An experimental model of an interbody implant for stabilizing cervical vertebrae after removal of a herniated intervertebral disc based on ct-metric data (a brief review of the literature and own research) with its approbation in a cadaver experiment

I. V. balyazin-Parfenov1, I. V. basankin2, V. A. balyazin1, E. V. balyazina1,

R. Sh. Abu Awimer1, A. b. bagaudinov2, A. A. Gulzatyan2, G. R. Tulendinov3,

G. P. zolotykh1, L. A. zibrova1, A. V. Skoropis1

ABSTRACT: Osteochondrosis of the cervical spine is 49.2 %, being the cause of pain syndrome in 60 % of cases, in 23 % of cases of sensitive disorders, in 18 % of motor disorders, as manifestations of cervical myelopathy. Anterior microdiscectomy with anterior access combined with stabilization is the gold standard of treatment. The origin of interbody implants remains foreign, the relevance of import substitution is extremely high.
THE PURPOSE OF THE STUDY: To develop an implant model based on CT-metric data for single-level interbody stabilization of the vertebrae of the cervical spine after removal of a herniated intervertebral disc.
MATERIALS AND METHODS: the analysis of metric indicators (length of height and interbody gaps at levels C 2/3, C 3/4, C 4/5, C 6/7, C 7/Th1) was carried out according to the CT of the cervical spine in 47 men and 122 women aged 18 to 75 years for the development of an implant for a single-level interbody stabilization of the vertebral neck, the implant holder for its its installations. A cadaver experiment was conducted to install an implant with fluoroscopic control.
RESULTS. An interbody implant has been developed, an implant holder for its installation, 2 universal samples of the implant model in length have been proposed, and the height for the patient is selected depending on the height of the interbody gap. The prototype of the implant was tested in a cadaver experiment. Fluoroscopic control showed a consistent stabilization of the bodies of adjacent vertebrae.
CONCLUSION. One of the variants of an experimental cage implant for single-level interbody stabilization of the operated segment has been developed, the installation of which is feasible both with open surgical intervention and minimally invasive endoscopic portal access. 

AIM OF THE STUDY: to study the dynamics of perioperative transcranial Doppler ultrasonography (tcD) in patients with aneurysmal subarachnoid hemorrhage (asah) with various clinical outcomes, in whom transient significant changes of responses (tscr) were registered according to intraoperative neurophysiological monitoring (IOnm), during aneurysm clipping.
METHODS: 56 patients with aSAh, 24 men and 32 women were included, who underwent aneurysm clipping with IONm. Patients were divided into three groups:
With an increase in neurological deficit (ND) due to delayed cerebral ischemia (DCI), with TSCR according to IONm — 7 people.
Without an increase in ND, with a TSCR according to IONm — 19 people. The control group without an increase in ND, and without TSCR according to IONm — 30 people.
RESULTS. There was a significant increase in peak systolic blood flow velocity (PSbFV) in the middle cerebral artery (mCA) after surgery in group 1 (before surgery 111.9 ± 47.6 cm/s, after — 196.5 ± 74.5 cm/s, p = 0.001), and in group 2 (before — 108.6 ± 20.3 cm/s, after — 158.0 ± 66.9, p<0.001), as well as the Lindegaard index (LI) in group 1 (before — 2,5 ± 0.7, after — 3.5 ± 1.1, p = 0.01), and in group 2 (before — 2.1 ± 0.3, after — 2.9 ± 1.1, p<0.001). At the same time, in group 3, the increase of PSbFV in mCA and IL after surgery was not significant (before — 130.5 ± 45.8 cm/s, after — 141.4 ± 48.9 cm/s, p>0.05). PSbFV in the mCA before surgery was significantly higher than in groups 1 and 2.
CONCLUSION. TSCR according to IONm can be a marker of a decrease in cerebrovascular reserve and one of the risk factors for the development of DCI.

SUMMARY. In the adult population, meningiomas are observed in 18–34 % of all intracranial neoplasms, confidently taking second place among brain tumors and second only to gliomas. With meningiomas, the incidence is ~ 4–6 people per 100 thousand population. Gliomas are the most common primary brain tumors: they account for up to 81 % of all malignant neoplasms of the central nervous system.
PURPOSE OF THE STUDY: to evaluate the parameters of the acid-base state in patients with meningiomas and gliomas in the early postoperative period and to evaluate the metabolism of tumors.
MATERIALS AND METHODS: the data of analyses of the acid-base state indicators of patients with gliomas and meningiomas being treated at the neurosurgical department No. 4 of the Polenov Neurosurgical Research Institute, who were divided into two groups: 20 patients with high grade tumors (mainly Grade III and IV gliomas, 10 men and 10 women) and 19 with low grade (mostly Grade I meningiomas, 9 males and 10 females). The study of the acid-base state indicators was carried out in the postoperative period, for comparison, the nonparametric mann-Whitney criterion was used.
RESULTS. Among patients with high grade tumors, there is an increased average ph value and a reduced average pCO2 value, which indicates gas acidosis, and not the initially expected metabolic alkalosis. Among patients with low grade tumors, deviations from the normal values of the acid-base state were not detected. mann-Whitney statistical analysis shows a high level of reliability in terms of ph and pCO2. For the remaining indicators, there are no deviations from normal values and the confidence level is low.
CONCLUSION. During the analysis of the indicators of the acid-base state of patients with gliomas, it was found that the values obtained indicate gas alkalosis, and not the initially expected metabolic acidosis, presumably in connection with the provision of resuscitation benefits. In conclusion, there is no significant effect of tumors on systemic metabolomics, which makes it possible not to take it into account when conducting further studies of local tumor metabolism.

THE PURPOSE OF THE STUDY is to analyze the social and demographic characteristics of neurosurgical patients with drug-resistant epilepsy.
MATERIALS AND METHODS. A non-randomised, retrospective parallel group study was conducted at Polenov Neurosurgical Institute, a branch of Almazov National Research Centre.
THE OBJECT OF THE STUDY was neurosurgical patients with drug-resistant epilepsy. The subject of the study was social and demographic indicators.
The study involved 100 patients diagnosed with pharmacoresistant temporal lobe epilepsy and treated at the DeparTment of Functional Neurosurgery No. 2 of Polenov Neurosurgical Institute in 2022.
Patients were divided into 2 groups depending on the type of surgical procedure: Group 1 — those who underwent resective surgery, and Group 2 — destructive surgery. Social, demographic and clinical data were examined in both groups and the cohort. Social functioning was assessed by education, employment and disability status.
RESULTS. Group 1 consisted of 78 patients; group 2 included 22 patients. Patients ranged in age from 19 to 54 years, with an average age of 32.3±8.18 years. males outnumbered females, 53 % and 47 % respectively. The mean duration of epilepsy in the cohort was 20.09±9.24 years, with no difference between groups. The level of education in the cohort was characterised by a preponderance of vocational education at 42 % compared to general secondary education at 24 % and tertiary education at 34 %. There were twice as many unemployed as employed people in the cohort — 63.9 % and 30.6 %. The number of patients with disabilities was 59 %, with patients with disabilities predominating in Group 1 and patients without disabilities in Group 2.
CONCLUSION. There were no significant differences in social functioning between the groups, as there was no difference in the duration of the disease before treatment. Long-term disease progression has a negative impact on social functioning in people with epilepsy. The neurosurgical cohort with drug-resistant epilepsy is characterised by problems of social adjustment: Two-thirds were disabled and unemployed, and a quarter of patients had only a school leaving certificate and no qualifications. There is a need to actively inform physicians and patients about existing surgical management options for epilepsy in order to increase the use of modern epilepsy neurosurgery.

Computer programs are a method that effectively complements the cognitive rehabilitation of neurosurgical patients.
THE AIM OF THE STUDY is a comparative assessment of the effectiveness of cognitive rehabilitation in neurosurgical patients with isolated use of psychocorrection methods and their combination with the habilect computer program.
MATERIALS AND METHODS: Among the studied 33 patients (19 men and 14 women, average age 58,35±14,75 years) suffered a non-traumatic intracranial hemorrhage, 38 were operated on for a brain tumor (20 women, 18 men, average age 54,38±15,27 years). 33 patients underwent neuropsychological correction sessions in isolation, 38 — in combination with the habilect computer program.
RESULTS. The average mmSE score in the group of patients who studied under the habilect program was 25,25 (20,25; 27,0) points at admission, 28,0 (25,75; 28,75) at discharge, the dynamics index was 2.5 (1.50; 4.0) points. The average FAb score was 14,5 (12,25; 15,0) points at admission, 17,25 (15,0; 18,25) points at discharge, the dynamics index was 2.75 (2.0; 3.0). The average score on the Roschina scale was 24,0 (17,0; 25,0) points at admission, 15,0 (12,0; 22,0) points at discharge, the dynamics indicator was 4,0 (3,0; 6,0) points.
The average mmSE score in the control group at admission was 25,5 (20,75; 27,25) points, at discharge — 28,5 (24,75; 29,0) points, the dynamics index was 2,75 (1,0; 4,25) points. The average FAb score at admission was 15,0 (11,25; 16,75) points, at discharge — 17,5 (16,75; 18,0) points; dynamics indicator — 2,25 (1,0; 3,25) points. When tested on the Roschina scale, the average score at admission was 17,75 (14,5; 24,0) points, at discharge — 12,5 (10,25; 15,75) points; dynamics indicator — 5,0 (3,25; 8,25) points.
CONCLUSION. Thus, it seems appropriate to use computer programs as an additional rehabilitation method in young patients with mild and moderate disorders of higher cortical functions, especially in the field of spatial gnosis and praxis

Polyneuropathies include a wide range of diseases that are characterized by impaired function an
AIM OF THE STADY: using the possibilities of pathomorphological methods for the differential dianosis of various types of neuromuscular diseases.
MATERIALS AND METHODS: the study was performed on the current material obtained from 18 patients during operations for the removal of a nerve and a musculocutaneous flap for morphological diagnosis in patients with neuromuscular diseases. 8 drugs were studied in patients with myodystrophy and 2 drugs with spinal amyotrophy, 2 drugs with a generalized form of myasthenia gravis, motor neuron disease 2, with myositis 4.
The material was subjected to special processing methods for routine hematoxylin-eosin staining, special stains to identify nerve fiber, adipose tissue and immunohistochemistry (IhC) to determine inflammatory infiltration (CD 45), as well as vessels (CD 34).
RESULTS. With the help of a morphological study in patients with neuromuscular diseases, the following changes were revealed: with myodystrophy, a different degree of damage to the muscle fiber from 20 to 80 % was revealed, productive inflammation with the presence of plasma and giant cells in the infiltrate, which is typical for cases with the presence of genetic damage. The severity of productive inflammation is comparable to the amount of damage to the muscle fiber.
In the same preparations, different degrees of fatty degeneration are noted. There are no changes in the nervous system in muscular dystrophies. A violation of the structure of motor plaques with the disappearance of fibrillar plaques was noted. muscle fibers become thinner, replaced by adipose and connective tissue.
In the group with spinal amyotrophy, morphological features characteristic of neurogenic amyotrophy and myodystrophy are combined, however, changes in the muscle fiber are mainly associated with impaired innervation and manifest themselves in moderately pronounced dystrophic changes (protein degeneration, fatty degeneration). There was no productive inflammatory infiltration.
In patients with motor neuron disease, severe changes in the muscle fiber of a dystrophic nature were noted. Fatty degeneration occupied from 50 to 90 % of muscle fibers, nerve fibers were absent.
CONCLUSION. Thus, modern approaches to the diagnosis of neuromuscular diseases are based not only on classical clinical and laboratory research methods, but can also be largely based on morphological diagnostics. being a highly informative research method, the histological study of biopsy material requires a technically complex procedure, but when it is carried out qualified, it gives a good result.

It is known that the clinical course of glial tumors often shows similarities with inflammatory diseases of the brain, which made it possible to distinguish a special inflammatory type of gliomas. Chronic processes associated with the persistence of an infectious etiological factor proceed as a productive inflammation, while the etiological factor itself causes a proliferative cellular response.
AIM OF THE STUDY: biopsies of 1424 glial tumors contaminated with hSV (glioblastomas (748), anaplastic astrocytomas (103), astrocytomas (248), oligodendrogliomas (126), anaplastic oligodendrogliomas (25), mixed gliomas (60), anaplastic mixed gliomas (15), ependymomas (85), anaplastic ependymomas (14)).
The control groups consisted of tumors that did not express antibodiEs to hSV, in which intranuclear inclusions characteristic of hSV were not detected.
Staining with hematoxylin-eosin was carried out in an automatic staining apparatus according to the generally accepted histological method. To detect hSV in tumors, an immunohistochemical study was used with antibodies to the antigen of hSV type I and II. Proliferative activity (Ki-67) was determined. Vessels were counted (CD 34). To identify inflammatory infiltration, an IhC study was performed with a set of monoclonal antibodies CD 45 (total leukocyte factor), CD 8 (T-lymphocytes). The IhC assay with p53 and bcl-2 was used to study apoptosis. To study the aggressiveness of tumor growth, the epidermal growth factor receptor (EGFR) was studied.
RESULTS. It was found that glioblastomas occurring against the background of chronic inflammation have a median difference in the expression of bcl-2 and p53 in the vascular endothelium equal to 7.9 %. With an exacerbation of a chronic inflammatory process — 8.7 %. For anaplastic astrocytomas, the difference in chronic inflammation was 7.9 %, with its exacerbation — 8.2 %, for anaplastic oligodendrogliomas — 6.9 % and 7.1 %, for anaplastic oligoastrocytomas — 7.4 and 8.1 %, for anaplastic ependymomas — 7.2 % and 7.8 %, respectively. The difference between the expression of bcl-2 and p53 in tumor cells during chronic inflammation and its exacerbation for glioblastomas was 1.4 % and 1.5 %, for anaplastic astrocytomas — 0.73 % and 0.8 %, for anaplastic oligodendrogliomas — 0.7 % and 0.8 %, for anaplastic oligoastrocytomas — 0.7 % and 0.8 %, for anaplastic ependymomas — 0.6 % and 0.7 %. The difference in the expression of anti-apoptotic (bcl-2) and apoptotic (p53) factors for endothelial cells is significantly greater than for tumor cells (p<0.01), which determines the primacy of vessel growth. When comparing each of the groups of high-grade glial tumors with the control group, the amount of Ki-67 expression in endothelial cells was increased by an average of 3 times in each of the groups. This was manifested by a significant increase in the number of vessels in the «hot spot», accompanied by an acceleration of tumor growth.
The correlation analysis between the amount of expression of antibodies to hSV and EGFR in high-grade glial tumors showed that there is a positive correlation between the amount of expression of antibodies to hSV and EGFR.
Glial tumors of low malignancy progress due to an increase in the cell population, with a twofold increase in which the appearance of a proliferating vessel is fixed, which increases the degree of aggressiveness of tumor growth.
CONCLUSION. The main growth mechanism of high-grade glial tumors is that the difference in the expression of antiapoptotic (bcl-2) and apoptotic (p53) factors for endothelial cells is significantly greater than for tumor cells (p<0.01), which determines the primacy of vessel growth. The main growth mechanism of low-grade glial tumors is characterized by an increase in their cell population. With an increase in the number of cells by 2 times, a proliferating vessel is formed, which increases the degree of aggressiveness of the tumor process. The aggressiveness of the disease depends on the presence of signs of exacerbation of inflammation caused by contamination of glial tumors with hSV, since EGFR activation is directly related to a high degree of tumor malignancy, aneuploidy, and a proliferative index. When planning the volume of surgical intervention during operations to remove glial tumors, the removal of the maximum number of proliferating vessels in the peritumorous zone should be taken into account as a cause provoking the onset of relapse, which will significantly increase the radicalness of the surgical intervention without reducing the quality of life of the patient.

At the current stage of epileptology development there are positive changes concerning the solution of the problem of drug-resistant epilepsy. Modern capabilities of neurosurgery make it possible to successfully solve the problems of treating this disease, however, the issues of postoperative management of patients remain insufficiently developed, and relapses of seizures during the first year after surgery require further development of conservative treatment. Purpose of the study: optimization and study of the effectiveness of medication-assisted antiepileptic and pathogenetic treatment at early (6 months) and late (up to 3 years) stages of the postoperative period. Materials and methods. The analysis of the work is based on the material of 70 patients with drug-resistant epilepsy accompanied by symptoms of epileptic encephalopathy. These patients received optimized antiepileptic therapy and pathogenetic treatment for 3 years, as well as a thorough follow-up examination according to specially developed algorithms for the immediate and long-term postoperative periods. Results. It was established that after 3 years, a different degree of seizure reduction and regression of convulsive activity according to electroencephalographic data were observed in 17 (56.7 %) patients, restoration of higher mental functions occurred in 19 (63.3 %) patients, a decrease in the indicator of mental disorders (anxiety, depression) — in 29 (73.1 %). A significant (p < 0.05) increase in the proportion of favorable outcomes and a significant improvement in the quality of life were registered in 41 (58.6 %) patients as a result of the analysis of data obtained in the immediate and longterm postoperative periods. Conclusion. The data we obtained and presented in the proposed article confirm the validity of optimization of drug antiepileptic and pathogenetic therapy in patients with drug-resistant epilepsy, accompanied by encephalopathic symptoms, in the immediate and distant postoperative periods for a total period of not less than 3 years.

Abstract. Severe spinal cord injury, leading to a persistent neurological deficit, is currently classified as an incurable pathology. However, active research in this area has made it possible to determine the main directions of the search for the treatment of spinal cord injury. So, fundamentally different and new is the use of substances that promote the primary fusion of cell membranes, the so-called fusogens. The article presents the results of comparing two schemes of fusogen therapy developed by the authors — with intraoperative administration of a compound fusogen, and in combination with intravenous administration of a simple fusogen solution. Objective: to compare the clinical effect of two schemes of experimental fusogen therapy. Methods: California rabbits, females 2.5 kg, N=25. All animals were modeled with a spinal cord injury with its complete transverse intersection. The first group (N=10) received PEG-chitosan conjugate into the diastasis, the second group (N=10), in addition to the introduction of PEG-chitosan conjugate into the diastasis, received intravenous injection of 20 % polyethylene glycol solution. The third group (N=5) did not receive fusogens and was the control group. Motor, pelvic functions, and sensitivity were assessed using neurological deficit scales for experimental animals. Results: in the group with the combined use of fusogens, there was an accelerated recovery of spinal cord functions, compared with the regimen, which implies only intraoperative administration, and the final indicators of neurological deficit reached high values. Conclusion: intraoperative administration of fusogen in combination with intravenous administration accelerates the process of recovery of spinal cord functions after its complete transection in the experiment, and shows the best results in the final values of neurological deficit. 

Summary. Currently, many modifications of the orbitozygomatic approach (OZA) have been proposed, including the number of bone flaps. When performing a two-flap OZA, it is necessary to perform a resection of a part of the large wing of the sphenoid bone and squama of the temporal bone. Resection of these bones is associated with the risk of such a fairly frequent and underestimated cosmetic complication as temporal hollowing. In turn, when performing a three-flap OZA, proposed by A. Campero, conditions are created for reducing the area of bone resection at the base of the skull, which probably reduces the risk of developing a temporal hollowing. Objective. The objective was to compare a removal rate of the bones of of petrosal squamosa and greater sphenoid wing during two- and three-flap orbitozygomatic approaches. Materials and Methods. The study was conducted on 8 sides of the head-neck block preparations of cadaverous material of 6 deceased aged 45 to 86 years, whose death was not associated with a disease of the central nervous system. Results. The usage of three-flap orbitozygomatic approach allows reducing a removal rate of the bones of skull base by 274 mm2 . Discussion. When this bone fragment is preserved, the congruence of the skull is not disturbed, there is no need for resection of the bones of the skull base, there is no need to cut out the bone rim for the bone cuts connecting the superior and inferior orbital fissures, during the formation of the orbitozygomatic flap. Also, the risk of developing a cosmetic defect in the form of a temporal hollowing is probably to be reduced. However, the orbitozygomatic bone flap consists of two bone fragments, and therefore there is a need for additional bone fixation during its reconstruction. 

The practice of using neuronavigation systems, as well as intraoperative ultrasound scanning, is an attribute of modern neurosurgery. But use their combination is very rare. Nevertheless, even with the relatively small described experience of such practice, it is obvious that the potential of this technology is large. We present the first experience of using ultrasound scanning coupled with neuronavigation in pediatric neurosurgery in Russia. 

Summary. T2/FLAIR mismath sign identification is a non-invasive method of preoperative identification of molecular subtypes of low-grade gliomas that may be useful for surgical planning, choosing of the optimal treatment strategy and outcome prediction. Purpose of the study. To assess the validity of the T2/FLAIR mismatch sign as a genetic profile marker of lowgrade gliomas. Materials and methods: preoperative MRI images of 57 patients that subsequently underwent surgical treatment in the Russian neurosurgical institute (Saint-Peterburg) in the period 2019–2022 were analyzed. Diagnosis of «diffuse astrocytoma» or «oligodendroglioma» were histologically confirmed in all cases. The analysis of preoperative MRI 82 Том XV, №2, 2023 RUSSIAN NEUROSURGICAL JOURNAL named after professor A.L. Polenov Оригинальные с тат ь и data was carried out by two qualified neuroradiologists in St. Petersburg, who checked the presence of the T2 and T2/ FLAIR mismatch sign in case of homogenity in the T2 mode. Patients were included in the main group only in case of a consensus of specialists, further, the histological profile of the removed tumors was assessed and interpreted with the data obtained. Results. T2/FLAIR “mismatch” sign was detected in 28 % of patients. In 92 % of these cases the genetic profile of the tumor was IDH+ and 1p/19q noncodeleted and only in 8 % of cases IDH- and 1p/19q-. The mean age was significantly lower in the group with the T2/FLAIR “mismatch” sign and was 38.6 years (p = 0.000214). The T2/FLAIR “ mismatch” sign was strongly (92 %) associated with the IDH-mutant Noncodel molecular subtype. Conclusion. The T2/FLAIR “mismatch” sign can be considered as a highly specific non-invasive neuroimaging marker for identifying the molecular genetic subgroup of IDH1+ 1p/19q codeleted low-grade gliomas. This simple analysis of MR data can improve preoperative diagnosis and optimize the tactics of surgical and adjuvant treatment of patients. 

SUMMARY. Timely and complete diagnosis of AVM-associated aneurysms is essential to prevent the risk of intracranial haemorrhage. AVM-associated aneurysms are found in 12–46 % of patients with AVMs, which is many times the incidence of cerebral aneurysms in the population. When an AVM is combined with an aneurysm, the risk of haemorrhage is 9.8 % per year, increasing the risk of recurrent intracranial haemorrhage to 53.6 %, whereas when there is no such combination, haemorrhage occurs in only 1.7 % of patients with an AVM per year. Currently, there is no consensus on the management tactics for patients with AVM-associated aneurysms. Л.В. Рожченко с соавт. Том XV, №2, 2023 РОССИЙСКИЙ НЕЙРОХИРУРГИЧЕСКИЙ ЖУРНАЛ имени профессора А.Л. Поленова 89 MATERIALS AND METHODS. The study included 287 patients with cerebral AVMs who received surgical treatment in the Department of Brain Vascular Surgery at the A.L. Polenov Russian Research Institute for Cardiovascular Surgery from 2010 to 2020. We assessed AVM-associated aneurysms shutdown against the background of multistage endovascular treatment as well as the occurrence of AVM-associated aneurysms de novo. Serum levels of matrix metalloproteinase‑9 (MMP‑9) were determined before and 24 hours after each stage of endovascular embolization using an enzyme immunoassay (Personal Lab, Adaltis, Italy) at each stage of endovascular treatment. Sixty-eight (23.7 %) of 287 patients were found to have preoperatively associated AVM aneurysms (Group 1). Intracranial hemorrhage occurred in 56 (82.3 %) of 68 patients. 219 patients with AVMs without aneurysms (Group 2) showed hemorrhagic course in 116 (52.9 %) cases. CONCLUSIONS. It was found that 29 % of partially embolized AVM-associated aneurysms with high baseline MMP9 levels form de novo aneurysms, and increasing MMP9 levels over time is a predictor of this risk. The pathogenesis of AVMassociated aneurysms in AVMs is unclear. High baseline MMP9 levels increasing with multistage embolisation may be an easily identifiable predictor of the risk of de novo AVM-associated aneurysms in AVMs identified prior to treatment. 

Summary. The membrane-bound heat shock protein mHsp70 is selectively expressed on the surface of tumor cells, but not on normal cells; it makes mHsp70 a promising target for theranostics of malignant tumors. Objective: in vivo visualization of mHsp70-positive cells in malignant human brain tumors. Materials and methods: intraoperative sampling of histological material was carried out from 7 patients with malignant tumors and from 3 patients with epilepsy. Localization of Hsp70 was determined using live confocal microscopy. To identify intergroup differences in the intensity of green pixels (Hsp70), the Kruskal-Wallis test was applied. Results. A method for intravital staining of tumor samples and image registration by the laser scanning confocal microscopy was developed. High expression of mHsp70 was found in tumor cells compared to control cells in the brain tissue of patients with epilepsy. Conclusion. For the first time, in vivo visualization of mHsp70-positive cells in malignant brain tumors was performed. The results indicate the possibility of using mHsp70 as a marker of tumor cells. 

Summary. This article demonstrates the personal experience of using and performing awake surgery with eloquent brain area tumors in children. Purpose of the study: to introduce the technique of performing neurosurgical operations in consciousness («awake surgery») in children’s patients and evaluate its effectiveness and safety. Materials and methods: the article presents an analysis of the experience of performing neurosurgical operations in children in the period from 2016 to 2022, carried out in the RRCS of Neurology and Neurosurgery. 17 patients underwent 20 operations in consciousness using the sleep-wake-sleep technique. There were 8 boys and 9 girls. The age of the patients ranged from 8.2 to 17.6 years, the median age was 14.5 years. The minimum age of a boy is 8.2 years old, a girl is 9 years old. Three patients were operated twice. The follow-up period was 2.93 years. Results. The results of the study demonstrated high indicators of the quality of life, only 4 (23.5 %) developed a temporary neurological deficit in the early postoperative period, which in most cases completely regressed. It was possible to achieve gross total resection of the tumor in 76.5 % cases. Conclusion. Our experience of performing awake operations in children’s patients has shown that with careful preliminary preparation and planning of each stage of the operation. Operation in consciousness is safe enough, allows preserving the quality of life of the patient, significantly reducing the number of patients suffering from epilepsy associated with tumor, while not reducing number of patients with the gross total resection. 

Summary. 20 % of supratentorial tumors are located in eloquent brain area. The aim of the neurosurgical treatment is to do gross total resection of the neoplasm. Gross total removal is the main factor of a favorable prognosis, improving not only survival, but also the possibility of ridding the patient of epilepsy associated with the tumor. Purpose of the study: to study the outcome of epilepsy and the factors affecting it in patients witch operated eloquent brain area tumors (EBATs). Materials and methods: The study included 68 patients with tumors of eloquent brain area. Epilepsy was diagnosed in 54 (79.4 %). Median age is 11.8 years. The follow–up period before surgical treatment was 2.93 years. Results. After surgery, no seizures were registered or the result of Engel I in 60 (88.2 %) patients, (p<0.001). In a single-variant analysis, it was found that the factors influencing of epilepsy after surgery are: gross total removal of the tumor, p=0.0362 and p=0.0478 for low-grade gliomas (LGG), as well as epilepsy of duration less than three years, p=0.0011. Multivariate regression confirmed the statistical significance of the gross total removal of the tumor p=0.0086 and the duration of epilepsy before surgery, p=0.0008. Epilepsy associated with the operation was in one (7.1 %) cases. Conclusion. The study identify two main factors influencing the outcome of epilepsy in patients with eloquent brain area tumors in children, these are the duration of the epilepsy and gross total removal of the tumor. 

Ischemic stroke is an acute condition arising from impaired cerebral circulation with damage to brain tissue, loss or reduction of brain function due to obstruction or cessation of blood supply to a particular department. Among the causes of ischemic stroke are atherosclerotic changes in the precerebral and cerebral arteries, thromboembolism from the heart cameras, as well as disorders of the blood clotting system and others. Various methods of revascularization are used to improve cerebral blood flow and prevent recurrent ischemic stroke in case of precerebral artery occlusion. Case description: A 67-year-old woman was admitted to the neurosurgery department on the 39th day after an ischemic stroke, with diagnosed carotid occlusive disease and left hemiplegia. After surgical contraindications were excluded, double-barrel STA-MCA bypass was performed. In the early postoperative period, there was complete regression of the hemiplegia. Conclusion: Double-barrel STA-MCA bypass is feasible and potentially advantageous in simptomatic carotid occlusive disease treatment. 

Relevance. Primary-multiple cerebral tumors of various histological types represent a poorly studied group of diseases. The development of multiple pathological formations in a single patient becomes a clinical problem since such situations are not regulated by recommendations, and the doctor has to make a decision based solely on their own experience and common sense. The situation where several independent neoplasms develop in the patient’s body generates scientific interest and leads to the idea of genetic determinism of processes, as well as a number of typical epigenetic abnormalities that lead to their occurrence. The article examines possible causes that lead to the simultaneous development of meningiomas, schwannomas of cranial nerves, astrocytic tumors, pituitary adenomas, and other rarer cerebral tumors, including the phenomenon of «tumor collision.» Conclusions. Apparently, primary-multiple cerebral tumors of various histological types constitute a nosological cluster that includes conditions caused by different pathogenetic processes. In some cases, neoplasms are associated with clear genetic determinism of carcinogenesis processes. Many of them are linked to hereditary tumor syndromes (neurofibromatosis types 1 and 2, schwannomatosis; tuberous sclerosis; Noonan, LEOPARD, Costello, Legius, Turcot, Li-Fraumeni, DICER1, von Hippel-Lindau syndromes, and many others). In other cases, mechanisms of paracrine nature are observed. Thirdly, some cases appear to be random combinations of sporadically occurring tumors. 

The article presents a clinical case of the development of diffuse angiospasm after clipping of an asymptomatic aneurysm of the middle cerebral artery in a 60-year-old woman. The operation was uneventful, temporary clipping was not performed. The patient was discharged on the 10th day after the operation in a satisfactory condition. On the 12th day, severe headache appeared, hemiparesis and loss of the right visual fields developed. Additional examination by MSCT revealed ischemic zones in the parietal-occipital and temporal regions on the left, MSCT angiography revealed pronounced angiospasm in the carotid and vertebrobasilar basins. Against the background of the appointment of nimotop, the symptoms regressed and after 9 days, angiospasm completely resolved, no new foci of ischemia appeared. The article also provides an overview of the few similar observations by other researchers. 

Malignant newt tumor (MNT) is a highly aggressive malignant neoplasm classified as a variant of malignant peripheral nerve sheath tumor (MPNT) with rhabdomyoblast differentiation. MDRF with divergent (heterologous) differentiation with the presence of a rhabdoid component is extremely rare, accounting for 5 % of all MRRF, which accounts for approximately 2 % of all soft tissue sarcomas. A subgroup of tumors in which malignant Schwann cells coexist with malignant rhabdomyoblasts is called malignant newt tumor (MNT) [10]. In most published clinical observations, newt tumor malignancy occurs in the head, neck, limbs, and trunk [15]. Limited reports of OST are available in the neurooncological literature and are most commonly described as sporadic newt tumor malignancy in the setting of neurofibromatosis type 1 (NF1). A rare clinical case of surgical treatment of OST, Th5 spinal root in a 61-year-old woman is described. 

Schwannoma is a benign, encapsulated, and slowly growing tumor of Schwann cell origin and is rare in the peripheral nervous system. Schwannoma surgery should be performed with a low risk of postoperative neurological complications, with the maximum possible removal of tumor volume, and an acceptable reduction in clinical symptoms. The use of fluorescent navigation during surgery may bring the surgeon closer to the balance in achieving these goals. Purpose of the study. Analysis of scientific publications reporting on the possibilities and results of using fluorescent diagnostics in schwannoma surgery. Materials. Data were collected from various databases MEDLINE, Cochrane Controlled Trials Register, Pub Med reporting on the use of fluorescent diagnostics in schwannomas of various localizations. Results. All authors who used sodium fluorescein and indocyanine green reported that the use of fluorescence in schwannomas surgery improved the visual differentiation of the tumor from the surrounding nerves, and increased the radicalness of the surgical intervention. The authors using 5-aminolevulinic acid as a fluorescence inducer noted the absence of fluorescence in all cases of schwannomas, and thus the lack of benefit during surgery. Conclusion. It is necessary to further study the possibilities of fluorescent navigation in schwannoma surgery in order to improve the quality of the surgical intervention. The latest data of scientific publications demonstrate impressive results in this direction, expanding the operational possibilities in schwannoma surgery. 

A rare case of the specific lesion of the optic nerve’s intracranial part due to occult sarcoidosis in young woman presented. The disease started with unilateral progressive visual loss. The magnetic resonance imaging (MRI) with contrast enhancement was primary suspected of optic glioma. The patient underwent surgical removal of lesion to prevent its future spreading to the optic pathways and for histopathological investigation. Diagnosis of the disease was associated with certain difficulties. Specimen examination revealed sarcoid granuloma, and following clinical screening confirmed sarcoidosis.

Introduction. Meningiomas are common tumors of the central nervous system, most of which are benign. Anaplastic and atypical meningiomas, which together account for 25 % of all meningiomas, have a high recurrence rate even after gross total resection and radiotherapy, which determines a significantly worse prognosis. The mechanisms of recurrence remain poorly understood. Purpose. To assess the significance of arachnoid granulations in the recurrence of meningiomas; to present our own clinical case; to make the review of the literature on this topic. Materials and methods. We searched for publications in the Pubmed, EMBASE, Cohrane Library, and eLibrary databases published between the beginning of database management to February 2023 on the issue of the role of arachnoid granulation in meningioma reccurence. The materials of the desease history and results of histological examination of 71-year-old with intracranial meningioma who were treated in Almazov National Medical Research Center are used in this work. Results. The clinical case of intracranial meningioma surgery is described. Histological examination of the tumor revealed papillary meningioma, grade 3. Tumor growth of meningioma was found in the granulations of the arachnoid. According to the review the clinical case shows the importance of the arachnoid granulations in determining the clinical management for this group of patients. 

Malignant brain tumors are particularly aggressive. Various kinds of sleep disturbances in patients with brain tumor lesions are a widespread problem. It is a known fact that there is a significant systemic pro-tumor impact of disturbed sleep in patients with malignant neoplasms of various localizations. In this connection, a review and systematization of current knowledge about sleep disturbances in malignant lesions was carried out, with a special emphasis on malignant brain neoplasms. In particular, the known mechanisms by which sleep disorders contribute to the progression of malignant tumors are reviewed. The second part of the paper, however, presents the theoretical basis for the reverse process. Namely, several pathophysiological mechanisms are described that make patients with malignant brain tumors more likely to experience sleep disturbances. There is reason to believe that normalization of sleep architectonics and circadian rhythms in patients with malignant brain tumors, firstly, has the potential to improve their quality of life and, secondly, gives hope by opening the possibility to actively inhibit the progression of this disease, especially when other treatment methods have been exhausted. That is why future research on this issue seems to be so necessary