INTRODUCTION. The paper considers the possibilities of surgical treatment of diseases and injuries of the peroneal nerve, which are based on the analysis of a comprehensive examination and surgical treatment of 143 patients with injuries and diseases of the peroneal nerve in 2009–2020 operated in Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre.

AIM. To evaluate the possibilities of surgical treatment of diseases and injuries of the peroneal nerve.

MATERIALS AND METHODS. Among the patients, men predominated 60.3% in the age group from 21 to 50 years (48 %). Compressive-ischemic neuropathies of the peroneal nerve (CIMN) were detected in 41 (28.7 %) cases, space-occupying lesions of the peroneal nerve were detected in 7 (4.9 %) cases, closed traction injuries (CIMN) of the peroneal nerve (dislocation in the knee joint) were noted in 22 (15.4 %) patients, open injuries of the peroneal nerve were detected in 31 (21.6 %) cases, neuropathy of the peroneal nerve as a result of closed injuries (NMNRLD) in 31 (21.6 %) cases.

RESULTS. The variants of surgical treatment depending on the etiology of the peroneal nerve lesion were studied. After the surgical treatment and processing of the obtained results, the analysis showed that a significant regression of neurological symptoms and an improvement in ENMG parameters in the immediate postoperative period was detected in groups of patients with tumors of the peroneal nerve and CINMN (p<0.01), in contrast to the groups of patients with MTMT, open injuries of the peroneal nerve where the results appear no earlier than 6 months after surgical treatment. And they are quite comparable with the results of treatment of patients with NMNRZD. The pain syndrome is similar to that in lesions of the spinal nerve root at the level of the L5 vertebra in lateral stenosis. A thorough clinical examination with Tinel’s sign at the level of the fibular head and an ankle re-extension test allows a correct diagnosis of peroneal dysfunction and, accordingly, reduces the incidence of ineffective surgical interventions on the lumbar spine. The proposed technique for severe diastasis of the peroneal nerve after excision of intratruncal neuromas (patent RF No. 2766800 dated March 15, 2022) is an effective method of surgical treatment.

INTRODUCTION. WHO declared epilepsy one of the most common neurological diseases. According ILAE classification developmental and epileptic encephalopathies (DEE) are generalized genetic epilepsy. DEE represent a clinically and genetically heterogeneous group of age-dependent neurologic disorders characterized by onset of refractory seizures in infancy or early childhood with delayed psychomotor development or developmental regression. Advanced genetic methods have enabled more specific delineation of these clinically defined disorders at the molecular level.

MATERIALS AND METHODS. We tried to search DEE from positions of system genomics. As the basic instrument of search resource OMIM was used (data current as of July 2024). An analysis of the success of predicting cytogenetic loci and functional groups of new genes was performed.

RESULTS. Over 2.5 years, 17 new variants of DEE were described. In 94% of cases, their genes corresponded to the functional groups we had previously published. In 53 % of cases, the genes of new forms were in the same loci as previously known genes. New data allowed us to clarify the boundaries of “hot” cytogenetic loci.

CONCLUSION. The obtained data confirm the high efficiency of the developed predictive model. Testing with new data showed 94 % compliance for physiological mechanisms and 53 % for cytogenetic loci. This model can be applied to other nosological groups.

INTRODUCTION. Ependymomas are rare tumors; according to the literature, they account for 2 to 6 % of all spinal cord tumors in adults, while they are one of the most common intramedullary tumors. The main goal of surgical treatment of spinal ependymomas is total removal of the tumor while preserving healthy spinal cord tissue. At the moment, little information is provided about the consequences of radiotherapy before surgery.

AIM. Analysis of surgical treatment of 37 own observations and presentation of a clinical case of a patient with intramedullary ependymoma at the level of the cervical spine.

MATERIALS AND METHODS. We analyzed the data of 37 patients, including 20 men and 17 women, aged from 19 to 83 years (the average age of patients was 44.3 years), operated on at the Neurosurgical Department No. 1 of the Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre in the period from 2019 to 2023. Upon admission, all patients underwent an assessment of their neurological status, functional status according to the McCormick scale, and an assessment of the involvement of the spinal canal structures in the pathological process according to MRI data.

RESULTS. We describe a series of 37 operated patients with the aim of contributing to the already published knowledge about the course and results of surgical treatment of patients with spinal cord ependymomas of various locations.

CONCLUSION. Based on the analyzed data, it can be concluded that radiation therapy in the preoperative period had a negative effect on the radicality of surgical treatment. A molecular genetic study of the MYCN gene carried out in recent years makes it possible to predict the further course of the disease: growth rate and possible tumor relapse.

INTRODUCTION. Determination of indications for liquorosunting operations in patients with chronic impairment of consciousness (CHF) is an urgent problem, and the criteria for the effectiveness of surgical treatment have not been fully studied.

AIM. To determine the indications and criteria for the effectiveness of liquor shunting operations in patients with chronic impairment of consciousness.

MATERIALS AND METHODS. In Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre in the period from 2004 to 2018, surgical treatment of patients with CNS was carried out, the decision on the need for liquorosunting surgery was made on the basis of a comprehensive clinical and intrascopic examination, since standard indications for surgery were not enough.

RESULTS. After the infusion-load test and determination of biomechanical parameters of the craniospinal system, the parameters of the valve of the shunting system were determined. Dynamics of ventricular system size in the early postoperative period was not revealed. 30 days after surgery, control CT perfusion was performed, according to which there was a significant increase in cerebral blood flow in the basal nuclei and a decrease in the average time of passage of the contrast agent.

CONCLUSION. The definition of indications for the implantation of a shunt system must have an integrated approach must consider not only the CT signs of increasing ventricular system in combination with the hypertension syndrome, but these modern methods of examination (TCD, MRI/CT perfusion, the data of infusion-load test).

INTRODUCTION. Paraclinoid aneurysms (PA) account for 5.4 % of all intracranial aneurysms, 49% of these cases are large or giant. The hospital mortality rate of patients who have undergone aneurysm rupture is 27–67 %. More than half of the survivors have persistent neurological deficits and a decreased quality of life.

AIM. To evaluate the immediate and long-term results of microsurgical treatment of PA in the acute period of subarachnoid hemorrhage (SAH).

MATERIALS AND METHODS. We analyzed the results of clinical examination, microsurgical treatment, and outcomes of 75 patients with paraclinoid aneurysms who were in the Department of Neurosurgery of the Moscow Regional Research and Clinical Institute for the period from June 2019 to November 2023. A preoperative clinical and neurological assessment of the patients’ condition was performed, and the Glasgow Coma Scale (GCS) and the Hunt-Hess scale were used. All patients underwent brain CT and CT angiography. The size of aneurysms, the presence of hydrocephalus, intracerebral and subdural hematomas, ventricular hemorrhages, and dislocations of median structures were assessed. The following evaluation scales were used: Fisher, Hijdra, and Graeb. All patients underwent microsurgical intervention—the clipping of aneurysms in the acute period of SAH. Immediate and long-term treatment outcomes were assessed using the modified Glasgow Outcome Scale (mGOS) and the modified Rankin Scale (mRS).

RESULTS. The majority of patients underwent surgery through traditional approaches: pterional (n=36, 48.0 %) and lateral supraorbital (n=17, 22.7 %). Anterior clinoidectomy (AC) was performed in 62 (82.7 %) cases. In 9 (12.0%) cases the cervical segment of the ICA was exposed, and retrograde suction decompression of the aneurysm was performed. The majority of patients had good and satisfactory immediate and long-term treatment outcomes.

CONCLUSION. Microsurgical clipping is an effective and safe method of treating PA in the acute period of hemorrhage. Individual approach, experience, and proficiency in various «skull base» surgery techniques make it possible to achieve a good long-term outcome in most patients with a minimum number of postoperative complications. The assessment of immediate treatment outcomes in patients with PA is an important prognostic factor determining long-term treatment outcomes. When comparing immediate and long-term results, there is a tendency to increase the proportion of good outcomes in the group of patients with satisfactory outcomes at the time of discharge.

INTRODUCTION. Interest in the use of navigation systems in surgery is steadily growing. The use of the Gertzbein – Robbins scale is convenient for assessing the accuracy of various navigation systems in the laboratory and comparing navigable and fluoroscopically controlled pedicle fixation techniques in the clinic.

AIM. Analysis of the results of using intraoperative image-guided navigation for transpedicular fixation in the surgical treatment of patients with metastatic lesions of the spine.

MATERIALS AND METHODS. The study included 60 patients with metastatic lesions of the spine, operated on from January 1, 2018 to December 31, 2023. All patients underwent palliative surgical treatment, including transpedicular fixation using BrainLab intraoperative image-guided navigation (nTPF group, n=30) or under C-arm control and the «free-hand» technique (TPF group, n=30).

RESULTS. The Mann – Whitney test revealed a significant difference in the mean strength between the groups according to the degree of malposition of the installed pedicle screws (p=0.005); malpositioned screws predominated in the TPF group. There were no statistically significant differences between the nTPF and TPF groups in the duration of surgical interventions, intraoperative blood loss and length of hospitalization.

CONCLUSION. The use of image-guided navigation in the surgical treatment of metastatic tumors can significantly improve the quality of spinal stabilization and reduce the risk of postoperative complications, eliminating malposition of pedicle screws of more than 4 mm, and also reduce radiation exposure to the patient.

INTRODUCTION. Currently, significant progress has been made in the surgery of intracranial meningiomas. However, surgery for recurrent meningiomas has its own peculiarities; compared to the removal of initially detected meningiomas, it is more difficult and leads to significantly worse results.

AIMS. Analysis of the factors affecting the radicality of tumor removal, determination of the basic principles and features of surgical treatment of patients with relapse and continued growth of giant intracranial meningiomas, presentation of a clinical case of microsurgical removal of a giant recurrent sphenoid wing meningioma.

MATERIALS AND METHODS. The study was based on patients (n=32) with relapse and continued growth of histologically confirmed intracranial meningiomas of gigantic size (more than 50 cm3 in volume) operated on in the Department of Neurosurgery No. 4 of the Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre in the period from 2014 to 2024. The degree of radicality was assessed by the operating surgeon intraoperatively and using contrastenhanced computed tomography and (or) contrast-enhanced brain magnetic resonance imaging in the period 24 to 72 hours after surgery.

RESULTS. The basic surgical techniques are described and the principles of surgery for recurrent giant meningiomas are formulated. A description of a clinical case of surgical treatment of a patient with a giant recurrent sphenoid wing meningioma is presented.

INTRODUCTION. Correlation between the optic nerve sheath diameter (ONSD) and the intracranial pressure (ICP) in the acute period of severe traumatic brain injury has been confirmed in numerous publications by foreign and Russian authors. Evaluation of ONSD in patients with cerebral edema and suspected intracranial hypertension (ICH) is possible using neuroimaging (CT, MRI) and ultrasound diagnostic methods (US). The use of ONSD data in patients with severe traumatic brain injury may be of diagnostic and prognostic value in the analysis of therapeutic and surgical methods effectiveness, including decompressive craniectomy (DCT).

AIM. To evaluate changing in the ONSD on computed tomography (CT) in patients with severe traumatic brain injury after decompression craniotomy (DCT).

MATERIALS AND METHODS. For the period from 2020 to 2022 on the basis of the N. N. Burdenko National Medical Research Center of Neurosurgery conducted a prospective single-center observational study included 31 patients (7 women and 24 men) with severe (GCS ≤ 8 points) traumatic brain injury (TBI) and invasive ICP monitoring. The final version of the study included 8 patients (3 women and 5 men) with a wide DCT during the first 3 days after the injury. The mean age in this group was 30 [26.3; 53.0]. All patients underwent invasive ICP monitoring and ICP-oriented therapy according to international and Russian recommendations. Analysis of the ONSD dynamics was carried out based on the comparison of the average, maximum, and minimum values of the ONSD before and after decompression.

RESULTS. Significant differences were found in the ONSD in patients with severe TBI before and after decompressive trepanation: decrease in the maximum ONSD from 7.53 to 6.89 mm and decrease in the minimum ONSD from 7.20 to 6.54 mm (p=0.022 in both cases). These results allow us to conclude that changing in the ONSD parameter is affected by the fact of DCT – significantly lower ONSD values and also stabilization of ICP were noted after DCT in 75 % of the observations.

CONCLUSION. The conductedstudy indicates the relationship between significant decrease in the ONSD parameter and the fact of DCT, accompanied by stabilization of ICP, in patients in the acute period of severe TBI.

INTRODUCTION. The efficacy and safety of transvenous embolisation in the treatment of cerebral arteriovenous malformations (AVMs) remain poorly understood, given the very limited number of reported cases. This prospective study was conducted to evaluate this technique in the treatment of cerebral AVMs.

MATERIALS AND METHODS. From January 2018 to December 2023, 53 patients with cerebral AVMs who underwent transvenous or transvenous-transarterial (combined) total embolisation were examined at the Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre. AVMs were divided according to the Spetzler – Martin classification: gradation I was in 3 (5.7 %) AVMs , II in 13 (24.5 %), III in 26 ( 49.1 %), IV in 8 (15.1 %), and V in 3 (5.7 %). The mean age of the patients was 37.94±11.13 (range 19-66). The sex ratio M:W was 49.1:50.9%. The mean embolisation stage was 2 (range 1–13). The incidence of complete AVM occlusion was calculated based on DSA images obtained immediately postoperatively and 6–12 months after surgery. The occurrence of haemorrhages and infarcts after embolisation was assessed by CT and MRI immediately after surgery and at 1 month after total embolisation. The mRS scale was used to assess functional outcomes.

RESULTS. Complete AVM obliteration was noted in 46 (86.8 %) of 53 patients after embolisation, in 5 (9.4 %) patients total AVM obliteration was achieved with a combination of endovascular and microsurgical treatment. Of 53 patients 2 (3.8 %) died. Postoperative intracranial haemorrhages were detected in 10 (18.9 %). Functional outcomes were assessed: the proportion of patients with mRS ≤2 decreased from 94.2 % (49/53), before embolisation to 82.9 % (44/53) after embolisation, mRS 3–4 =5.7 % (3/53) before embolisation, after 11.3 % (6/53); mRS 5 = 1.9 % (1/53). The mRS scores at the time of follow-up angiography mRS ≤2 90.1 % (46/51), mRS 3–5 =9.9 % (6/51). The percentage of good results (mRS ≤2) in the remote period increased by 7.2 % from 82.9 % (44/53) to 90.1 % (46/51), the percentage of poor results decreased by 3.3 % mRS 3–5 from 13.2 % to 9.9 %.

CONCLUSION. Transvenous embolisation can be performed as an independent technique for total occlusion of cerebral AVMs with a high rate of complete obliteration, improved functional outcomes and acceptable morbidity and mortality, but it should be considered mainly as the method of choice when performing the final stage of multistage embolisation.

INTRODUCTION. Cervical osteochondrosis is a pressing issue in modern medicine. Today, there are many ways to evaluate the results of surgical treatment of cervical osteochondrosis.

AIM. In this regard, the aim of the study was to evaluate the effectiveness of surgical treatment of neurological complications in various forms of cervical osteochondrosis.

MATERIALS AND METHODS. The work is based on the analysis of the results of a comprehensive clinical examination, treatment and dynamic observation of 238 patients who underwent surgical treatment for cervical osteochondrosis. Our method is based on a multifactorial analysis of information about patients with cervical osteochondrosis.

RESULTS. Studying data on the effectiveness of treatment measures for cervical osteochondrosis makes it possible to detail the formulation of treatment results, individually and more objectively than allows us to evaluate the result of surgical treatment of cervical osteochondrosis.

INTRODUCTION. Glioblastoma (GB) is a lethal recurrent glial tumor.

AIM. To study the effect of the CXCR4 inhibitor plerixafor on the processes of homing of bone marrow stem cells (BMSCs) into the tumor site and to evaluate the survival of animals after chemoradiotherapy (CRT).

MATERIALS AND METHODS. C6 cells and Wistar rats were used. The experiment was approved by the local ethics committee. The methods used were cultural, flow cytometry, experimental surgery, CRT, morphological, immunohistochemical and enzyme-linked immunosorbent analysis, Kaplan – Meier survival assessment.

RESULTS. Administration of granulocyte colony-stimulating factor (G-CSF) to rats with C6 glioma increases the content of BMSCs in the bloodstream by 24.4 times, the combination of G-CSF and plerixafor (PLX) – by 32.9 times. Stimulation with G-CSF increases the content of proliferating cells in the tumor and enriches it with microglial markers, which is accompanied by an increase in the content of TGFβ1 82.4±11.4 ng/ml (versus 38.8±16.3 ng/ml in the control), wnt3A and wnt5A – 52.2±6.4 and 100±11.2 ng/ml (versus 18.6±9.4 and 38.6±14.2 ng/ml in control) and β-catenin – 174±11.2 ng/ml (versus 82.2±16.4 ng/ml in the control). This effect is absent in rats treated with G-CSF and PLF. The median survival of rats receiving CRT was 35 days: rats receiving CRT + G-CSF or PLX were 49 and 51 days, CRT + G-CSF + PLF was 64 days.

CONCLUSIONS. Plerixafor enhances the recruiting effect of G-CSF on BMSCs, disrupts the processes of their migration and homing into the neoplastic lesion, which is accompanied by a decrease in the number of proliferating elements and microglial cells, a decrease in the content of TGFβ1, wnt ligands and β-catenin in the brain substance and an increase in experimental survival animals with C6 glioma.

INTRODUCTION. The posterior petrous bone meningiomas are one of the most difficult tumors for microsurgical removal. Despite the modern possibilities of neurosurgery, the mortality and disability rates of these patients continue to be high.

AIM. To analyze results of microsurgery of posterior petrous bone meningiomas depending on the location of the tumor matrix.

MATERIALS AND METHODS. The study assessed the results of microsurgical treatment of 59 patients with large and giant posterior petrous bone meningiomas. All patients underwent microsurgical removal of the tumor by retrosigmoid approach. The Karnofsky Performance Scale Index at admission and discharge, the radicality of surgery, the presence of complications, the severity of neurological disorders and the outcome on the Glazgo Outcome Scale Extended were assessed.

RESULTS. In 30.5 % of patients, meningiomas had petroclival localization, in 10.2 % of cases the tumor matrix was located in the area of the jugular foramen, in 8.5 % of patients the matrix was expanded and occupied the entire surface of the petrous bone and in 50.8 % of cases the tumor arose in the area of the posterior surface of the petrous bone. In 76.3 % of cases, the tumor was removed radically, in 15.2 % – subtotally and in 8.5 % – partially. The median functional status at the time of discharge was the highest in the group of patients with meningiomas of the posterior face of the petrous bone (p=0.006). Ischemic complications were more common in patients with an extended matrix (p=0.002). The best results of facial nerve function were achieved in the group of patients with meningiomas of the posterior face of the petrous bone (p<0.001). The largest number of patients with postoperative prosoparesis was observed in the groups of jugular meningiomas (p=0.016) and meningiomas with an extended matrix (p=0.032).

CONCLUSION. The results of surgical treatment depend on the size and the localization of the tumor matrix. The greatest radicality and the best functional outcomes can be achieved in the group of patients with meningiomas of the posterior face of the petrous bone. The most common postoperative neurological disorders and low functional status were observed in patients with an extended tumor matrix over the entire surface of the petrous bone.

INTRODUCTION. Intracerebral hemorrhage accounts for 10–15 % of all strokes and carries very high morbidity and mortality rates of up to 50 %.

MATERIALS AND METHODS. A retrospective multicenter study included data from patients with hypertensive intracerebral hemorrhages from 4 regional vascular centers and 14 primary vascular centers in the Republic of Tatarstan in 2022, registered from January 1, 2022, to December 31, 2022, for patients over 18 years of age.

RESULTS. The study included 1127 patients with hypertensive intracerebral hemorrhages. The median age was 64 years [56;72]. Women with hypertensive intracerebral hemorrhages were older than men, with a median age of 67 [59; 78] years for women and 62 [54; 68] years for men (p<0.05). The proportion of men was 56,1 %, women were 43,9 %. The most common triggering factors were physical exertion and alcohol consumption. Most patients experienced the first symptoms of the disease at home (72,5 %). 58,1% of patients with hypertension did not take antihypertensive therapy regularly. Men were less adherent to antihypertensive therapy. The mortality rate at the time of patient discharge from the hospital was 30,6 %.

CONCLUSION. The epidemiological characteristics obtained as a result of the study make it possible to form a «portrait» of a patient with hypertensive intracerebral hemorrhage in the Republic of Tatarstan, which is one of the most multi-ethnic regions of Russia.

29 literature sources from 1982 to 2023 were used as a literature review. PubMed and Google Scholar databases were used as resources using queries on medical topics for the terms «vertebral artery injuri, complication in cervical spine surgery, vertebral artery anomalies» that are most suitable for search criteria published in English language. There were no evidence level restrictions. The issues of etiology, epidemiology, clinical presentation, as well as various surgical treatment methods of VA damage are highlighted.

The aim of this literature review is to highlight the problem of to vertebral artery injury in anterior cervical spine surgery based on the literature data.

Despite the presence of advanced neuroimaging techniques used in surgical treatment planning, the problem of vertebral artery damage in anterior cervical spine surgery remains unsolved and can lead to a fatal consequences. Taken into account various methods of VAI treatment, prevention by careful preoperative planning remains preferable

INTRODUCTION. The article discusses the problem of impaired cerebrospinal fluid circulation, in particular a rare form of hydrocephalus – low (“negative”) pressure hydrocephalus.

AIM. To improve the results of surgical treatment of patients with low-pressure hydrocephalus based on a comprehensive study of the pathomorphology and pathophysiology of the disease, improvement and optimization of surgical tactics. CLINICAL CASES. Two patients with acute and chronic GND. Patient N., 69 years old. Hospitalized in September 2022. A year before hospitalization, he underwent complex treatment for adenocarcinoma of the soft palate (removal and radiation therapy: 60 Gy for the soft palate and 50 Gy for the cervical lymph nodes). 6 months before hospitalization, he underwent surgery: removal of an arteriovenous malformation (AVM) of the right hemisphere of the cerebellum. Patient K., 73 years old, was hospitalized in November 2022 with a clinical picture of the Hakim – Adams triad (cognitive impairment, unsteady gait, urinary incontinence). According to CT scan of the brain, enlargement of the ventricular system with periventricular edema.

CLINICAL CASES. The condition of patient N. worsened within 1 week, according to the level of consciousness from 15 to 9 points on the Glasgow Coma Scale (GCS). According to CT scan of the brain: signs of internal hydrocephalus (ventriculomegaly, periventricular edema, smoothness of the sulci of the hemispheres, compression of the base cisterns). An emergency surgical intervention was performed: installation of an NVD with an ICP control sensor. 12 hours later, after a short-term improvement in the level of consciousness, the patient’s condition showed negative dynamics (level of consciousness 9 GCS points); on the control CT scan, signs of internal hydrocephalus remained. The NVD is functioning. When the ICP level was corrected to “negative” (–7 mm Hg), the patient regained clear consciousness. The ICP measured by the hydrostatic method was –100 mm H2O, which corresponded to the value obtained from the sensor. Patient K underwent a lumbar puncture and the pressure was measured using the hydrostatic method, which was 75 mm of water column in the supine position. In a sitting position, the pressure was 300 mm of water column from the level of the puncture needle, which corresponds to a pressure at the level of Monroe’s holes of –250 mm of water column, that is, subatmospheric. Moreover, according to a CT scan of the brain, the patient had an enlargement of the ventricular system with periventricular edema, and clinically symptoms of the Hakim-Adams triad. After performing a tap test (withdrawal of 30 ml) once, the patient’s cognitive abilities objectively improved, her gait became more coordinated when turning, and the number of steps required to move 5 meters decreased from 15 to 12, which was recorded on video. CSF removal was performed three times, once a day, 30 ml. After 3 days, the patient moved relatively normally and noted a significant improvement in urinary function (regression of urinary incontinence). Subsequently, the patient underwent ventriculoperitoneal shunting with an adjustable shunt with a minimum pressure set at 20 mm of water column.

In the presented clinical example, acute GND was probably provoked by previous radiation therapy, as well as surgery on the posterior cranial fossa. In the acute period of GND, it is necessary to install an NVD, with correction of ICP (up to subatmospheric pressure) in order to achieve the maximum level of consciousness of the patient. An available surgical method for permanent correction of ICP remains low-pressure ICP using methods of additional reduction of ICP (aspiration of cerebrospinal fluid from the shunt valve, “pumping”, verticalization of the patient) with a gradual decrease in their intensity over 3–4 weeks. It should be emphasized that the nosological form described above is only one of the clinical manifestations of the underlying disease. As for the mechanisms of the pathophysiology of chronic GND, they are currently unclear and require study. In this category of patients with the classic Hakim – Adams triad and hydrocephalic changes according to CT (MRI), when determining “normal” cerebrospinal fluid pressure in the supine position, a diagnosis of “normotensive hydrocephalus” is usually established. As for the mechanisms of the pathophysiology of chronic GND, they are currently unclear and require study. In this category of patients with the classic Hakim – Adams triad and hydrocephalic changes according to CT (MRI), when determining “normal” cerebrospinal fluid pressure in the supine position, a diagnosis of “normotensive hydrocephalus” is usually established. When measuring cerebrospinal fluid pressure in an upright position of the patient, it can be subatmospheric at the level of the foramina of Monroe.

CONCLUSION. Despite the fact that, in our opinion, the treatment tactics for such patients in any case involve the installation of a low-pressure ventriculoperitoneal shunt, studying the pathophysiology of impaired cerebrospinal fluid circulation in the above cases seems important for the development of non-invasive methods for correcting this condition.

INTRODUCTION. Abducens nerve schwannoma are an extremely rare neurosurgical pathology. The peculiarity of these tumors is diagnostic difficulties at the preoperative stage, as often the neoplasms mimic schwannoma of the Gasser’s ganglion. Often persisting oculomotor disorders after surgery remain an unsolved problem.

CASE REPORT. We report a rare observation of such a tumor. A 38-year-old man presented with complaints characteristic of a left cerebellopontine angle lesion. Magnetic resonance imaging showed the presence of a dumbbell-shaped tumor with near the brainstem and parasellar nodes; its radiological characteristics were typical schwannoma of the Gasser’s ganglion. Intraoperatively, a left abducens nerve schwannoma destroying Dorello’s canal was verified, and the integrity of the nerve was anatomically disrupted by the tumor. Morphologic examination confirmed the diagnosis of schwannoma. Before surgery, the patient had paresis of the left abducens nerve, facial musculature dysfunction, and pyramidal insufficiency; after surgery, paralysis of the abducens nerve and some increase in hemiparesis were observed.

CONCLUSION. Clinical features and neuro-radiologic signs are often insufficient to make an accurate preoperative diagnosis. The source of the growth (the diverting nerve) can be suspected by careful history taking, when abducens nerve insufficiency appears before other symptoms, which are much more severe in the prime of the disease. The diagnosis of “abducens nerve schwannoma” is established intraoperatively and confirmed by pathomorphologic examination. It is necessary to emphasize the importance of the earliest possible diagnosis of this pathology, careful collection of anamnesis and timely neuroimaging examination in order to improve the results of treatment and prevent the appearance of gross oculomotor disorders after surgery.

The incidence of spondylodiscitis is 1.0–2.5 cases per 100 000 population, accounting for 4–8 % of the total incidence of osteomyelitis. In some studies, the overall incidence ranges from 2.2 to 11.3 cases per 100 000 and higher.

The aim of the study – to demonstrate the significance of a comprehensive approach to the treatment of inflammatory diseases of the spine.

A comparative analysis of relevant scientific articles was performed. Lethality in spondylodiscitis due to inadequate treatment reaches 20% of cases. In order to avoid inadequate treatment it is necessary to create a unified protocol for the management of patients from this group.