INTRODUCTION. The restoration of defects in the bones of the cranial vault remains an urgent task to this day, since it is necessary to prevent the development of post-trepanation syndrome. When using various materials for cranioplasty (titanium, PEEK, hydroxyapatite, etc.), the incidence of infectious complications ranges from 6.02 to 21.03 %, and they do not undergo osseointegration. For allocranioplasty with individual implant manufacturing using 3D modeling, a domestic bone replacement material biopolymer “Recost-M” has been developed and used, the ability of which to osseointegration has already been proven.

AIM. To assess the degree of osseointegration of an allograft from the “Recost-M” biopolymer in patients after its implantation in the long-term postoperative period.

MATERIALS AND METHODS. From 2017 to 2023, 27 cranioplasty operations were performed in adult patients at RostSMU. Among them, men – 16, women – 11. The average size of the defect of the bones of the cranial vault in men is 110.4±32.5 cm², in women – 85.7±37.8 cm². The implant made of “Recost-M” biopolymer using 3D modeling was fixed with craniofixes from any manufacturer, or with bone sutures at three or four fixation points. In all cases, when the skin-aponeurotic flap was detached, the integrity of the dura mater was preserved in order to avoid possible complications, such as accumulation of cerebrospinal fluid under the implant, cerebrospinal fluid, infection of the implant. In the neurosurgical department of the Republican Children’s Clinical Hospital of Ufa (NHO RDKB), the possibility of reconstructing skull defects using the material was studied “Recost-M” in 16 children aged 2 to 6 years.

RESULTS. During the entire observation period, infectious complications and trophic disorders of the skin-aponeurotic flap and implant depressurization, which may lead to implant removal, were not observed in all clinical observations. 5 years after allocranioplasty by CT scan of the brain in adult patients, signs of osseointegration of the implant from the biopolymer “RecostM” in the form of calcinate inclusions into the porous structure of “Recost-M” were revealed. There were no complications during the plastic surgery of skull defects in children with the domestic material “Recost-M” during the follow-up in the longterm period.

CONCLUSION. The obtained results of using an allograft from the “Recost-M” biopolymer showed both the absence of complications in the early postoperative period and the presence of osteointegration of the biopolymer in the long-term postoperative period, which indicates its advantage over existing titanium implants. And in the context of the need for import substitution, a biopolymer of domestic development is competitive and can be recommended for more frequent use in pediatric neurosurgical practice.

INTRODUCTION. The negative pressure therapy method for draining wounds in infectious and inflammatory diseases of the spine is an effective way to treat patients with infectious and inflammatory diseases of the spine. Available statistical data on the effectiveness of the method make it possible to create a mathematical function that predicts the effectiveness of therapy.

AIM. To evaluate the effectiveness of negative pressure therapy for wound drainage in infectious and inflammatory diseases of the spine in comparison with other drainage methods.

MATERIALS AND METHODS. 108 patients were included in the study. Drainage of purulent foci using the NPWT system was carried out in 30 patients who were treated in a hospital from 2016 to 2018 inclusive. The average age of the patients was 57.8 years. Supply-lavage drainage and active aspiration drainage using a Redon-type system were performed in 78 patients. The average age of patients in this group was 54.9 years. The disease was diagnosed on the basis of clinical and laboratory data and the results of radiological diagnostics (CT, MRI). The effectiveness criteria were: the duration of inpatient treatment, the wound healing time, the number of repeated surgical treatments (NPWT dressing change).

RESULTS. Good results were obtained in 100 patients: the duration of wound drainage in the study group was 4.3±1.8 days from the onset of NPWT, in the control group – 12.4±4.6 days (p<0.05). The average hospitalization period for patients in the study group was 46.6±26.3 days, in the control group – 33.8±10.8 days. In all patients, against the background of antibiotic therapy, the indicators of the systemic inflammatory response returned to normal within 6–8 weeks.

CONCLUSIONS. NPWT is an effective method of drainage of purulent foci in the treatment of infectious and inflammatory diseases of the spine and is not inferior in efficiency to other methods of drainage. At the same time, it allows the patient to remain mobile during the entire drainage period and facilitates patient care. Application of the NPWT method for drainage of purulent foci in the treatment of infectious and inflammatory diseases of the spine can shorten the drainage time.

INTRODUCTION. A modern assessment of the state of the brain and cerebrospinal fluid (CSF) communications in hydrocephalus in premature infants should include characteristics of outflow – absorption of CSF and the reactivity of brain tissue to pressure increase with increasing intracranial and cerebrospinal volume.

AIM. To study hydrocephalus in premature infants.

MATERIALS AND METHODS. The use of craniocerebral elastogram (CCE) with infusion hydrodynamic load (IHL) tests in 143 premature infants with hydrocephalus since 2008 has been studied. The effectiveness of restoring intracranial pressure (ICP) was evaluated, taking into account the volume of rapid (12–18 ml/min) and slow (18–27 ml/hour) movements of the CSF.

Results. An increase in ICP of more than 50 % reflected the lack of recovery of CSF outflow from the ventricles (after the ventricular IHL test) and resistant absorption (after the lumbar IHL) with the justification of indications for ventricularperitoneal bypass. With a decrease in CCE to 3 cm³/mm water pressure there was a residual expansion of the ventricular system with a ventricular index greater than 0.5, and below 1 cm³/mm water pressure irreversible changes in brain tissue without restoring the thickness of the brain mantle.

CONCLUSION. The data obtained make it possible to use the options of CCE and IHL in the diagnosis of hydrocephalus in premature infants, expand the possibilities of assessing the state of the brain and CSF communications with a characteristic of the effectiveness of outflow and absorption of CSF. 

INTRODUCTION. Non-specific pyogenic spinal infections (NSPSI) are represented by such nosological forms of the disease as spondylitis, spondylodiscitis, epiduritis, or their various combinations, caused by nonspecific microflora. One of the reasons for the increase in the duration of the disease before treatment and the frequency of complicated forms is the lack of regulated routing of patients with NSPSI. The work analyzes the results of implementing the developed algorithm for diagnosis and tactics for nonspecific pyoinflammatory lesions of the spine, as well as the route regulatory orders of the Ministry of Health of the Sverdlovsk region based on it.

AIM. To improve the results of surgical treatment of patients with NSPSI by reducing the time required for diagnosing the disease and providing specialized neurosurgical care.

MATERIALS AND METHODS. A comparison was made of the treatment outcomes of two groups of patients: 1 – control (before the implementation of the algorithm and orders) 73 patients, 2 – research (after implementation of the proposed algorithm and orders) 338 patients. A comparative assessment of the duration of the disease, the initial neurological status according to the Frankel scale, the severity of the systemic inflammatory response syndrome and the results of surgical treatment in terms of the dynamics of the neurological status, the frequency of postoperative complications, and the presence of severe disability of patients was carried out.

RESULTS. In the comparison groups, there was an increase in the number of patients with a short duration of NSPSI (15–30 days) from 13.7 % in group 1 and to 34.9 % in group 2, and a reduction in the number of patients with long periods (more than 90 days) from 31.5 % in group 1 and up to 7.9 % in the main group (p<0.05). From the comparison results, it was proved that in group 2 of patients there was an increase in the number of good treatment outcomes up to 80.2% compared to group 1 (57.5 %), and a fourfold decrease in unsatisfactory treatment results from 20.6 to 4.4 % (p<0.05).

CONCLUSION. By introducing a diagnostic algorithm and tactics for non-specific pyogenic spinal infections, it was possible to improve the provision of medical care to patients in clinics and hospitals in the Sverdlovsk region, and to create a flow of patients to a specialized multidisciplinary hospital.

INTRODUCTION. The general strategy for the growth of neuroepithelial tumors is a cascade of changes in the biological behavior of tumor cells and vascular endothelium that occur during the progression of the tumor process, taking into account transformation.

MATERIALS AND METHODS. The study material included current and archival biopsies of 780 highly malignant glial tumors contaminated with herpes simplex virus (HSV).

To detect HSV in tumors, an immunohistochemical (IHC) study was performed with antibodies to the HSV antigen. The control groups consisted of tumors that did not express antibodies to HSV and in which intranuclear inclusions characteristic of HSV were not detected.

RESULTS. High-grade glial tumors, which include glioblastoma, anaplastic astrocytoma, anaplastic oligodendroglioma, anaplastic oligoastrocytoma, and anaplastic ependymoma, showed staged growth. The growth rate was determined by the ratio of growth factors, which include primarily the ratio of apoptotic p53 and anti-apoptotic factor bcl-2, the index of proliferative activity, as well as the number of vessels in the most vascularized (“hot”) spot. Part of the viral genome that entered the tumor and endothelial cells changed the growth rate of the host cell population. The productive inflammation that occurs in response to changes in the host cell genome stimulates proliferation processes, changing the rate of apoptosis. During the study, a method of using etiopathogenetic antiviral treatment was proposed.

CONCLUSION. The significance of the HSV genome for glial tumors is enormous. It tries to preserve the tumor cell, on the one hand, but sharply increases the ability of the endothelium to divide during the joint replication of genetic material, on the other hand. The result of the proven complex mechanism of growth of glial tumors was the method of etiopathogenic antiviral treatment, which made it possible to extend the relapse-free period by an average of two times for all groups of high-grade gliomas.

The formation of hydrocephalus in Arnold – Chiari type II anomaly has an obstruction mechanism, which consists in disconnecting the cerebrospinal fluid system of the brain and the cerebrospinal fluid space, turning off the damper function. Having considered the pathogenetic foundations and anatomical variants of the relationship between the structures of the posterior cranial fossa, it was revealed that endoscopic third ventriclostomy does not restore the communication of two liquor compartments and, as a result, cannot be a method of treating hydrocephalus in this pathology. Decompression of the posterior cranial fossa has extremely limited use. Ventriculo-peritoneal shunting is a universal and effective method of treating hydrocephalus in Arnold-Chiari type II malformation. Intrauterine correction myelomeningocele is the only method of preventing hydrocephalus in children with open forms of spinal dysraphism.

INTRODUCTION. High level expression in tumor cells of various cellular growth factors, their receptors and activation of intracellular signaling pathways take an important part in recurrence of intracranial meningiomas (Grade III). There is a group of patients with aggressive meningiomas characterized by frequent recurrences and low survival rate. The following surgery is associated with high risk of appearance or worsening of neurological deficit, radical tumor removal is not always possible. Radiotherapy is also limited in some cases or not effective enough.
AIM. To evaluate the degree of development of the theme of chemotherapy use in patients with meningiomas of different anaplasia degree according to the world literature data; to present our own data on chemotherapeutic treatment of a patient with recurrent meningioma.
MATERIALS AND METHODS. The search of printed works in Pubmed, EMBASE, Cohrane Library and eLibrary databases was carried out on the issue of chemotherapeutic treatment use in patients with intracranial meningiomas. There is a description of a clinical case of chemotherapy use in complex treatment of a patient with recurrent intracranial anaplastic meningioma in Polenov Neurosurgical Institute — the branch of Almazov National Medical Research Centre.
RESULTS. The results of some experimental studies and clinical use of chemotherapeutic drugs of different groups in patients with intracranial meningiomas are presented. Our own data on chemotherapy use in a patient with recurrent meningioma are given.
CONCLUSION. Specific antitumor treatment is a part of complex treatment for patients with recurrent meningiomas Grade II–III. The efficiency and safety of this therapy have been proved in some studies and also shown in our clinical example.

INTRODUCTION. In this paper, a literature review on the use of intravascular embolization in the treatment of patients with intracranial meningiomas is performed, and an example of using the technique of endovascular superselective chemoembolization of the tumor vascular network in a patient with a recurrent type of intracranial meningioma course is presented.
AIM. To conduct a meta-analysis, to evaluate results of preoperative endovascular superselective embolization of the vascular network of intracranial meningiomas with continued growth and recurrent course, and to present a clinical case.
MATERIALS AND METHODS. We searched Pubmed, EMBASE, Cohrane Library, and eLibrary databases for papers published between January 2010 and January 2023 on embolization of the vascular network of intracranial meningiomas, particularly in recurrence. Endovascular superselective embolization of tumor vascular network was performed in a patient with recurrence of histologically verified meningioma of parasaggital localization. Endovascular treatment was performed with the patient’s voluntary informed consent. Non-adhesive compositions and hypospheres loaded with Doxirubicin were used. In the early postoperative period, clinical, laboratory and intrascopic controls were performed.
RESULTS. The review systematizes the data on the application of techniques of intravascular embolization of meningiomas, presents the latest data on the efficacy of endovascular techniques for the treatment of patients with recurrent meningiomas. The authors conclude that endovascular superselective embolization of tumor vascular network in the structure of complex treatment of patients with relapsed and continued growth of intracranial meningiomas is an effective treatment method. A clinical case of successful application of endovascular techniques in a patient with recurrent meningioma of the base of the middle cranial fossa is presented on the example of our own material.
CONCLUSION. Application of endovascular superselective embolization of tumor vascular network in complex treatment of one of the most complicated groups of patients with recurrent course of neoplastic process (“aggressive” meningiomas) testifies to the effectiveness of this technique for devascularization of meningioma tissues, local administration of cytostatics and local control of tumor growth. Further development of the technology of endovascular super-selective embolization of tumor vascular network in the treatment of patients with “aggressive” meningiomas is necessary.

INTRODUCTION. The high frequency of hypertensive hydrocephalus and the effect of craniocerebral disproportion on the brainstem determine the relevance of this problem.

AIM. Show the possibility of indirect assessment of intracranial pressure (ICP) in children with hypertensive hydrocephalus based on non-invasive electrophysiological criteria and their use as a prognostic criterion.

MATERIALS AND METHODS. Electrophysiological studies were performed with the analysis of electroencephalography (EEG) in 96 children and brainstem auditory evoked potentials (BAEPs) in 42 (23 with occlusive and 19 with communicating). The functional state of the cerebral cortex and brain was assessed on the basis of the EEG, and the stem structures – using the BAEPs method.

RESULTS. Almost all (97.9 %) patients showed stable general changes in biopotentials in the form of high-amplitude hypersynchronous polymorphic activity, spreading to all parts of the cerebral cortex. Evaluation of BAEPs dynamics after liquor bypass surgery (LSS) in the immediate postoperative period showed a positive dynamic of BAEPs in 23 (79.3%) cases with the appearance of previously unidentified peaks, restoration of the waveform and the V/I amplitude ratio. In 13 (44.8 %) children, the amplitude and time parameters of BAEPs completely returned to normal.

INTRODUCTION. Traumatic brain injury (TBI) is a heterogeneous group of traumatic brain injuries, the heterogeneity of which is due not only to the variability of anatomical forms and biomechanics of damaging effects, but also to the degree of development of the neuroinflammatory process as a reaction to damage, followed by the involvement of cells of the innate immune response, followed by increased production of cytokines/chemokines, as well as recruitment to the injury zonee T- and B-lymphocytes.

AIM. to assess the relationship between changes in immunological parameters and the course of the post-traumatic period of the disease.

MATERIALS AND METHODS. 110 patients with TBI of varying severity aged from 18 to 55 years. Neuropsychological examination and evaluation of the outcomes of the disease were carried out according to the extended Glasgow and Rankin scale. The content of subpopulations of T- and B-lymphocytes was determined in venous blood, the level of cytokines and chemokines was determined in cerebrospinal fluid.

RESULTS. Significant correlations have been established between subpopulations of lymphocytes in peripheral blood (Th EM, Th2, eBm5) and disease outcomes, as well as the development of cognitive impairment. There were significant correlations between the outcomes of the disease and the content of cytokines (IL-6, IL-18, sCD40L) in the cerebrospinal fluid (CSF).

The analysis of correlations allowed us to evaluate the role of individual subpopulations of lymphocytes and cytokines in predicting the course of traumatic illness. Thus, the severity of the post-traumatic period of TBI is largely determined by the activity of the immune response, followed by secondary damage to the nervous tissue and maintenance of neuroinflammation.

INTRODUCTION. Currently, 23 AEDs with different mechanisms of action and different efficacy and safety/tolerability profiles are authorised in Russia. Clinical guidelines do not provide clear parameters for the choice of a particular drug in focal epilepsy – the decision on the AED regimen is at the discretion of the specialist. In such a situation, a comprehensive approach to AED selection is important, taking into account not only efficacy but also tolerability, especially in pharmacoresistant patients.

AIN. To evaluate the efficacy, tolerability and peculiarities of Zonisamide use in daily clinical practice in patients of different age groups.

MATERIALS AND METHODS. The study design was a review of the pharmacokinetic parameters of Zonisamide according to the literature and our own analysis of patient data in the structure of a retrospective observational cohort study. The study included patients with epilepsy receiving drug therapy with Zonisamide in 2 age groups: 1 gr. – adults up to 37 patients, 2 gr. – paediatrics (6 years – 17 years 11 months) – 13 patients. The age criterion in the paediatric group was chosen taking into account the authorised minimum age of administration of Zonisamide: 6 years and older.

RESULTS. The mean age in the cohort was 29.8±12.5 years. The male:female ratio was 1:1.2. The duration of disease in the cohort was 16.2±10.8 years (in group 1 = 19.7±10.1, in group 2 = 6.1±4.4). Zonisamide was used as monotherapy in 12 % and as polytherapy in 88 %. The average dosage in adults was – 301.6 mg/d. and in children – 182.7 mg/d. In the cohort, the combination of Zonisamide with levetiracitam dominated in polytherapy, followed by valproic acid and lacosamide in descending order.

A positive response to the therapy was observed in 36 (71 %) patients. Lack of efficacy or insufficient efficacy (less than 50 % reduction in seizure frequency) was observed in 14 (29 %) patients, but 40 % of them reported positive dynamics in the reduction of seizure severity and/or duration.

Adverse drug reactions were reported in 15 people. The average distribution of adverse drug reactions per person was 1.3.

Discontinuation of the drug due to intolerance occurred in 2(4 %) cases.

CONCLUSION. Zonisamide is used in a wide range of epilepsies: from idiopathic focal epilepsies to pharmacoresistant epilepsies in neurosurgical patients. Side effects of Zonisamide occur in less than one third of patients and are of mild to moderate severity.

INTRODUCTION. Traumatic radial neuropathy is not only an urgent problem of modern neurosurgery, but also cause serious socio-economic damage, as they lead to the disability of the working-age population. To this day, there are no generally accepted diagnostic algorithm and treatment of radial nerve injury.

AIM. To identify the reasons for the lack of effectiveness of primary diagnosis and treatment of radial nerve injuries in injuries of the upper extremities. To optimize the tactics of primary diagnosis and timely treatment of traumatic neuropathy of the radial nerve.

MATERIALS AND METHODS. Backcasting of 57 cases of isolated treatment of radial nerve, confirmed by clinical and instrumental diagnostic methods.

RESULTS. Traumatic neuropathy of the radial nerve cannot always be reliably determined in the acute period of damage to the upper extremities, which increases the risk of irreversible functional and morphological changes in the nervous and muscle tissue due to untimely treatment of neuropathy.

INTRODUCTION. Craniosynostoses (CS) are a group of malformations of the skull bones, manifested by the congenital absence or premature closure of cranial sutures. The method of correction of CS from 6 months is reconstructive surgery, which is characterized by high morbidity, and risk of perioperative complications, as well as a high frequency of transfusions of donor blood components. The issues of surgical stress response (SSR) after reconstructive operations with CS in children remain poorly studied.

Aim. To analyze hormonal and biochemical markers of SSR in CS children who underwent reconstructive surgery to substantiate the methods of SSR modulation for reducing the risk of postoperative complications.

MATERIALS AND METHODS. A prospective study of SSR markers was conducted in 32 patients with CS (24 boys and 8 girls) aged 10.29±4.99 months who underwent reconstructive surgery in the period 10.2021 to 06.2022 at the National Medical Research Center of Neurosurgery named after Academician N. N. Burdenko. Non–syndromic forms of CS were presented in 25 (78.1 %) cases, and in 7 (21.9 %) cases – there were syndromic forms. Several markers of metabolic, hormonal and hematological SSR were studied. Laboratory studies were carried out before surgery and on the 1^st, 3^rd and 5^th days after.

RESULTS. The article presents the dynamics of the studied clinical and laboratory parameters after reconstructive surgery for CS in children, as well as the characteristics of typical homeostasis disorders.

CONCLUSION. The course of the early postoperative period after reconstructive operations in children is accompanied by statistically significant changes in the level of stress response hormones, as well as a number of metabolic changes that cause the severity of the course of the postoperative period and determine the risks of undesirable consequences and complications. The study revealed the development of hypoferriemia in the early postoperative period, signs of insulin resistance and hyperglycemia, transient euthyroid sick syndrome. The absence of typical changes on the part of the levels of adrenocorticotrophin and cortisol was a consequence of the use of dexamethasone. The severity of the revealed changes testifies to the high morbidity of reconstructive operations in CS children, and also dictates the need for drug modulation of the stress response, and justifies the need to reduce surgical trauma due to the active introduction of minimally invasive surgery into clinical practice. 

INTRODUCTION. Meningioma is a common tumor of the central nervous system (CNS) in adults. Intraventricular meningioma localization is a rare location variant and accounts for 0.5 to 3.0 % of all intracranial meningiomas, and meningiomas of the IV ventricle are extremely rarely diagnosed.

AIMS. 1. To present a clinical example of successful fourth ventricle meningioma surgical treatment with patient follow-up assessment. 2. To assess the fourth ventricle meningioma diagnosis and treatment problem state based on the medical literature analysis.

MATERIALS AND METHODS. The disease history and histological examination data of the patient, who was operated in the 6th neurosurgical department of the Almazov National Medical Research Centre for the fourth ventricle meningioma with two-year catamnesis data after the surgery. Publication analysis in the Pubmed, EMBASE, Cochrane Library and eLibrary databases on the fourth ventricle meningioma issue.

RESULTS. The surgery clinical case of a patient with a fourth ventricle meningioma is described. It was fibrous meningioma (Grade I) by the tumor histological data. According to the two-year catamnesis data of the operated patient, a recurrence-free course of disease was noted. The literature review of fourth ventricular tumors issue is presented, the intraventricular meningioma issues origin are discussed.

This article is dedicated to the problem of occipital lobe epilepsy associated with intraparenchymal occipital schwannoma localization. The peculiarity is that occipital lobe epilepsy accounts for less than 10% of all forms of locally determined (partial) epilepsies, which is why some authors doubt its existence. Nevertheless, occipital lobe epilepsy is the second most frequent manifestation of such a rare condition as intraparenchymal occipital schwannoma localized in the occipital lobe. In our study, 15 clinical cases describing intraparenchymal occipital and occipital/temporal localization of schwannoma were analyzed, and up-to-date information on the pathogenesis, clinical presentation, diagnosis, and treatment of occipital lobe epilepsy and intraparenchymal occipital schwannoma was presented. The conclusions were made about confirming the existence of occipital lobe epilepsy and the need for further research in order to expand knowledge about this pathology and develop modern treatment methods.

Aim – to analyze clinical cases of occipital lobe epilepsy associated with intraparenchymal occipital lobe schwannoma.

According to the results of our analysis of known clinical cases, we found that epileptic seizures are the second most frequent symptom in the clinical presentation of intraparenchymal occipital and occipitoparietal schwannoma. Thus, this cannot but prove the possibility of diagnosing “occipital epilepsy.”

Occipitoparietal epilepsy is the rarest form of locally determined (focal) epilepsy, and according to some authors, it does not exist at all. The existence of occipital epilepsy as a diagnosis is confirmed by the fact that it is the second most frequent symptom detected in patients with intraparenchymal occipital lobe schwannoma. Undoubtedly, further clinical observations, morphological and genetic studies will expand the etiopathogenetic understanding of existing locally determined occipital forms of epilepsy associated with tumor processes, which in turn will allow us to approach the development of modern strategies for personalized treatment of occipital epilepsy.

It is known that most cancers arise as a result of genetic mutations leading either to loss of function of tumor suppressor genes or to activation of oncogenes against the background of a decrease in the body’s antitumor immune surveillance.

A number of patients with primary multiple cerebral tumors of various histological types may have one or another hereditary tumor syndrome.

This article discusses 27 hereditary diseases, one of the phenotypic manifestations of which are tumors of the nervous system, such as: neurofibromatosis 1 (Recklinghausen disease) and types 2; schwannomatosis; tuberous sclerosis; retinoblastoma; syndromes: Noonan, LEOPARD, Costello, Legius, Turcot 1 and 2 types 1, Li – Fraumeni, DICER, von Hippil – Lindau, Cowden, Gorlin, rhabdoid tumor predisposition, familial paraganglioma, melanoma-astrocytoma, BAP1, ELP1 tumor predisposition – medulloblastomas, Louis – Bar, Nijmegen, Wiskott – Aldrich, Bloom, Rubinstein – Taybi, as well as Fanconi anemia and Carney complex.

Degenerative cervical myelopathy (DSM) occupies a leading place among the causes of spinal cord dysfunction in the adult population in industrialized countries, and there is a tendency to increase the prevalence of the disease due to an increase in life expectancy. The clinical picture of myelopathic syndrome is quite multifaceted and in cases of disease progression, the existing neurological deficit can lead to significant disability. Effective prevention of irreversible disability is possible due to early diagnosis and timely surgical intervention followed by a course of postoperative rehabilitation. Currently, there are numerous data in the scientific literature on the effectiveness of postoperative rehabilitation, but clinical recommendations on this topic have not yet been published. This review presents current data on the epidemiology, diagnosis and principles of postoperative rehabilitation. Special attention is paid to the discussion of rehabilitation treatment regimens, both with potential for use and already used in clinical practice.

Cervical subaxial kyphotic deformity is a socially significant problem, leading to a decrease in the quality of life, up to complete disability. This article highlights modern methods of subaxial deformity surgery, their advantages and disadvantages.

Aim is analysis of treatment option using in cervical spine deformity surgery, based on the literature data.

117 literature sources were analyzed from 2004 to 2023 PubMed and Google Scholar databases were used as resources using queries on medical topics for the terms “cervical spine deformity”, “cervical kyphosis surgery”, “cervical spine sagittal balance”. We used 27 articles that are most suitable for search criteria published in English and Russian. There were no evidence level restrictions. The issues of pathogenesis, clinical picture, methods of assessing the sagittal profile of the cervical spine, as well as various methods of surgical treatment and their complications are highlighted.

Choosing the optimal treatment tactics can be difficult and often contradictory due to the large number of complications, both anesthetic and surgical. Therefore, the design of the surgical option should be based on deformity severity, its type, clinical presentation, as well as the individual characteristics of the patient.

INTRODUCTION. In some cases, after laminoplasty or anterior corporodesis, radiculopathy of the C5 root develops at the cervical level of the spine, the features of which are not reflected in the domestic literature, which may cause doctors difficulties in predicting its outcome and treatment.

AIM. To present our own observation of radiculopathy of two – C5 and C6 – roots after laminoplasty and laminectomy, its features and possible measures to prevent such a severe postoperative complication.

MATERIALS AND METHODS. The work is based on anamnesis, assessment of the dynamics of movements and sensitivity on a well-known five-point scale, pain – on a visual analogue scale, data from magnetic resonance imaging and electroneuromyography in a patient born in 1937, who was diagnosed in one of the institutions in St. Petersburg at the age of 85 years, laminoplasty of C3, C4, C6 and laminectomy of the C5 vertebrae were performed due to stenosis at this level.

RESULTS. The presented clinical and ENMG data indisputably indicated radiculopathy of the C5 and C6 roots associated with the operation of laminoplasty-laminectomy at the cervical level of the spine. The frequency of such complications, according to summary literature data, ranges from 0 to 30 %, averaging 5.6 %. Moreover, the more severe the degree of movement disorders, the slower the recovery occurs, taking from 3 to 12 months. At the same time, in 28 %, recovery is insufficient even after 55+17 months.

CONCLUSION. When performing laminoplasty and laminectomy for cervical spinal stenosis, there is a possibility of developing radiculopathy of the C5, C6 roots, for the prevention of which, taking into account the literature data, it is recommended: 1) before the operation, perform ENMG to identify signs of subcompensated suffering of the cervical roots in the operation area. Identification of such signs gives grounds to supplement laminoplasty with microforaminotomy at this level; 2) at the access stage, gently spread the neck muscles to the sides, followed by periodic weakening of their retraction; 3) when performing laminoplasty, limit the angle of spread of the arches within 15–30°, and during laminectomy, the width of the latter should not exceed the width of the spinal cord by more than 2–3 mm; 4) in cases of eliminating kyphosis, in order to avoid compression of the roots, pay attention to limiting the arc of lordosis formation. 

Aneurysms of the cavernous segment of the internal carotid artery (ICA) are a rare pathology. Due to their deep localization in an anatomically complex region, these aneurysms are difficult to access for open microsurgical treatment. Due to the development of intravascular methods of treatment, including the appearance of flow-diverter stents, new opportunities in the treatment of this pathology with reconstruction of the affected segment have appeared.

Aim – to describe a case of successful treatment of a large aneurysm of the cavernous segment of the internal carotid artery with significant postaneurysmal stenosis using a flow-diverter stent followed by balloon angioplasty.

Flow-diverter stents is an effective method of treatment of large and giant aneurysms of the cavernous segment of the internal carotid artery. Due to the flow diversion effect, this modality of treatment allows to disconnect the aneurysm from the blood flow with a decrease in its mass effect on the surrounding structures, providing in the remote period the restoration of the function of the oculomotor nerves in the overwhelming number of cases.

The frequency of spondylodiscitis is 1.0–2.5 cases per 100 000 population, accounting for 4–8 % of the total structure of osteomyelitis.

In some studies, the overall incidence varies from 2.2 to 11.3 cases per 100 000 and above.

The aim of the study – to show the significance of the revision of clinical recommendations and to identify weak links at the pre-hospital stage.

A comparative analysis of the relevance of scientific articles was carried out.

The methods of detecting spodilodiscite are very ambiguous, today they require the creation of a single protocol.

Diagnosis of spondylodiscitis at the prehospital stage is not effective. In most patients, the disease is detected in the advanced stage. To improve the effectiveness of medical care and reduce neurological deficit in this category of patients, it is necessary to revise clinical recommendations with the creation of a single protocol for inflammatory diseases of the spine.

INTRODUCTION. The use of laminoplasty is increasingly common in modern clinical practice. Despite the obvious advantages, this operation is fraught with a number of problems, in addition, like any invasive procedure, it is fraught with potential complications. In recent years, revolutionary advances in technology have changed many disciplines and sectors, with medicine, more specifically neurosurgery, becoming the most important area of such innovative metamorphoses. The intersection of artificial intelligence (AI) and neurosurgery heralds a futuristic chapter with unprecedented potential that promises improved surgical practice conditions and patient outcomes. The application of AI to the laminoplasty method can be considered as the basis for the development of this direction.

AIM. To to analyze the possibilities of using AI in laminoplasty, the most important method of decompression of the spinal canal.

MATERIALS AND METHODS. A meta-analysis was carried out on publications on this topic, on English- and Russianlanguage resources: PubMed, Medscape, eLibrary. The search was carried out by keywords: “AI”, “laminoplasty”, “posterior access”, “introduction of AI into neurosurgery”, “cervical spine”. All works were considered in the time range from 2019 to 2023. The number of selected and analyzed works is 68.

RESULTS. The data on the positive outcomes of the use of AI in neurosurgery were revealed, namely, those related to the analysis of instrumental data (MRI), preoperative studies, intraoperative changes and also the direct use of AI in surgical intervention.

CONCLUSION. By integrating AI, we can optimize diagnostic accuracy, surgical planning, and operational accuracy, significantly improving patient outcomes. However, the introduction of AI involves relevant ethical and legal considerations that require careful study.

INTRODUCTION. Traumatic subarachnoid hemorrhage is common in brain injury and is associated with direct mechanical damage to cortical arteries and veins. Such hemorrhages are typically found on the convexital surface of the hemisphere. Cases of massive traumatic subarachnoid haemorrhage in the basal tanker area are more rare. In some of these patients, the cause of hemorrhaging is a ruptured cerebral aneurysm.

MATERIALS AND METHODS. Presented the clinical case of a 24-year-old patient who was treated in the Department of Neurosurgery of the Regional Clinical Hospital of Krasnoyarsk. The fracture of the jaw and rupture of the cerebral aneurysm in 2021. The article reviews scientific publications on cerebral aneurysm ruptures in patients with injury in databases Library and Pubmed for the period 2000-2023.

RESULTS. In the presented clinical observation in a patient who suffered an injury – a fracture of the jaw, a rupture of the communicative segment of the internal carotid artery was found. The patient had no primary cerebral complaints, which did not immediately raise concerns about a possible rupture of the aneurysm. Emergency surgical treatment – microsurgical clipping of aneurysm. There are similar observations in scientific publications, but none of them have been able to establish the primacy of injury or rupture of an aneurysm.

CONCLUSION. It is virtually impossible to prove conclusively that the patient suffered an injury or a rupture of a cerebral aneurysm. However, this is not a priority for practical work. The main thing is to diagnose a ruptured aneurysm in time, including in patients with a clear traumatic history, when subarachnoid hemorrhage is considered as a consequence of brain vascular trauma.