Alexey Gavrilovich Molotkov (1874–1950) was a Russian and Soviet scientist, neurosurgeon, Doctor of Medical Sciences, professor, organizer and first director of the Leningrad Research Institute of Surgical Neuropathology (1926–1929), participant (doctor) of the First World War (1914–1918) and the Great Patriotic War (1941–1945), Honored Scientist of the RSFSR (1947). He is the author of 57 scientific papers, including 3 monographs devoted to the study of the role of the nervous system of trophic disorders, as well as the clinic and surgical treatment of nerve damage, studied the pathogenesis and results of treatment of spontaneous gangrene. He is the author and developer of a two-moment operation for a brain abscess. He proposed an original method of crossing the skin nerves for the treatment of various neurodystrophic disorders. He studied the role of skin nerves in the genesis of causalgia, phantom and scar pain. Scientific works of A.G. Molotkov became the basis for further study of injuries and diseases of the peripheral nervous system.

THE PURPOSE OF THE STUDY: To clarify the autobiographical data of A.G. Molotkov according to archival and published sources.

AIM: The purpose of this work is to present the immediate results of cranioplasty using additive technologies.

METHODS:

The study included 25 patients with skull defects of various locations and sizes, operated on at the Military Medical Academy named after. CM. Kirova using additive technologies from April 2022 to September 2023. Cranioplasty was performed using polymethylmethacrylate implants made from custom 3D printed molds.

RESULTS:

The principal aims of cranioplasty in this study are to restore aesthetic contour and to provide cerebral protection. However, it has been noted that a great improvement occurs in cerebral blood flow and cerebral perfusion after cranioplasty.

CONCLUSION:

The use of additive cranioplasty technologies allowed us to achieve optimal cosmetic results. The incidence of immediate complications was 16 % (n=8), but only one of them (4 %) was indirectly related to the use of this technology and was due to the patient’s individual reaction to polymethyl methacrylate.

Cervical myelopathy is a serious modern challenge that requires careful attention. Clinical manifestations of cervical myelopathy are variable, from mild neurological disorders to tetraplegia. This results in the decrease of accuracy and delayed diagnosis, and therefore, poor treatment results. Currently, magnetic resonance imaging is the main method for diagnosing cervical myelopathy. Diffusion tensor imaging tractography is the most appealing method because of the more detailed visualization of spinal cord structure. Together with MRI Diagnostic Center in Tushino, we studied patients with cervical myelopathy in NGHCI NCC OJSC RZhD. For the first time, such parameters as fractional anisotropy and apparent diffusion coefficient were used to evaluate tracts and perform their 3D reconstruction. Our research showed that these data correlated with the severity of clinical symptoms of myelopathy. This provided an opportunity for development of early and precise topical diagnosis of myelopathy, differential diagnosis with spinal cord demyelination, and could be used to improve the quality and results of patient management.

The article presents theoretical provisions on the use of impedance spectroscopy in medicine. Electromagnetic processes occurring in the body tissue at the cellular level are considered.

PURPOSE OF THE STUDY: Determination of how elements of the geometry of tissue structure at the cellular level and elements of electromagnetic parameters determine the frequency dependence of the impedance on that tissue.

Non-specific infectious and inflammatory diseases of the spine are a rather rare pathology, which still remains a difficult problem for neurologists and neurosurgeons despite the advances in treatment achieved in last years. The outcome of the disease, in addition to the characteristics of the infectious agent and the clinical and morphological form of the disease is influenced by the early terms of diagnosis and surgical treatment. There is an analysis of 265 patients treated in the neurosurgical department for nonspecific diseases of the spine in the article. The long-term outcomes of treatment after decompression-sanitation and decompression-sanitation-stabilization operations were assessed on the basis of subjective (using standardized scales) and objective data. The relief of vertebral pain syndrome and neurological deficits, restoration of working capacity as early as possible after surgical treatment are the most important criteria for patient satisfaction with treatment. The decompression-sanitizing-stabilizing operations compared to decompression-sanitizing operations is accompanied by significantly lower residual pain syndrome and better regression of neurological deficit in the early and long-term period of surgical treatment, which helps to improve the quality of life and satisfaction of patients after surgery.

Scientific research begins with the collection of information on the subject, its systematization, which helps to come to conclusions on the issue under study. All the data obtained in this case are usually distributed in a format convenient for their detailed study, which is represented by a database (Db). When creating common databases for conducting medical research in the field of neurology and neurosurgery, taking into account the peculiarities of storing personal information, the legal aspects of both parties involved must be taken into account.

PURPOSE OF THE STUDY: to study individual problems of forming a database for conducting medical research in the field of neurology and neurosurgery, taking into account the peculiarities of storing personal information, as well as to find an approach to combining common applied concepts for conducting joint scientific research in Russia and the Republic of Belarus.

MATERIALS AND METHODS: the material for the study was the study of problems that influence the formation of the concept of a database for the purpose of conducting medical research in the field of neurology and neurosurgery, taking into account the peculiarities of saving patients’ personal data. The methodological basis of the research is the general scientific method, the method of formal logic and system analysis, synthesis, induction, the method of description and comparison.

RESULTS: when studying various databases, a number of features were systematized, which made it possible to highlight a number of common aspects. One of such system-forming aspects is the nature of the stored information. Another aspect is the way the database information is stored, which can have a decisive impact on the possible options for storing the personal data of patients participating in scientific medical projects. A distributed database operates in a local and global network. In these cases, fragments of the database may be stored on different computers or servers, which may be in conflict with the Federal Law “On Information, Information Technologies and Information Protection” (No 5 st. 4 of the Law on Information, Informatization and Information Protection of the Republic of Belarus, which must be strictly observed when planning and creating scientific projects. In neurological and neurosurgical practice, the method of morphological research is now widely used. This method is associated with a number of limitations when creating a database, since it has its own characteristics that are directly related to compliance with the Federal Law «On Information, Information Technologies and Information Protection» (dated July 27, 2006 N 149-FZ in the latest edition), and also from par. 5 st. 4 of the Law on Information, Informatization and Information Protection of the Republic of Belarus when planning joint projects. A rather serious help in the implementation of the above laws is a confidential consent, which must be filled in by patients participating in planned projects. It must be developed for both sides of the Union State, combining our capabilities and observing all conditions.

CONCLUSION. When studying certain problems of creating a database for conducting medical research in the field of neurology and neurosurgery, taking into account the peculiarities of storing personal information for conducting joint scientific research in Russia and the Republic of Belarus, the main areas of work were identified to create comfortable conditions when working on joint projects. An important area of   work is the creation of equal conditions in the creation of information resources of a medical institution, which includes the operation of an automated corporate database that includes information from patients’ medical records, data on the volume and nature of the medical care provided to them. Due to the constant increase in the information being processed at the moment, databases widely used in neurology and neurosurgery should be created taking into account the legal regulation of information relations, which will become the starting point for creating the scientific potential of joint interstate projects, which are the new reality of our time.

In the structure of traumatic injuries, the highest risk of mortality and disability is associated with traumatic brain injury. Despite the fact that traumatic brain injury has been a subject of study since the time of Hippocrates, its relevance has not lost its significance. From these positions, the issues of primary injury prevention, early diagnosis and assessment of the severity of injury, and the choice of an effective treatment method are extremely important. With the rapid development of scientific and technological progress and changes in social and economic conditions of life, the nature of injuries has also changed. This applies to both adult and child populations. According to the literature, the main causes of severe TBI are accidents, falls, blows to the head, and crime. Issues of mild and moderate-severe TBI have been studied to a lesser extent. On the other hand, studying the mechanisms of primary injury can become an important tool in the diagnosis of intracranial injuries accompanied by subtle clinical manifestations that pose a serious threat to the victim’s life.

THE PURPOSE OF THE STUDY: to analyze the severity of intracranial injuries according to computed tomography data in victims with traumatic brain injury (children and adults), admitted with a high level of consciousness (13–15 GCS points).

MATERIALS AND METHODS: At the Republican Clinical Hospital in Nalchik, a retrospective analysis of data from 2228 patients (from 2011 to June 2018) with mild and moderate TBI. In all patients, GCS score on admission was 13–15 points. The severity and structure of the damage was verified by brain CT scan in all cases.

RESULTS. The most common mechanism of TBI among both children and adults is falling, mainly from a height of <1 m. Among children, there are also registered headbutting, blows to the head or falls of a heavy object on the head associated with active behavior. Among adults — road accidents and beatings. Head soft tissue injuries, and fractures of the skull are almost twice as common when falling and hit by a heavy object than in a road accident or beating. Depressed fractures of the skull were typical for the mechanism of injury by a direct impact on the head with an object, which happens 3 times more often (13 %) than other mechanisms of injury, such as falls (4 %), beatings (6 %), and road accidents (4 %). Subdural hematomas are mostly found in the mechanism of injury by falling (13 %). Epidural hematomas were less detected with fall of the victim from a height of <1 m, and most often occur when falling from moving objects. Subdural hematomas, intracerebral hematomas and SAH were characteristic of the mechanism of trauma of falling from steps and were more common than in other types of falls. When a TV or other heavy object falls on a child, combined injuries are characteristic, which include about 81 % fractures of the arch and the base of the skull. The average statistical amount for damage in a crash accident was 11 %, and for other types of road accidents like run over or falls from vehicles, was 18 %. All types of damage caused by road accidents like run over or falls from vehicles were detected almost twice as often as in crash accidents, except for depressed skull fractures, which were 3 times more common in crash accidents.

CONCLUSION. The data analysis showed that the pattern of outcomes in victims with TBI with a high level of consciousness (13–15 GCS points) largely depends on the mechanism of injury. Acarefully collected anamnesis, consideration of injury conditions, and indication of injury mechanism can become an additional tool for early detection and diagnosis of intracranial injuries in victims admitted with a high level of consciousness (13–15 GCS points) when clinical manifestations are still latent. A report of the mechanism of injury with high damaging energy may be an indication for brain computed tomography in emergency situations, even in the absence of obvious clinical manifestations of intracranial injuries requiring surgical treatment.

Initially, hydrocephalus was divided into communicanting and non-communicanting by W. Dandy. After that terms “intraventricular” and “extraventricular” obstruction were determined. Improvement of radiological technologies have allowed to determine the level of CSF obstruction exactly. In some situations, CSF-disorders combine signs of different forms hydrocephalus. Their correct classification allows you to choose the type of surgical treatment, which reduces the rate of complications and patient’s visits on the doctor.

PURPOSE OF THE STUDY: To study the radiological signs of hydrocephalus in idiopathic obstruction of the posterior cranial fossa cisterns.

MATERIALS AND METHODS. From 2007 to 2020, 289 adult patients with idiopathic hydrocephalus were operated in the Burdenko Neurosurgical Institute. Sixty five (18,7 %) had clinical and radiological signs of extraventricular cistern obstruction. Gender distribution was 25 and 40 (38.5 % and 61.5 %), respectively. A lot radiological sings were marked and determined to the different forms of hydrocephalus.

RESULTS. FOHR was the highest (compared with other forms of idiopathic hydrocephalus (mean 0.52)). Other ventricular indexes were also high. None of them correlated with patient’s condition. Ventral dislocation of the premamillary membrane was in 89.2 %. Turkish saddle was of normal size in 51 (78.4 %) patients, and its enlarged was in 13 (20 %). A change in the periventricular signal was noted in 18.4 %. Aqueduct and IV ventricle outlets were patent in all cases. The cerebral aqueduct was dilated in 63 (96.9 %) patients. Enlargement of the cisterna magna and hypotrophy of the caudal cerebellum simultaneously was noted in 90.7 %, and this sign was significant for extraventricular cisternal obstruction (p < 0.001). FIESTA scans were showed additional membranes in the subarachnoid spaces between the ventral brainstem and the clivus. These were found in 100 % of patients, which was also a pathognomonic sign (p < 0.001).

CONCLUSION. The MRI of hydrocephalus with obstruction of the posterior cranial fossa cisterns has specific signs. It combines the sings of other forms of hydrocephalus, chronic disease in combination with symptoms of obstruction of the CSF pathways. It can be classified into a separate form and both endoscopic and shunt-surgery can be used to treatment.

This work is devoted to the study of the immediate and long-term results of treatment of patients with aneurysms of the upper third of the basilar artery with the use of endovascular treatment methods.

PURPOSE OF THE STUDY: To evaluate the immediate and long-term results of endovascular treatment of patients with aneurysms of the upper third of the basilar artery.

MATERIAL AND METHODS. The results of endovascular treatment of 91 patients with 95 aneurysms of the upper third of the basilar artery operated in the neurosurgical department #3 of the Prof. A.L. Polenov Russian Research Neurosurgical Institute from January 1, 2017 to March 31, 2023 were analyzed.

RESULTS. The following endovascular methods were used: 1) selective aneurysm coiling (n=39); 2) stent-assisted coiling (n=35); 3) implantation of flow-diverting stent (n=21). Grade of occlusion for aneurysms treated with selective aneurysm coiling and stent-assisted coiling was classified according to the Raymond-Roy classification, as well as according to the Cekirge-Saatci classification for aneurysms treated with flow-diverting stents.

In the group after spiral occlusion, 23 (60.5 %) aneurysms were totally (Class A), 8 (21.1 %) were subtotally (Class b), and 7 (18.4 %) were partially (Class C) occluded.

In the group after stent-assisted coiling totally occluded (Class A) were 22 (61.1 %), subtotally (Class b) — 8 (22.2 %) and partially (Class C) — 6 (16.6 %), with no statistically significant differences in the group of braided and laser-cut stents (p = 0.571).

In the group after implantation of the flow-diverting stent, primary reconstruction (grade 4A) was achieved in 15 (71.4 %) cases.

Control cerebral angiography at a period not earlier than 6 months was performed in 72.5 % (n=69) of patients.

In the long-term follow-up after aneurysm occlusion with detachable coils, control angiography was performed in 73.7 % (28/38) of observations, totally occluded (Class A) were 16 (57.1 %) and partially (Class C) — 12 (42.9 %). In this group the recurrence rate was 21.4 % (n=6), in 10.7 % (n=3) requiring repeated surgical intervention. In the remote period after aneurysm occlusion with stent-assisted coiling, control angiography was performed in 66.7 % (24/36). After occlusion of aneurysms with usage of stents made by laser cutting technology in the remote period there was a decrease in radicality of aneurysms occlusion — (Class A) — 5 (38,4 %) and partially (Class C) — 8 (61,5 %). There were 7 recurrences in this group of cases, 4 of which required repeated surgical treatment. In the remote period after occlusion of aneurysms with stent-assisted coiling, with usage of braided stents there was an increase in radicality of aneurysms occlusion from blood flow. Totally were occluded (Class A) 10 (90.9 %) and partially (Class C) — 1 (9.1 %). In this group, 1 (9.1 %) recurrence was identified. In the remote period after implantation of the flow-diverting stent, total/subtotal aneurysm occlusion was observed in 47 % (n=8) of cases.

Clinically, the postoperative outcome was excellent in 83 (87.9 %) patients (mRS score 0–1); 7(7.7 %) patients had mild impairment (score 2–3), 3 (3.3 %) patients had severe impairment (score 4–5), and 1 (1.1 %) patient died (score 6).

Complications related to surgery were observed in 4.2 % (n=4) of observations, of which 3.2 % (n=3) affected the final patient outcome.

In the remote period after implantation of the flow-diverting stent, total/subtotal aneurysm occlusion was observed in 47 % (n=8) of cases.

Clinically, the postoperative outcome was excellent in 83 (87.9 %) patients (mRS score 0–1); 7(7.7 %) patients had mild impairment (score 2–3), 3 (3.3 %) patients had severe impairment (score 4–5), and 1 (1.1 %) patient died (score 6).

Complications related to surgery were observed in 4.2 % (n=4) of observations, of which 3.2 % (n=3) affected the final patient outcome.

CONCLUSION. Endovascular treatment of aneurysms of the upper third of the basilar artery with microspirals and / or with the use of other modern endovascular techniques is effective and safe enough. The use of modern braided assisting stents allows to achieve higher radicality of aneurysm occlusion in the long term period. Safety and efficacy of flow-directing stents in the treatment of aneurysms of the upper third of the basilar artery require further study; however, our results indicate the possibility of their effective usage of this treatment modality for complex aneurysms of this localization.

SUMMARY. Extradural and intramedullary tumors are classified as intradural neoplasms of the spinal cord. The median approach followed by laminectomy is considered to be the traditional approach to removal of intradural neoplasms of the spinal cord. In recent decades, hemilaminectomy has become the most commonly used technique due to its many benefits. Traditionally, hemilaminectomy was performed through a median approach, however, this approach limited the viewing angle in patients with ventrally located neoplasms. The use of paramedian approaches for tumors located ventrally and ventrolaterally from the spinal cord improves the view and angle of surgical attack.

OBJECTIVE. To conduct a comparative analysis of paramedian and posterior minimally invasive approaches in the surgical treatment of ventral and ventrolateral tumors, as well as to compare the effectiveness and safety of their use in terms of the radical removal of the tumor, the time of operation, the volume of intraoperative blood loss, the time spent in the hospital, postoperative liquorrhea, the time of suturing solid meninges (dura mater), the severity of postoperative pain syndrome according to the visual analogue scale (VAS) and the assessment of quality of life according to the EQ-5D-5L VS scale.

MATERIAL AND METHODS. One hundred twenty-one (121) patients with vental and ventro-lateral intradural extramedullary tumors were treated in spinal department of Burdenko Neurosurgical Center between 2016 and 2020. The study included only patients with extramedullary neoplasms that did not extend to more than 1 segment of the spine, patients with tumors of the upper cervical spine were excluded. The median age of the patients was 49[20;81]. The average follow-up period was 12±3 months. The patients were divided into 2 groups: the first group (group I) of 53 patients underwent minimally invasive tumor removal with hemilaminectomy and partial joint resection window via paramedian approach, the second group (group II) of 68 patients underwent minimally invasive tumor removal through the hemilaminectomy window using the posterior approach. After surgery, the radicality of tumor removal, the time of the operation, the volume of intraoperative blood loss, in-hospital stay, postoperative liquorrhea, time for duraplasty, and severity of postoperative pain syndrome according to VAS were estimated. The degree of tumor resection was assessed by MRI with intravenous contrast. Time for dura suturing and sealing was estimated using intraoperative videorecording.

RESULTS. The Group of patients underwent surgery with paramedian approach (I group) showed a decrease in the duration of surgery (90±34 to 95±39 min), a decrease in the frequency of postoperative liquorrhea (2 to 6 cases) and provides better view on the ventral and ventrolateral tumors, that, in turn, improves the treatment radicality. The time of in-hospital stay was equal between groups (4±1 to 5±1 days), volume of intraoperative blood loss was equal in both groups (55±19 to 54±15 ml). The severity of pain syndrome on the first day was slightly higher in the I group (3.1±0.8 to 2.9±0.7 points), but on the third day, the results did not differ significantly (2.2±0.7 to 2±0.7 points). Also, it was found that the paramedian approach provides a better intraoperative view of the lesions of the ventral and ventrolateral localization and allows the paramedian incision of the dura mater to be performed, which in turn reduces the time required for suturing and sealing the dura mater 8.7±3.7 to 12±3.9 min.

CONCLUSION: The use of minimally invasive paramedian approach for ventral and ventrolateral extramedullary intradural tumors surgery is an effective method that provides better angle of surgical attack and allows to increase safety and radicality of tumor resection.

INTRODUCTION. Meningiomas occur in 18–34 % of cases of all intracranial neoplasms in adults. Intracranial meningiomas recurrence and progression occurs, on average, in 25 % of patients, even after radical tumor removal and radiotherapy, which significantly worsens the prognosis and functional outcome.

PURPOSE. To describe the neuroimaging features picture in patients with Intracranial meningiomas recurrence and progression, to show the capabilities of modern diagnostic methods (MRI, MR perfusion, PET-CT) in assessing the progression in meningiomas.

MATERIALS AND METHODS. The basis of the study consisted of patients (n=105) with intracranial meningiomas recurrence and progression Grade I–III, treated in the Department of Neurosurgery No. 4 of the Russian Neurosurgical Institute named after. prof. A.L. Polenov in the period from 2014 to 2022. An analysis of intrascopic data in patients with recurrence and progression of meningiomas was carried out. Tumors were characterized by volume, contours, the presence of perifocal edema and the degree of its severity with analysis in DWI mode (ICD) and assessment of MR perfusion parameters (ASL-perfusion), severity and type of contrast, the presence of a border with normal brain and assessment of additional signs (“comet tail”, hyperostosis, erosion of adjacent bone, extracranial spread, sinus invasion). The PET/CT procedure was performed on a combined system for positron emission and X-ray computed tomography. In case of tumor recurrence, its localization and direction of growth were also assessed. During the study, the results obtained were processed by the STATISTICA 10.0 software system.

RESULTS. Introscopy data for recurrent intracranial meningiomas were analyzed, the main trends in the oncogenesis were identified, and the most common diagnostic features of tumor progression were identified, which need to be taken into account for planning surgery and treatment tactics.

CONCLUSION. In diagnosing recurrence and progression of intracranial meningiomas it is important to examine patients comprehensively, using the modern research methods of neuroimaging.

Patients should be followed up, and if signs of tumor progression occur, immediately be referred to the stages of specialized medical care.

Patients with glioma demonstrate a high variability of clinical symptoms, in addition to differences in treatment response and survival. Many patients experience epileptic seizures at the onset of the disease, especially with low-grade gliomas, but not all have seizure episodes. A significant portion of patients develop refractory seizures. It is likely that the variability of epileptic symptoms cannot be explained solely by tumor-related factors, but rather reflects a complex interaction between tumor-related factors, environmental factors, and genetic factors.

MATERIALS AND METHODS. There is no data on predisposition genes associated with epileptic symptoms in patients with glioma. However, an increasing number of candidate genes have been proposed for other focal epilepsies, such as temporal lobe epilepsy. Some candidate genes associated with focal epilepsy may contribute to the development of epileptic symptoms in patients with glioma.

RESULTS. This review presents updated information on studies of genetic polymorphisms and focal epilepsy, as well as described candidate genes for tumor-associated epilepsy based on the assumption that there may be common etiological pathways for glioma development and glioma-associated seizures.

CONCLUSION. Genes involved in immune response, synaptic transmission, and cell cycle control are discussed as potential players in the pathogenesis of tumor growth and epileptic symptoms in patients with gliomas.

The high prevalence of arachnoid cysts (AC) of the brain, often with epileptic seizures, and the uncertainty of their relationship.

PURPOSE: To analyze the experience of surgical treatment of children with AK and epileptic seizures using the method of determining craniospinal compliance.

MATERIALS AND METHODS: The study included 36 children with supratentorial AKs aged from 9 months to 17 years. Inclusion criteria: 1) patient age under 17 years; 2) the presence of supratentorial ACs according to MRI of the brain; 3) detection of at least 2 epileptic seizures in patients with AK for more than 24 hours; 4) verification of pharmacoresistance is not mandatory; 5) patients were taking antiepileptic drugs. AK with epilepsy without hypertensive syndrome and AK with a combination of hypertension and epileptic syndrome. During surgery, an infusion-load test was used in 10 patients to assess the biomechanical properties of the craniospinal system.

RESULTS. ACs of the lateral fissure of the brain were detected in 24 (66.7 %) patients, convexital ones — in 11 (30.5 %), interhemispheric fissure — 1 (2.8 %). In the first group, localized epileptic activity was found in 20 (76.9 %), unilateral multifocal — in 4, diffuse — in 2. The localization of AC in 22 (84.6 %) cases did not coincide with the location of the epileptic focus. In the second group, focal activity was detected in only one child, and the localization of the lesion and the AC did not coincide. In the first group, operations aimed at removing the epileptic focus, neuromodulation and disconnection were performed. In the second group — cystocisternostomy for the correction of hypertension syndrome. In the first group, the outcome was Engel I in 14 (53.8 %) patients, Engel II–IV in 12 (46.2 %). In the second group, the hypertension syndrome regressed in all observations, and the epileptic syndrome did not undergo significant changes.

CONCLUSION. AK manifested by hypertensive syndrome is an indication for cystocisternostomy, and the use of methods for assessing craniospinal compliance allows optimizing treatment tactics. Drug-resistant epilepsy with a localized epileptic focus requires its removal, regardless of the presence of AC.

Ulnar tunnel neuropathy at the level of the elbow joint is a common compression-ischemic neuropathy of the upper extremities. There are a large number of minimally invasive and endoscopic methods of decompression and subcutaneous relocation of the ulnar nerve, which are aimed at preventing the development of dislocation. In this article, we describe a method of endoscopically assisted axillary ulnar nerve transposition that avoids the negative side of subcutaneous nerve transposition.

PURPOSE OF THE STUDY — to present a new method of endoscopically assisted axillary repositioning of the ulnar nerve in cubital tunnel syndrome. The endoscopically-assisted axillary movement of the ulnar nerve in cubital tunnel syndrome using an endoscope with an external diameter of 4.0 mm and optics 300 (Richard Wolf, Germany) is described and illustrated in detail.

THE METHOD of axillary transposition of the ulnar nerve developed by us corresponds to the principles of minimally invasive surgery and allows us to significantly reduce intraoperative trauma, keep the muscles attached to the medial epicondyle of the humerus intact, perform decompression and neurolysis of the ulnar nerve at all possible levels of compression with a small skin incision.

This article is devoted to the description of historical aspects of the development and formation of modern clinical and instrumental methods of examination of patients with diseases (compression-ischemic, peripheral nerve sheath tumors) and injuries of the brachial plexus.

Taking into account the complex anatomical structure of the brachial plexus, it is problematic to reliably compare anatomo-pathological parameters with functional-pathological changes of peripheral nerves in patients with diseases and traumatic lesions. Then to help, in addition to clinical and neurological examination, come instrumental methods of diagnosis, which can be divided into 3 large groups: vegetative, neurophysiological and radiation. With the help of all these studies, it is possible not only to localize the topical lesion of the brachial plexus, but also to determine its severity.

Brain damage against the background of a new coronavirus disease is characterized by a wide range of clinical and morphological manifestations: from cognitive impairment to massive strokes. However, the response of glia and the microvascular changes in the cerebral cortex in asymptomatic CNS lesions against the background of COVID-19 have not been studied enough.

PURPOSE OF THE STUDY: to analyze the glial-vascular reaction of the brain of patients with COVID-19.

MATERIALS AND METHODS: In the course of the study, a comparative characteristic of reactive changes in the glial and vascular components of the brain tissue of patients who died of heart failure (n=5) and patients infected with the SARS-CoV-2 virus and died of respiratory failure (n=10) was performed.

RESULTS. In patients with COVID-19, the expression of the SARS-CoV-2 nucleocapsid protein marker in the cytoplasm of neurons was detected. The glial-microvascular reaction was characterized by reactive astrocytes proliferation and hypertrophy, reactive microglial cells proliferation with an increase in the proportion of intermediate and activated morphotypes and changes in the capillaries and arterioles.

CONCLUSION. Reactive changes in astrocytes and microglial cells indicated neurodegenerative processes in the brain of patients infected with a new strain of coronavirus, which, in combination with pathology of the microvasculature, can cause further progression of central nervous system damage against the background of COVID-19.

The authors revealed the nutritional features of patients after neurosurgical surgery. The work describes the requirements of the European community for the maintenance and time of nutrition of patients after neurosurgical operations. The work presents as an example the ratio of proteins and carbohydrates recommended for consumption by patients after neurosurgical operations in the first twenty days. Peculiarities of eating behavior and key dangers that threaten patients in the event of untimely consumption of food on the first day after surgery are also revealed.

The possibility of developing hydrocephalus due to extraventricular cisternal obstruction was discovered in the 20th century. The development of neuroimaging and endoscopic techniques has made it possible to plan and perform minimally invasive surgeries in a narrow anatomical corridor with a good results.

PURPOSE OF THE STUDY: to determine the effectiveness of endoscopic surgery for hydrocephalus due to idiopathic extraventricular cisternal obstruction of the CSF pathways.

MATERIALS AND METHODS. Sixty-five patients with hydrocephalus due to extraventricular obstruction was evaluated and operated at the Center of Neurosurgery from 2007 to 2020. Preoperative Kiefer scale rate was 6.8 + 3.3 (0–15) points, and Rankin scale rate — 2.2 + 1 (0–5) points. Endoscopic third ventriculocisternostomy was performed in 42 (64.6 %) patients. Shunt-surgery was performed in 17 (26.1 %) patients. Six (9.2 %) patients didn’t operate.

RESULTS. After endoscopic surgery, the condition of patients significantly improved (p < 0.001) after 2 and 12 months. Complete or partial regression of symptoms was noted in 85 % of patients 1 year after surgery. After shunt-surgery, the trend is comparable. The only position of the premamillary membrane and “flow void” have correlated with the condition of patients. Other characteristics of the CSF-pathways of the brain didn’t actually change. In all cases of the endoscopic surgery, an additional membrane conglomerate was found under the premamillary membrane that was the same to preoperative tomograms.

CONCLUSION. The high efficiency of endoscopic third ventriculocisternostomy allows to recommend using that as the primary one in patients with extraventricular obstruction of the CSF pathways. but not for cases of anatomy abnormalities of the third ventricular fundus area (short premamillary membrane in combination with a high standing bifurcation of the basilar artery) and cisterns of the posterior cranial fossa base (narrow cisterns, impossibility to move endoscope under the premamillary membrane).

Since 2021, theoretical studies in the framework of a collaboration between researchers of Mental Health Research Center (and Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University) and Polenov Neurosurgical Institute, Almazov National Medical Research Centre have resulted in the formation of a consortium designated as “Cytogenomic epileptology”. Here, the work of the consortium is described; the essential problems, which are planned to be solved by our consortium members, are listed. More specifically, chromosomal abnormalities and copy number variants are insufficiently studied in epileptic disorders; these types of genetic pathology are excluded from current epilepsy classification; analyses of intraoperational (postoperational) samples are limited to searching gene mutations; systems genomics is rarely used for uncovering epilepsy pathogenesis. It is planned to invite additional consortium members according to selection criteria.

Cerebral AVMs can be considered one of the most difficult problems in the practice of vascular neurosurgeon. Modern studies indicate that AVMs are a dynamically developing disease, the main role in the progression of which is played by angiogenesis.

CASE REPORT. A 46-year-old patient with AVM of the right temporal lobe with epileptic type of course. After pre-investigation and preoperative preparation the patient underwent two-stage endovascular and microsurgical treatment. The patient was evaluated the dynamics of vascular endothelial growth factor (VEGF) level, which served as a reason for correction of surgical approach.

CONCLUSION. The combination of all studied technological solutions in embolization of cerebral AVMs with the detailing of biological features of the malformation (identification of AVMs prone to growth or recurrence) will allow to create an optimal strategy of surgical treatment of AVMs.

Epilepsy remains a difficult disease to overcome. One of the modern and promising areas in the search for new strategies for the treatment of difficult-to-treat forms of epilepsy is the combination of AEDs with antioxidants that affect the pathogenetic aspects of this disease. In 2021, PIK-PHARMA launched a new original drug for the treatment of epilepsy on the Russian market with the international generic name “fenosanoic acid” (FA) — dibufelon.

AIM: To evaluate the clinical efficacy and prospects of dibufelon using data from the literature review and clinical observation

MATERIALS AND METHODS. Study design — analytical review of the scientific literature. Subject of the study — focal epilepsy. Subject of the study was the clinical efficacy and prospects for the use of FA. The clinical example shows the effects of the use of dibufelon in seizure relapses.

RESULTS. In the study of the pharmacological properties of the drug, it was found that FA is rapidly absorbed from the gastrointestinal tract into the systemic circulation, remains long enough in the human body despite its high total clearance, and also penetrates well into organs and tissues. The study of the tissue availability of FA confirmed its entry into the brain as the zone of realisation of the anticonvulsant effect. Simultaneous administration of FA and valproic acid did not significantly affect their pharmacokinetic parameters.

According to the results of the clinical trial of the drug, a reduction in seizure frequency of at least 50 % from baseline was observed in 41 % of patients; the frequency of secondary generalised seizures decreased by an average of 75 %. A clinical example of the addition of dibufelon to a relapse of seizures showed good tolerability and efficacy of the drug.

CONCLUSION. Experience with the use of dibufenol in clinical practise has shown that, taking into account its complex antiepileptic and antioxidant effects, it can be optimally used as an adjunctive therapy in seizure relapses.

Dibufenol is a new antiepileptic drug with an original mechanism of action, efficacy in add-on therapy for focal epilepsy and a favourable tolerability profile.

Brain herniation is a congenital combined malformation of the brain and skull. Cause of this pathology is a defect in the closure of the anterior end of the neural tube during embryogenesis. The uniqueness of this clinical review is based on the fact that we have considered case of occipital encephalocele in a child, the family anamnesis of which suggests an autosomal dominant inheritance of the defect.

MATERIALS AND METHODS: We have analyzed results of the clinical and anamnestic examination and microsurgical treatment of encephalocele in a patient at the pediatric neurosurgery department № 7 of the Almazov National Medical Research Centre. A genealogical method was used to identify the nature of inheritance of the defect. Analyze of polymorphisms in the folate cycle genes (MTHFR, MTR, MTRR) was performed.

RESULTS: The patient and his relatives have a mild form of the disease with only the meninges present in the hernial sac. The patient underwent successful microsurgical correction of the anomaly. Analysis of the pedigree made it possible to identify 7 more relatives on the maternal side with similar formations in the occipital and frontal region, without severe consequences for life and health, with a probability of inheritance of about 50 %, which indicates an autosomal dominant type of inheritance. We also have identified heterozygous carriage of the MTHFR: 677 C>T (Ala222Val) and MTRR: 66 A>G (lle22Met) polymorphisms, likely predisposing to the formation of a mild phenotype of the disease

CONCLUSION: Serious defects in the formation and closure of the neural tube are in most cases incompatible with life. Such pathology is most often associated with habitual miscarriage or gross malformations such as cranial and spinal hernias. These developmental anomalies have a neurological component complementary to their severity, depending on the degree of involvement of brain structures.

The clinical case we have examined is atypical — the child and his relatives have only external manifestations of the anomaly without obvious focal and cerebral symptoms and a decrease in the quality of life.

Clinical and genealogical data allow us to assess this situation as a genetic disease with autosomal dominant inheritance.

INTRODUCTION. Meningiomas are the second most common central nervous system (СNS) tumors after gliomas in adults. The overall rate of meningioma recurrence is 14–33 % according to different authors.

PURPOSE. To discuss the challenges in diagnosis and treatment of recurrent meningiomas, to assess the clinical features and adjuvant treatment options. To present a clinical case of comprehensive treatment of intracranial meningioma recurrence.

MATERIAL AND METHODS. We searched for publications in the Pubmed, EMBASE, Cohrane Library and eLibrary databases published between January 2000 and January 2019 on the issue of recurrent intracranial meningiomas, in particular atypical and anaplastic meningiomas. The clinical case of supratentorial meningioma recurrence is reported.

RESULTS. The review systematizes data on the prognostic factors for survival, relapse-free period, and disease progression. Particular attention was paid to the radical resection of the tumor and the assessment of the grade of anaplasia. The current data on adjuvant treatment options were presented. The controversial issues of approaches to the assessment of morphological prognostic criteria were discussed.

Extensive transcranial approaches in brain tumor surgery are gradually being replaced by minimally invasive approaches. For meningiomas of the anterior cranial fossa (ACF) and middle cranial fossa (MCF) mini-pterional approach (MPA) and supraorbital approach (SOA) are most often used.

OBJECTIVE: The purpose of this study is to compare mini-invasive approaches in the treatment for tumors in the chiasm-sellar region (CSR) with an assessment of their frequency of use, topographic and anatomical features, basic surgical parameters, the nature and frequency of complications. In this paper, a systematic literary review of studies on SOA and MPA is carried out.

MATERIALS AND METHODS: This literature review was conducted in accordance with the recommendations of PRISMA 2020. To search for published works, such online databases as Pubmed/Medline and elibrary.ru with the corresponding search criteria for the period 1956–2023. For each publication, the type of study, the follow-up period, the number of investigated cases of each of the surgical approaches and the result of the study according to the selected criteria were evaluated. The data from the publications were grouped into two groups, respectively. In total, 51 publications were analyzed and a comparative assessment of MPA and SOA was carried out according to 4 criteria: frequency of use, topographic and anatomical features, basic surgical parameters, nature and frequency of complications.

RESULTS: MPA, unlike SOA, is not limited by any anatomical structures, as a result of which the size of the craniotomy in MPA is 1.5 times larger, which provides a significantly larger range of surgical working angles with a smaller depth of the surgical corridor. The complication rate is approximately comparable for both approaches. At the same time, SOA is much more often used in the surgery for tumors in the ACF and MCF, despite the same functional outcomes.

CONCLUSION: With the introduction of endoscopic and microsurgical techniques, many criteria for evaluating MIS-technologies fade into the background. The choice of the most appropriate access should not be based on the personal preferences of the surgeon, but on knowledge of the limitations of each type of approach and taking into account the individual characteristics of the patient. The main criteria for choosing approach are full-fledged visualization of the pathological focus, ease of operation in the operating wound and approach safety, which depend on its surgical parameters, topographic and anatomical features and the nature of postoperative complications.

The first attempts to use immunotherapy in the treatment of patients with glioblastoma were not successful enough. This failure was associated with the immunological privilege of the brain, such features of the tumor itself as low mutational load and genetic heterogeneity. Research conducted in recent years has clarified the features of the functioning of the immune system in the patients with glioblastoma. Today, one of the leading factors of immunosuppression is systemic lymphopenia, not only of an iatrogenic nature, but also induced by the tumor itself. We have presented a review on this topic with a description of three clinical cases with an assessment of the lymphocyte subpopulation in the peripheral blood and the infiltration of immune system cells into the tumor. Immunotherapy options for this group of patients are also presented, taking into account the particularities of the functioning of the immune system.