ABSTRACT: Minimally invasive methods of treatment of herniated intervertebral discs of the cervical spine using devices of foreign origin inserted percutaneously into the intervertebral space are described. And in the context of the need for import substitution, the relevance of further in-house development of devices for minimally invasive anterior cervical discectomy remains extremely high.

THE PURPOSE OF THE STUDY: to develop a domestic system of tubular retractors for microsurgical minimally invasive or endoscopic microdiscectomy with the development of surgical techniques on a cadaver experiment.

MATERIALS AND METHODS: A cadaverous experiment of anterior minimally invasive access was performed to perform minimally invasive discectomy with complete stabilization of adjacent vertebrae with various implants.

RESULTS: A domestic system of tubular retractors for microsurgical minimally invasive or endoscopic microdiscectomy with the possibility of attachment to the operating table has been developed, a patent of the Russian Federation for invention No. 2790945 of 2022 has been obtained.

CONCLUSION: The developed device — a system of tubular retractors with the possibility of attachment to the operating table, is simple and convenient to use, which is relevant in the context of the need for import substitution. The developed system allows using any implants to stabilize the operated segment of the cervical spine at the discretion of the operating surgeon.

SUMMARY. Currently, there are conflicting data on the results of surgical treatment of patients with obturator neuralgia in chronic pain in the hip joint. The scarce information available in the specialized literature indicates frequent variability of the obturator nerve and its branches.

PURPOSE OF THE STUDY: to study the topographic features of the obturator nerve and its branches in a cadaveric study for the anatomical justification of surgical treatment for its neuralgia.

MATERIALS AND METHODS: 30 lower limbs (15 right and 15 left) from 15 cadavers (10 men, 5 women) were studied. The age of the deceased varied from 45 to 70 years. Racial and ethnic affiliation included 8 cadavers of the Caucasoid race, 7 of the Mongoloid race. The obturator nerve and its branches were isolated by layer-by-layer preparation from the obturator canal to the lower third of the femur along the Ken line.

RESULTS: localization of the bifurcation of the obturator nerve in 80 % of cases occurred inside the obturator canal, in 13.3 % — after exiting the canal, and in 6.7 % — inside the pelvic cavity. The innervation of the capsule of the hip joint was carried out by the articular branch, which in most cases departed from the common trunk of the obturator nerve inside the canal of the same name in 77.3 %, from its anterior branch in 16.7 %, from its posterior branch in 10 %.

CONCLUSION: detailed knowledge of anatomy and reliable information about the variant structure of the obturator nerve and its branches will improve the results of surgical treatment of patients with chronic pain in the hip joint due to obturator nerve neuralgia. Taking into account the found anatomical and topographic features, an additional point of destruction of the articular branch of the obturator nerve is needed, which will cover a wide range of impact on, regardless of its origin.

SUMMARY: Back pain in degenerative-dystrophic diseases of the spine is one of the most common causes of patients seeking medical help. The occurrence of radicular syndrome in various age groups of patients during life varies with a frequency of 12.2 to 43.0 %. Drug therapy is not always effective. The short duration and low effectiveness of the analgesic effect of certain types of blockades makes us think about using their optimal combination to achieve the best analgesic effect.

PURPOSE OF THE STUDY: to propose a new type of blockade and demonstrate its effectiveness in exacerbation of radicular syndrome.

MATERIALS AND METHODS: a new combined injection method for the treatment of vertebrogenic lumboishialgia in degenerative-dystrophic diseases of the spine is proposed. A comparative analysis of the effectiveness of treatment of pharmacoresistant vertebrogenic radicular syndrome using classical paravertebral blockade and combined blockade was carried out. The effectiveness was evaluated based on the dynamics of the pain radicular syndrome, estimated in points according to VAS (visual analog pain scale) — after the blockades, after 3 days, 14 days, 1 month, 3 months. ь и

RESULTS: VAS scores in patients of the 1st (control) group after the blockade were 3.5± 0.8, after 3 days — 5.6± 1.1, after 14 days — 4.8± 1.2, after 30 days — 4.2± 0.7, after 3 months — 4.1± 0.9. In patients of the 2nd (main) group: after the blockade — 0, after 3 days — 1.8 ± 0.2, 14 days — 2.1± 0.9, after 30 days — 1.8 ± 0.5, after 3 months — 1.2± 0.4.

CONCLUSION: the use of combined blockade can significantly reduce the level of residual radicular pain in patients with lumboishialgia (p<0.05).

OBJECTIVE. To evaluate the results of using an optimized method of laser vaporization in the treatment of patients with degenerative-dystrophic lesions of the lumbar intervertebral discs.
MATERIALS AND METHODS. The data of 48 patients with degenerative-dystrophic diseases of the lumbar spine were analyzed. The patients were divided into two groups, where in the first group, patients underwent laser vaporization with intraoperative monitoring of laser radiation power with correction of parameters if necessary, and in the second group, laser vaporization of a herniated disc at standard laser radiation power without simultaneous power control.
RESULTS. Analysis of the results of the applied optimized method showed its advantage against the background of constant monitoring and adjustment of power indicators during the operation, which clinically manifested itself in the form of a persistent regression of pain in the postoperative period (the level of pain at discharge, as well as 3 and 12 months after surgery, significantly lower in patients of the first group) and improve the functional status of patients.
CONCLUSION. The use of an optimized minimally invasive method of laser vaporization improves the results of treatment of patients with degenerative-dystrophic diseases of the intervertebral discs of the lumbar spine.

ABSTRACT. The choice of surgical treatment for patients with severe subarachnoid hemorrhage due to cerebral aneurysm (CA) rupture remains one of the key challenges in vascular neurosurgery. The widespread introduction of endovascular technology into clinical practice allowed to slightly change the paradigm of surgical treatment of ruptured cerebral aneurysms, making it possible to rapidly and practically atraumatically exclude aneurysms regardless of the initial severity in patients. However, the availability of endovascular (EV) interventions and the high cost of the procedure are limiting factors.

STUDY OBJECTIVE: to evaluate the treatment outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) of high severity (IV and V according to WFNS) depending on the method of aneurysm exclusion from the blood flow.

MATERIALS AND METHODS: From 2010 to 2020, a prospective study including two patient groups was performed: Group 1 comprised 100 patients with SAH of aneurysmal etiology who underwent endovascular occlusion of the ruptured aneurysm cavity, and Group 2 included 35 patients who underwent microsurgical clipping. All the patients were evaluated according to the accepted clinical and instrumental scales, and investigations were performed accordg to the standards of medical care.

OUTCOMES AND DISCUSSION: The patients enrolled in both study groups were comparable in terms of baseline severity. Immediate treatment outcomes were better in the endovascular group. Our study demonstrated the applicability of this statement in patients with severe aSAH. However, the effect of aneurysm exclusion procedure on patient survival during treatment has not been established. The risk of intraoperative complications in both endovascular and microsurgical groups is low, and the radicality degree of aneurysm exclusion is significantly higher in the microsurgical clipping group.

CONCLUSIONS: The EV and MC remain complementary treatment modalities for the ruptured cerebral aneurysms. When choosing the treatment method, if both procedures are available, intravascular interventions should be given priority in patients with severe aSAH, especially in the presence of sub- or decompensated somatic pathology (long history of diabetes mellitus and arterial hypertension).

A retrospective analysis of the introduction of transpedicular screws in 93 patients with spinal cord injury (PSMT) in the thoracic and lumbar regions is presented. According to the screw installation technique, 2 groups were formed: for patients of the first group (50 people), the installation of transpedicular screws was carried out by the “free–hand” method, for patients of the second group (43 people), the screws were installed using an original navigation device developed by us. The use of the proposed navigation device allowed not only to reduce the radiation load and the operation time, but also to increase the accuracy of the screws to 94.2 % with a minimum deviation from the planned trajectories in relation to the “free hand” method — 83.5 %.

SUMMARY. Chronic disturbances of consciousness (DoC) are characterized by a complete or partial absence of signs of awareness of oneself and the world around against the background of intact wakefulness. Recent data confirms the relationship of structural and functional characteristics in patients with Do C. Circadian rhythms are of particular interest, since the preserved sleep cycles are associated with prognosis in patients with Do C.

PURPOSE OF THE STUDY: to identify the relationship between changes in PSG and the rhythm of melatonin secretion, as well as structural changes in the brain, showed by MRI of the brain in patients with various forms of consciousness disorders.

MATERIALS AND METHODS. The study included 49 patients; all patients underwent a five-fold assessment on the Coma Recovery Scale — Revised (CRS-R scale). Patients in the vegetative state/areactive wakefulness syndrome (VS/AWS) were assigned to group 1 (19 patients, 70 % men), group 2 included patients in the “minus” state of consciousness (MCS “minus”) (17 patients, 59 % men), and group 3 was composed of patients in the MCS “plus” (13 patients, 46 % men). PSG was recorded for at least 24 hours, the level of melatonin in the blood was determined 6 times a day and 6-sulfatoxymelatonin in daytime and nighttime urine. An MRI of the brain (1.5 T) was performed with the assessment of structural changes in the thalamus, hypothalamus and stem structures.

RESULTS. In patients without structural changes in the hypothalamus, MRI showed distinct increases in the ratio of the total duration of the episodes of the sleep stage (REM, N 1, N 2, N 3) to the total sleep time. Preservation of the hypothalamic structures determined the presence of NREM/REM in patients in VS/AWS and MCS “minus” and closer to physiological sleep in patients in MCS “plus”. Disintegration was found in patients in VS/AWS — with excessive synthesis of melatonin, there was no formation of physiological sleep cycles according to PSG, which could indicate a dissociation of the functioning of the regulatory systems of the body.

CONCLUSION. In patients with a higher level of consciousness (MCS “plus”), melatonin secretion was maintained in a range close to normal, regardless of the etiology of brain damage. Correlations have been found between the severity of brain injury and melatonin levels. The study of the functional relationship of the structures regulating sleep-wake cycle will clarify the mechanisms underlying sleep disorders in patients with Do C.

INTRODUCTION. Meningiomas account for 18–34 % of all intracranial tumors in adults and are the second most common among all intracranial neoplasms. Recurrence and progression account for 25 %, on average, even after radical tumor resection and radiotherapy., that worsens the prognosis and functional outcome of the disease significantly. Clinical manifestations often occur with large tumor sizes, initial symptoms are not taken into account by patients and by doctors during follow-up after surgery.

PURPOSE. To assess the clinical features in patients with recurrence and progression of intracranial meningiomas and to identify the features of clinical manifestations in the progression of meningiomas.

MATERIALS AND METHODS. The study was based on patients (105 cases) with recurrence and progression of intracranial meningiomas with Grade I – III according to histology, who were treated in the Department of Neurosurgery No. 4 of the Russian Neurosurgical Institute named after professor. A. L. Polenov in the period of time from 2014 to 2022. Assessment of clinical neurological symptoms was performed according to standard methods in clinical practice. The results were evaluated using the software system STATISTICA 10.0.

RESULTS. The multifactorial analysis of the clinical manifestations of the disease in recurrent intracranial meningiomas was performed, the main trends in oncogenesis were identified, and the most common clinical symptoms of tumor progression were identified, which must be taken into account by doctors during follow-up after surgery.

SUMMARY. The article describes an algorithm for identifying the type of vestibular dysfunction and its severity in patients with dizziness and imbalance in the stage of subcompensation, based on the assessment of clinical, vestibulometric, stabilographic parameters and the assessment of balance on the Berg scale. The developed algorithm allows differentiating such types of ataxia as cerebellar, vestibular, sensitive and psychogenic. The timely start of medical rehabilitation, depending on the type and severity of vestibular dysfunction, significantly accelerates the process of compensating for impaired functions and improves the quality of life and patients.

OBJECTIVE OF STUDY. To determine the type of vestibular dysfanction and the degree of its severity in patients with vertigo and balance disoders during the period of subcompensation.

MATERIALS AND METHODS. Examined 42 patients with complaints of vertigo and balance disoders, mean age (40±3.5 years), including 12 men and 30 women. Neurological testing, vestibulometry with functional tests, stabilometry, neuroorthopedic testing of pericranial muscles, and acoustic stem potentials were performed. Neuroimaging studies cover magnetic resonance imaging and computed tomography. To evaluate balance function the Berg’s scale used.

RESULTS. Algorithm for assessing the type of vestibular dysfunction developed. Vestibular ataxia detected in 20 out of 42 patients, cerebellar ataxia in 17 out of 42 patients and sensitive ataxia in 5 out of 42 patients, as well as the severity of the identified type of ataxia in patients with dizziness and impaired detection function during the subcompensation period.

CONCLUSION. Determination of the type of vestibular dysfunction and its degree determines the conduct of adequate pathogenetic therapy and the use of medical rehabilitation methods. Rehabilitation of balance function depends on the nosological form of the disease and the assessment of kind of ataxia, the severity of its and speed of compensations mechanisms of disorders functions. A personalized approach in the choice of medical rehabilitation methods, work with phobic disorders, significantly improves the quality of rehabilitation care provided to patients with ataxia of different origin.

ABSTRACT. Malignant melanotic nerve sheath tumor is rare disease which is characterized by aggressive clinical course. In classification of tumors CNS WHO 2021 has been changed its position from benign to malignant nerve tumors, however, there are not guidelines for treatment such patients.

CASE REPORT. We present a rare case of MM NST in a 36-year-old woman with a paravertebral tumor of Th4-Th6 vertebrae, without metastases, mitosis, necrosis, invasive growth, with low proliferative activity, also presence of capsule, cystic component, growth from nerve — these features help distinguish from melanoma.

CONCLUSION. The clinical case of a rare nerve tumor underscores the key importance of morphological research in determining the degree of anaplasia of nerve tumors.

SUMMARY. Neuroblastoma (NB) and ganglioneuroblastoma (GNB) of the central nervous system are rare (1 % of all tumors) and poorly studied malignant embryonic tumors in adult patients. Now, the molecular genetic features of tumors and the prognosis of the disease for adult patients have not been sufficiently studied, and there are no generally accepted standards of therapy.

PURPOSE OF THE STUDY. To identify factors that affect progression-free survival (PFS) and overall survival (OS) of adult patients with NB and GNB based on the study of their clinical and morphological characteristics, treatment parameters, and molecular genetic profile.

MATERIALS AND METHODS. A retro-prospective study was conducted, which included 15 patients with NB and 16 patients with GNB aged 18 years and older. The histological diagnosis was established after immunohistochemical examination of the tumor material (staining for Syn, NSE, GFAP, CD 99, Ki67). Real-Time PCR was used to evaluate mRNA expression of TP, MGMT, ERCC 1, PDGFR-α, VEGF, C-kit, and β-tubulin III genes. Patients were studied clinical and molecular genetic characteristics, treatment approaches and long-term results.

RESULTS. Patients with GNB had both a higher risk of recurrence (HR = 2.67; 95 % CI 1.10–6.47; p = 0.022) and a higher risk of death (HR = 8.88; 95 % CI 1.99–39.50; p = 0.00045), compared with patients with NB. Given the difference in survival between NB and GNB, further statistical analysis was performed separately for each group of patients. Thus, in patients with NB, tumor removal of 50 % or more increased OS compared to biopsy by 37.0 months (p = 0.042). While in patients with GNB, total tumor resection increased both PFS by 10.8 months and OS by 28.3 months, even compared with subtotal resection (p = 0.014 and p = 0.017, respectively). In the group of patients with GNB, chemotherapy (ChT) in the amount of 6 cycles with temozolomide increased the FFS and OS compared with other chemotherapy regimens (p=0.026 and p=0.025, respectively). According to the results of molecular genetic profiling of tumors, the absence of a high level of expression of the VEGF gene in NB attracted attention. In GNB, a high level of expression was found in the PDGFR-α (53.8 %, 7/13), VEGF (53.8 %, 7/13) and β-tubulin III (84.6 %, 11/13) genes. Expression of VEGF above the average level (ΔCt < –1.0) significantly increased the risk of recurrence and death both in the general group of patients and in the GNB group.

CONCLUSION. The morphological type of the tumor significantly influenced the duration of PFS and OS in adult patients. The radical nature of surgical treatment affected survival in both groups, but especially in the group of patients with GNB. In patients with GNB, chemotherapy in the amount of 6 cycles with temozolomide increased the PFS and OS. The key molecular genetic prognostic marker in adult patients with GNB is the VEGF gene.

SUMMARY. Minimally invasive cytoreductive operations are relevant for surgery of cerebral malignant gliomas. Stereotactic laser hyperthermia is the most common cytoreductive operation for intracerebral tumors.

THE PURPOSE OF THE STUDY: to evaluate the efficacy and safety of the developed original method of minimally invasive laser hyperthermia for the treatment of local recurrence of glioblastomas.

MATERIALS AND METHODS: 16 patients with recurrent glioblastomas were operated on using minimally invasive laser hyperthermia (MILH). Aiming at the tumor was carried out using the neuronavigation station Medtronic 7. The average age was 48 years. Localization of tumors is supratentorial. Relapses with multifocal growth were 75 %. The average tumor volume is 4.0 cm3. Score on the Karnofsky scale (KPS) at admission 78.1 b. Operations were performed in the neurosurgical department of the St. Petersburg State Medical University. acad. I. P. Pavlova. Survival has been tracked.

RESULTS. Duration of MILH operation 143 min. Total hyperthermia was performed in 56.3 %, in all the rest — subtotally 43.7 %. KPS after surgery in the MILH group was 78.8 bp. Survival in the MILH group after laser surgery was 10 months, overall survival was 26 months. Postoperative mortality 0 %. Most patients were discharged within 5 days after surgery.

CONCLUSION. MILH is a low-traumatic, effective and safe cytoreductive operation that allowed to reduce the volume of a recurrent tumor and achieve a postoperative survival of 10 months. Stable KPS status and easy tolerability of surgery by patients, short postoperative bed-day allow to quickly continue antitumor treatment. MILH is considered for patients with recurrent GBM, especially those with deep localization, in whom open reoperation is associated with high risks. The relevance of MILH increases in recurrent GBM with a molecular genetic profile suggesting resistance to standard anticancer treatment, as well as in the presence of residual tumor.

SUMMARY. Recurrent and initially inoperable small gliomas can be effectively coagulated by minimally invasive laser hyperthermia. The article presents the results of temperature calculations and morphological effects of laser hyperthermia on rat glioma, which are the basis of the method of minimally invasive laser hyperthermia (MILH).

MATERIAL AND METHODS. To predict the spread of heat in gliomas during laser hyperthermia, computer simulation of the process was carried out. Real-time thermometry of glioma hyperthermia was carried out in the experiment. Morphological studies of the area of laser hyperthermia were made on the 7th day after irradiation.

RESULTS. Mathematical modeling predicted the temperature at the fiber tip in diffuse glioma (DG) to reach 194 °C (blue line) and in glioblastoma (GB) to 108 °C (orange line) by the end of irradiation. The estimated size of coagulative necrosis reaches 10.9 mm in HD and 8.7 mm in DG. A study on rat subcutaneous glioma showed that after 30 seconds at 3 mm from the tip of the fiber, the temperature reaches coagulation, at a maximum of 67.4 °C by 60 seconds. Morphologically, the zone of hyperthermia on the 7th day is represented by necrosis, with clear boundaries between the zone of necrosis and the surrounding tissue.

CONCLUSION. Laser hyperthermia with a continuous radiation power not exceeding 2 W, an exposure of 60 seconds, makes it possible to achieve irreversible changes in the tissue. Coagulative necrosis occurs within acceptable temperatures for coagulation.

SUMMARY: differential diagnosis of ACTH-dependent hypercorticism has certain difficulties, due to the lack of high diagnostic accuracy of noninvasive research methods. Performing catheterization of the inferior petrosal sinuses makes it possible to solve this problem, however, there is practically no information in the literature about personalized patient management tactics depending on the result obtained, especially when using several gradients.

PURPOSE OF THE STUDY: search for a new model of differential diagnosis of Cushing’s disease and ectopic ACTH dependent syndrome.

MATERIALS AND METHODS: cohort single-center retro/prospective study of 70 patients with confirmed ACTHdependent Cushing’s syndrome. A number of indicators were calculated for differential diagnosis (central-peripheral ratio, prolactin-normalized ACTH ratio). Based on the data obtained, we have developed a score scale for assessing the probability of corticotropinoma and an algorithm for differential diagnosis of Cushing’s disease and ectopic ACTHdependent syndrome.

RESULTS: The presented new algorithm for differential diagnosis of Cushing’s disease and ectopic ACTH-dependent syndrome based on bilateral simultaneous catheterization of the cavernous and inferior petrosal sinuses allows timely topical diagnosis with a low risk of diagnostic error, which in turn makes it possible to immediately perform endoscopic adenomectomy, thereby preventing the progression of hypercorticism.

CONCLUSIONS: the developed scoring scale and algorithm allow the clinician to perform not only differential diagnosis of Cushing’s disease and ectopic ACTH–dependent syndrome, but also to determine the further treatment tactics of a particular patient.

ABSTRACT. Patients with malignant tumors are prone to a variety of neurological complications that require urgent evaluation and treatment.

PURPOSE. To analyze the results of urgent neurosurgical interventions in the postoperative period in patients with malignant neurooncological pathology.

MATERIALS AND METHODS. In total, the results of 63 patients who underwent emergency neurosurgical operations for complications of malignant oncological diseases from 2016 to 2022 at the St. Petersburg State Budgetary Institution of Healthcare “Mariinsky City Hospital” were analyzed. The analysis included information on age, gender, primary location of the tumor, level of consciousness before surgery, histopathological diagnosis and the presence of metastases, the leading complication facilitating urgent intervention, and the volume of surgical intervention performed.

RESULTS. In the postoperative period, most patients showed partial regression of neurological deficit in 22 (34.9 %) patients or no dynamics in 18 (28.6 %) patients, an increase in neurological deficit in 8 (12.7 %) patients, complete regression of neurological deficit in 2 (3.2 %). 13 patients (20.6 %) had a lethal outcome during the same hospitalization.

CONCLUSION. A timely and well-thought-out surgical intervention, taking into account the general somatic status of the patient, the nature of the oncological disease, can preserve neurological functions, prolong survival and improve the quality of life.

The selection of effective antiepileptic therapy is an important task for any neurologist. Despite many studies in the field of epileptology, about 30 % of all patients do not achieve stable pharmacological remission. A promising direction in the treatment of epilepsy is the use of drugs from the group of antioxidants. One of the new drugs of this type, which have shown their effectiveness, is Dibufelon, a drug of phenosanic acid. This literature review highlights the main etiological, pathogenetic and pharmacological aspects of the use of a new drug.

SUMMARY. Epileptic seizures are a serious cause of impaired quality of life in patients with intracerebral tumors. Most often, the disease manifests precisely with an epileptic seizure. More than 50 % of patients experience at least one seizure during their illness, and more than 30 % develop tumor-related epilepsy. Low-grade intracerebral tumors are more likely to cause epileptic seizures than high-grade intracerebral tumors, although the reasons for this are still unclear.

PURPOSE OF THE STUDY: to analyze the incidence of symptomatic epilepsy in patients with neuroepithelial tumors, to study the factors influencing the development of epilepsy, to evaluate the effect of intraoperative neurophysiological monitoring on the volume and tactics of surgical treatment, to study the dynamics of epileptic seizures in the postoperative period.

MATERIALS AND METHODS. Cases of 336 patients with primary neuroepithelial brain tumors of supratentorial localization for 2017–2022, operated at the N.N. prof. A. L. Polenov were analyzed. Criteria were assessed such as the degree of malignancy of the tumor (tumors of low grade (LG) Grade 1, 2 and high grade (HG) Grade 3, 4), type of seizures (generalized, partial), localization and extent of surgical resection of the tumor, intraoperative detection epileptogenic foci by electrocorticography (ECoG) and type of foci resection, control of seizures in the early postoperative period. Follow-up was studied in 69 patients in terms of 13 to 25 months. The results of epilepsy treatment were assessed using the Engel scale.

RESULTS. Symptomatic epilepsy was detected in 170 (50.6 %) of 336 examined patients with neuroepithelial tumors. In the group of patients with LG tumor, epilepsy was more common (63 %). Intraoperative corticography was performed in 113 (67 %) of patients with epilepsy. The absence of seizures (Engel class I) was observed in the group of LG tumor in 38 %, HG tumor in 3 % of cases, improvement (Engel II, III) LG tumor — 38 %, HG tumor — 17 %, without improvement (Engel IV) HG tumor 3 %.

CONCLUSION. Neuroepithelial tumors are highly epileptogenic (47 %). The development of epileptic seizures in this group of patients associated with the spread of the tumor to functionally significant areas. The absence of seizures was more often observed in patients with low grade tumors and more radical resection of the tumor.

SUMMARY. An urgent neurosurgical problem is the identification of recurrent brain glioma and radiation necrosis, due to the absence of pathognomonic signs for these pathological processes at an early stage after CRT (up to 6 months). To solve this problem, methods of computer processing of MR images are used, the differentiation of RN and GBT in which is based on the difference in the signs of radiomics, but these methods do not show high accuracy.

PURPOSE OF THE STUDY: development and practical testing of a technique for differential diagnosis of radiation necrosis and recurrent glial tumor on MRI images based on the analysis and selection of a new combination of radiomics signs.

MATERIALS AND METHODS: development of a package of algorithmic, structural and mathematical models of the proposed solution. Practical implementation and testing of the technique in the framework of MR diagnostics of 108 patients with Grade III, IV glial tumors during dynamic follow-up — 1,3,6,9,12 months after surgery and a course of CRT.

RESULTS. As a result of the study, a combination of signs of radiomics underlying the proposed technique was selected; a practical approbation of the technique was performed, according to the results of which a high accuracy of differentiation of relapse and radiation necrosis on MRI images was established (98.1 %).

CONCLUSION. The results of the approbation of the presented technique allow us to assert that it is highly effective in diagnosis, which makes it possible to differentiate the recurrence of GBT and RN at an early stage.

SUMMARY: In the last decade, there has been a paradigm shift in the treatment of patients with intracranial aneurysms: in neurosurgical practice, the endovascular technique of cerebral aneurysm embolization is becoming increasingly common.

PURPOSE OF THE STUDY: to analyze the factors affecting postoperative mortality in two regional centers with different priority methods of surgical treatment of aneurysms (endovascular and microsurgical) in the first 14 days after the rupture of cerebral aneurysms.

METHODS: The results of treatment of 902 patients from 01/01/2013 to 12/31/2018 were analyzed: 443 patients after microsurgical treatment (group I) and 459 patients after endovascular surgery (group II). Postoperative mortality was analyzed in the first month after surgery.

RESULTS: In patients operated on in a compensated state (I and II degrees according to the Hunt Hess scale), the results of treatment in both groups were comparable (mortality 18 % in the first group and 17 % in the second group). In patients operated on with the severity of condition III–IV on the H-H scale, mortality was lower in the endovascular group (24 %) compared to the “microsurgical” group (31 %). In patients operated on in a serious condition of grade V according to H-H, in the “microsurgical” group, mortality was almost 2 times lower than in the “endovascular” group (44 % and 79 %, respectively).

CONCLUSION: the data obtained suggest further introduction of endovascular methods of aneurysm treatment into the practice of RCC, further development of microsurgical skills in surgeons and development of methods for the prevention and treatment of vascular spasm and cerebral ischemia.

Despite the increasing number of endovascular interventions for aneurysms of the basilar artery every year, a certain frequency of adverse outcomes remains. The possibilities of cerebral aneurysms surgery have expanded due to endoscopic assistance, which making it possible to minimize the size of approaches without changing the width of microsurgical corridors.

We present a case of successful clipping basilar artery trunk aneurysm via keyhole retrosigmoid approach supplemented with endoscopic assistance.

This clinical case demonstrates the possibility of successful clipping of a basilar artery trunk aneurysm without resorting to a wide approach, but with optimal visualization of the neck and dome before and after clipping. Keyhole approaches combined with endoscopic assistance can be an alternative to both traditional approaches and endovascular coiling.

The article presents a case of giant clival meningioma treatment. Giving the presence of hydrocephalus, manifested by the Hakim-Adams triad and inoperable size of the tumor, the patient underwent VPS implantation. Followup has shown slow progression of the tumor and syringomyelia formation.

Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system associated with demyelination. It has been proven that neurodegeneration processes play a key role in the disability of patients. Instrumental possibilities for detecting neurodegeneration in MS include magnetic resonance imaging (MRI), optical coherence tomography of the retina and evoked potentials. The signs of neurodegeneration on MRI include the detection of hypointensive T1 and hyperintensive T2 lesions, T1/T2 ratio, the appearance of metal deposition as “iron rims” (IRl), an increase in the size of the lateral ventricles and a decrease in cerebral parenchyma with MR morphometry. The central vein symptom (CVS) and leptomeningeal contrast enhancement are studied as differential diagnostic signs. With positron emission tomography (PET) it is possible to identify foci of microglia activation as a future localization of neurodegeneration. Early detection of markers of neurodegeneration permits to predict the severity of the course of MS, monitor the effectiveness of treatments, the transition of the remitting form of MS to the progressive form and promptly change the MS modifying therapies.