures were made: by controlling the range of impulse amplitude in the experiment, it is possible to induce seizures of various types in rodents.

CONCLUSION. An inexpensive modern, well-reproducible, impulse-dependent model of the formation of simple partial motor seizures and generalized seizures in rats has been modified and tested.

Currently, there is no common understanding of the management tactics of multiple malignant cerebral glioma patients. Despite the fact that this pathology accounts for 2 % to 5 % of all glial brain tumors, the domestic literature does not provide clinical recommendations for the complex treatment of this group of patients.

MATERIALS AND METHODS. Clinical cases were selected for the study in 70 patients with multiple cerebral malignant gliomas on the basis of RNSI named after prof. A.L. Polenov. An assessment was made of the radicality of surgical treatment, the effectiveness of adjuvant therapy, and the quality of life after completion of a comprehensive Bartel treatment. The histological examination was performed in all cases for each tumour node separately. The final morphological diagnosis was made after an immunohistochemical study using antibodies: IDH1(R 132H) (H09, Dianova).

CONCLUSION. It was found that the most radical and rapid removal of tumor lesions, given the general brain symptom as leading in the severity of patients, contributes to the most favorable outcome.

INTRODUCTION: Based on the CT examination of the thoracic and lumbar spine, morphometry and mathematical calculations of the spinal segment of three adjacent vertebrae and intervertebral discs were performed in 25 patients of different sex and age to simulate the recovery of the damaged vertebral body and adjacent discs. Measurements were made using computer software in the RadiAnt viewer on the mid-sagittal section.

MATERIALS AND METHODS: The results of spiral computed tomography (SCT) of 25 patients (12 women and 13 men aged 18 to 60 years) who were treated in the neurosurgical department were taken for the study.

RESULTS: According to the results of statistical processing with a 95 % confidence interval, the following calculation error was obtained: when modeling the anterior and posterior dimensions of the damaged vertebral body — 0.7±0.2 mm; anterior and posterior dimensions of the damaged disc — 0.8±0.2 mm and 0.65±0.2 mm, respectively; anterior and posterior dimensions of the vertebral body and upper disc — 1.1±0.4 mm and 1.2±0.5 mm; anterior and posterior dimensions of the vertebral body with adjacent discs — 1.4 ± 0.4 mm and 1.3 ± 0.5 mm. When modeling the angle α: with violation of the anterior and posterior dimensions of the vertebral body and upper disc, the error in the calculations is 2.7±0.8 degrees; with violation of the anterior and posterior dimensions of the vertebral body and adjacent discs — 2.5±0.6 degrees.

DISCUSSION OF THE RESULTS: The obtained calculations can be used when planning a surgical intervention to restore the damaged spinal motion segment in the thoracic and lumbar regions and modeling to the original undamaged state.

The presented work describes the experience of treating a patient with hypertrophic basal pachymeningitis, spread to the structures of the orbit, in combination with Tolosa-Hunt syndrome. The analysis of the tactics of surgical treatment for this disease in the world literature is given. Hypertrophic basal pachymeningitis is a chronic inflammatory disease that causes diffuse fibrosis and enlargement of the dura mater. In extremely rare cases, according to the clinical picture, this disease can be combined with Tolosa-Hunt syndrome due to compression of structures passing through the upper orbital fissure, which makes it difficult to make a basic diagnosis. The patient underwent surgical intervention with decompression of soft tissue structures of the orbit, optic nerve and taking a biopsy to determine the histological structure of the formation, a regression of neurological deficit was noted in the postoperative period. The combination of Tolosa-Hunt syndrome and hypertrophic basal pachymeningitis is very rare, an increase in the number of described cases will allow creating algorithms for the diagnosis and treatment of this disease.

In the surgical treatment of fossa posterior neoplasms, especially when they are localized in the brainstem and in the fourth ventricle, the use of intraoperative neurophysiologic monitoring is an obligatory tool for such operations. Corticobulbar motor evoked potentials allow to assess the functional state of the caudal group of cranial nerves in real-time. This article discusses the possibilities of this method in neurosurgery and shows a clinical observation with the use of corticobulbar motor evoked potentials during surgery.

The analysis of literature data on the factors of prognosis of the course and effectiveness of treatment of the most common malignant brain tumors in children — medulloblastoma, glioma of high malignancy, ependyma.

It is noted that the new data obtained in recent years on the molecular pathogenesis of the main groups of malignant brain tumors have served as the basis for the development of risk stratification systems, the search for prognostic factors and the improvement of methods of treatment of cerebral tumors in children. Examples of scales are presented that allow identifying candidates for surgical intervention in patients with recurrent cerebral tumors with an assessment of further prognosis and the possibility of developing personalized tactics for postoperative treatment.

It is indicated that the integration of clinical and biological data to provide a differentiated approach to the treatment of pediatric cerebral tumors, adapted to risk levels, can potentially change the intensity of traditional therapy and make it possible to introduce new methods of treatment of these tumors into clinical practice.

OBJECTIVE: to present an analysis of the literature data on the prognostic factors of the course and effectiveness of treatment of the most common malignant brain tumors in children — medulloblastoma, glioma of high malignancy, ependym.

In order to obtain complete and up-to-date information, search queries were performed in various relevant databases: MEDLINE, Cochrane Controlled Trials Register, International Pharmaceutical Abstracts, Pub Med Central, Cyberleninka.

The article presents current data on the role of neurotransmitter systems in the regulation of the sleep-wake cycle. The basic principles of the functioning of the systems of awakening, NREM and REM sleep are considered, the leading mediators of sleep and wakefulness (melatonin, orexins, GABA, glutamate, norepinephrine, histamine, dopamine, serotonin, acetylcholine) are characterized. Given the high relevance of prevention of stroke complications and the proven relationship between acute cerebrovascular accident and hypersomnolence spectrum disorders, the results of the analysis of modern studies on the problem of hypersomnolence biomarkers are presented. The role of some mediators involved in the regulation of the processes of sleep and wakefulness remains not fully understood, which allows us to consider them as potential biomarkers of hypersomnolence. Possible contenders are orexin-A, glutamate and GABA, also acetylcholine. This article provides a review of the currently available literature on laboratory markers of hypersomnolence and the possibilities of their assessment in patients with acute ischemic stroke.