INTRODUCTION. The structure of clinical forms of traumatic brain injury (TBI) is universally dominated by mild TBI (80–90 %). Light TBI in modern warfare is an urgent task.
AIM. Analysis of the mechanisms of exposure, clinic and outcomes of mild traumatic brain injury in the context of military operations of the SVO.
MATERIALS AND METHODS. 541 male soldiers aged 19 to 60 who were exposed to an explosive shock wave were investigated. The traumatic factors were analyzed by the mechanism of influence on the victim. All victims were examined by a neurologist.
RESULTS. According to the results of neurological examination and observation in the PMG, tactical measures were carried out: 310 (57.3 %) servicemen were returned to their units for further service due to the absence of manifestations of traumatic brain injury; 85 (15.7 %) of the victims were evacuated for examination and rehabilitation with a diagnosis: Mine-explosive injury. Closed TBI. Concussion; 146 (27.0 %) military personnel were treated in PMG for 5 days with a diagnosis of asthenicneurotic (asthenic-autonomic) syndrome. 15 (10.3%) patients were subsequently required to evacuate from this group.
CONCLUSION. In modern warfare conditions, a common damaging factor is mine-explosive injury. In this regard, diagnostics, medical and tactical measures for mild TBI become an urgent issue. These issues are resolved when examining the victims by a neurologist with the involvement of related specialists, if necessary, as well as when observing the victims while they are in the PMG.

INTRODUCTION. Foot extensor paralysis, steppage and the characteristic equinovarus deformity with foot eversion due to gunshot wounds of the common peroneal nerve are difficult to treat. The most common method includes nerve reconstructive surgery with further expectation of probable foot function recovery. At the same time, tendon-muscle transposition is performed at least 12 months after nerve reconstruction and rehabilitation treatment in case of its ineffectiveness. This study evaluates the possibility of treating gunshot wounds of the common peroneal nerve by simultaneous restoration of nerve and tendonmuscle transposition.
MATERIALS AND METHODS. In our study, we compared the results of treatment of 68 men with gunshot wounds of the common peroneal nerve for the period 2022 to 2024 who underwent nerve reconstruction in combination with or without tendon-muscle transposition.
RESULTS. Patients with simultaneous restoration of nerve and tendon-muscle transposition (main group) had better functional results comparing to patients where only nerve repair was performed (control group). In addition, in all patients from the main group, it was possible to restore their ability to work, while in patients in the control group, their ability to work was restored only in 18 % of cases.
CONCLUSION. The choice of surgical tactics for gunshot wounds of the common peroneal nerve the remains a subject of discussion for neurosurgeons and traumatologists. At the same time, our preliminary study suggests that simultaneous reconstruction of the nerve trunk and tendon-muscle transposition can provide a better functional outcome than the use of these techniques separately.

INTRODUCTION. The incidence of peripheral nerve injuries varies from 2–35 %, and the frequency of peripheral nerve injuries is second in the structure of all fractures in children. The pattern of nerve damage distribution in transcondylar fractures is heterogeneous, with the median nerve accounting for up to 43.4 %. In a number of cases, the clinical picture of posttraumatic neuropathy of the median nerve is represented by isolated sensory and autonomic disorders, which, from the anatomical point of view, are explained by the presence of the Richet – Canyou anastomosis compensating for the motor deficit. The role of electro diagnostic medicine (nerve conduction study (NCS)) as a non-invasive method of confirming the presence of anastomosis increases in case of dissociation of symptoms.
AIM. To evaluate the effect of the Richet – Canoux anastomosis on the clinical picture and electroneuromyographic data in the case of median nerve neuropathy complicated trans condylar fractures in children on the example of our own clinical group, to compare the obtained results with international data and to determine the indications for surgical treatment.
MATERIALS AND METHODS. Outpatient records and case histories of 15 patients aged 4 to 8 years who applied for consultative care in the period from 2022 to 2023 in the consultative-diagnostic center of the Research Institute of Research Institute of Emergency Pediatric Surgery and Traumatology were analyzed.
RESULTS. Of the 6 patients with sensory and autonomic disorders, five required surgical intervention, during which 3 patients underwent neurolysis, one underwent neurorhaphy of the sensory portion of the median nerve, and one underwent autotransplantation for trunk transposition in the fracture line. Clinical features and electroneuromyography and neuroimaging data in the presence of a Richet-Canine anastomosis are presented in two clinical examples.
CONCLUSION. The prevalence of the Richet – Canyou anastomosis detected in our clinical group coincided with the literature data. Clinical examples demonstrate the possibility of preservation of the tenar musculature and dominance of sensory and autonomic disorders in the clinic in the presence of anastomosis confirmed by NCS. Patients with dominant persistent autonomic and sensory disorders became candidates for surgical treatment.

INTRODUCTION. Meningiomas are common primary intracranial and spinal tumors in adults. Aggressive meningiomas can recur after surgical removal and radiotherapy. There are no treatment standards for such tumors. Modern artificial intelligence (AI) technologies can help a neurosurgeon predict the behavior of a neoplastic process in the central nervous system.
AIM. Development and evaluation of the effectiveness of a neural network algorithm predicting the further development of a neoplastic process in recurrent intracranial meningiomas.
MATERIALS AND METHODS. To solve the problem, an Excel database was used with patient information obtained from the analysis of medical records. More than 160 multimodal features grouped into sections were used. According to the results of statistical analysis, correlated, uninformative, and features with uneven data distribution within classes were removed. Finally, two of the most appropriate classification models were chosen: decision tree and random forest algorithms.
RESULTS. Four models were built and evaluated based on the results of the work. The basic random forest model showed the best classification accuracy (about 90 %). It also helped to assess the significance of the studied features.
CONCLUSION. Due to the constant growth of multimodal data in neuro-oncology, it is difficult for doctors to analyze them using traditional approaches and predict the behavior of a neoplastic process. Therefore, neurosurgeons need to turn to modern artificial intelligence (AI) technologies for help.

INTRODUCTION. The study is devoted to the search for possible risk factors for the development of delayed parenchymal hemorrhagic brain injuries (OPGPHM) in the acute period of traumatic brain injury (TBI), which combine delayed intracerebral hematomas and progressive foci of brain injury. This pathology is characterized by a high incidence, difficulty in treatment and high mortality.
AIM. To study the probable prognostic criteria for the development of OCD in the acute period of TBI.
RESULTS. A number of predictors of the development of OCD have been verified: 1) thrombocytopenia; 2) combined TBI (traumatic shock, blood loss); 3) extracranial complications (thrombotic complications); 4) chronic concomitant diseases (diseases of the cardiovascular system); 5) neuroimaging patterns (transformation of ischemic foci into hemorrhagic; formation of local edema with displacement of the median structures ipsilateral to the injury site; pronounced edema – swelling of the brain; damage to the diencephalic zone).
CONCLUSION. It seems advisable to take into account these risk factors for the development of delayed parenchymal hemorrhagic brain injuries in the management of patients in the acute period with severe traumatic brain injury.

INTRODUCTION. Low grade gliomas (LGG) steadily undergo anaplastic transformation with progression to a higher grade of malignancy. Currently in clinical practice, there is no accurate method that can be used in predicting the risk of progression of a resected tumor that takes into account not only the multifactorial nature of glioma transformation but also the unequal influence of various predictors.
AIM. To develop a mathematical model for predicting the risk of anaplastic transformation of low-grade malignant gliomas after surgical intervention.
MATERIALS AND METHODS. The study group consisted of 52 patients who underwent a second surgery for advanced LGG between 2019 and 2023. Inclusion criteria: age at the time of diagnosis older than 18 years; histologically and molecularly genetically verified LGG; no tumor accumulation of contrast according to MRI before the first surgery; radiopharmaceutical accumulation index according to PET-CT with methionine less than 1.7; Ki-67 expression level less than 6 %; no vascular proliferation and endothelial swelling. Radiological characteristics included localization, tumor size, extent of resection, and contrast accumulation after progression. More than 90 parameters were analyzed to identify factors influencing the progression of LGG. The distribution of all parameters and their comparison were performed using the Mann – Whitney and Kolmogorov – Smirnov criteria, median x2.
RESULTS. A model of probabilistic assessment of transformation risk with the following characteristics was built by means of logistic regression: sex; presence of seizures; tumor localization; histological data; postoperative treatment; time of progression. The role of the presented model is to obtain the characteristics of the logistic function Y for the standard equation, which makes it possible to calculate the probability of transformation depending on the factors and the degree of their influence on each other.
CONCLUSION. Integration of this mathematical model into the plan of dynamic follow-up of patients with LGG will allow to adjust the strategy of observation, diagnosis and treatment.

INTRODUCTION. Chronic subdural hematoma (CSDH) is a common neurosurgical pathology, usually in elderly patients, and the main cause of which is traumatic brain injury. Analysis of epidemiological data shows that the incidence of CSDH is increasing due to the increased use of anticoagulants and the growing elderly population. Surgical treatment is the standard treatment for this category of patients, although the options for this treatment strategy are still controversial.
AIM. To analyze clinical outcomes in patients with CSDH in retrospective material depending on the strategy of surgical treatment.
MATERIALS AND METHODS. A total of 110 patients. There were 71 (64.5 %) men and 39 (35.5 %) women. The age ranged from 45 to 96 years, with a mean age of 73.8 years. CSDH was unilateral in 79 (71.8 %) patients and bilateral in 31 (28.2 %). The following surgeries were performed: craniostomy (twist drill) was performed in 7 (6.4 %) patients, burr-hole craniostomy in 83 (75.5 %) cases, craniotomy in 5 (4.5 %) patients, craniectomy in 2 (1.8 %) patients, middle meningeal artery embolization in 10 (9.1 %) cases, and combined treatment (craniostomy + embolization) in 3 (2.7 %) patients.
RESULTS. When studying the GCS data, statistically significant improvement of the indicator in the postoperative period was revealed in most patients compared with the preoperative data (p=0.001); When assessing the neurological status, complete regression of neurological symptoms was achieved in 73 (66.4 %) patients, partial regression of neurological symptoms was observed in 20 (18.2 %) cases, no dynamics in the neurological status was noted in 8 (7.3 %) patients, an increase in neurological deficit was noted in 4 (3.6 %) cases, and 5 (4.5 %) patients died. Relapse was recorded in 13 (11.8 %) cases, and complications were found in 8 (7.3 %) patients. Patients with periosteal drainage had fewer relapses and a better neurological outcome in the early postoperative period compared to patients with subdural drainage. Patients who underwent middle meningeal artery embolization had no recurrence and fewer days of hospitalization.
CONCLUSIONS. The choice of the optimal treatment method for CSDH is within the competence of the neurosurgeon and is determined for each patient individually; as a rule, such an individual approach will allow for the best result.

INTRODUCTION. This article describes the experience of performing surgical operations on the lumbar spine with multilevel degenerative changes. The study included 105 patients aged 18 and over. The study included patients with multilevel intervertebral hernias in the lumbar region, including various combinations of conditions such as multilevel discosis with instability of the spinal motor segment, central and lateral stenosis, as well as pathologies of the arched joints. Patients underwent various decompression and stabilization operations, using transpedicular implants, dynamic implants, a combination of them or without fixation. According to the results of the evaluation of treatment, using a Visual Analog Scale and the Oswestry Disability Index (ODI), there was a significant improvement in the quality of life of patients, expressed in a decrease in pain, a decrease in neurological disorders and an increase in the level of daily activity.
MATERIALS AND METHODS. The results of surgical treatment in 105 (100 %) patients were analyzed, including 47 (44.1 %) women and 58 (60.9 %) men operated on the basis of the Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre for multilevel discosis of the lumbar spine in the period from 2019 to 2022. Given the presence of these pathologies, all patients are divided into 2 groups. Group 1 included 47 (44.76%) patients, the choice of treatment method was TPF with interbody fixation; the 2nd group included 58 (54.3%) patients, the choice of treatment method was interosseous dynamic fixation with decompression of the spinal canal and decompression of the spinal canal without fixation.
RESULTS. All patients underwent surgical treatment. With the correct choice of the surgical method, a regression of neurological symptoms is observed, which allows the patient to return to work and the usual daily workload.
CONCLUSION. A well-chosen treatment method contributes to the rapid return of patients to their professional activities and normal physical activity. Individualization of surgical tactics allows minimizing the risks of postoperative complications, such as migration of metal structures, recurrence of hernia and infectious processes. A personalized approach ensures a shorter and more effective rehabilitation period, reducing recovery time and improving overall treatment outcomes. The creation and application of an individualized approach to surgical treatment, taking into account clinical symptoms, the results of X-ray examination and neurophysiological examination data, can significantly increase the effectiveness of surgical interventions in patients with multilevel discosis in the lumbar spine.

INTRODUCTION. The most severe form of ischemic stroke is its malignant subtype, characterized by a high mortality rate. The cause of the severe course and unfavorable outcome of the disease, along with the volume of ischemia, is the addition of cerebral and extracerebral complications.
AIM. To identify predictors of the course and outcome of malignant ischemic stroke (MCI).
MATERIALS AND METHODS. Analysis of case histories is presented 55 patients with MCI in the MCA-supplied territory have been analysed. The study comprised patients aged from 44 to 92 years (average age: (71.4±1.6) years, Me = 73 years). Decompression hemicraniectomy was performed for 10 patients.
RESULTS. Dislocation syndrome is an obligatory complication of MCI and the cause of death in most patients. The leading factors determining the course and outcome of the disease are cerebral, in particular, the volume of ischemic injury of the cerebral hemisphere and dislocation syndrome.
CONCLUSION. MCI in the MCA-supplied territory is characterised by severe course resulting from the development of cerebral and extracerebral complications. The decisive events that determine the severe course and outcome of the disease are essentially a combination of multiple factors, which in turn necessitates an individual multidisciplinary approach to the choice of treatment tactics.

INTRODUCTION. Autopsy data indicate that metastatic involvement of the spine occurs in over 70 % of cancer patients. Treatment for this condition is predominantly palliative. Advances in spinal oncology are presenting new surgical technologies that minimize the extent of surgical intervention while maximizing the preservation of the patient’s quality of life. One innovative approach is laser interstitial thermotherapy.
AIM. To evaluate the impact of laser interstitial thermotherapy on functional activity, neurological status, and quality of life in patients with spinal tumors.
MATERIALS AND METHODS. The study sample comprised 60 middle-aged patients diagnosed with spinal tumors. The cohort was divided into two groups of 30 individuals each. Patients in the experimental group underwent surgery utilizing the LAHTA-MILON semiconductor laser. The surgical procedure was conducted in two phases: Phase 1 involved transcutaneous intracapsular exposure to tumor nodes located near the paravertebral region under ultrasound guidance using a laser. Phase 2 entailed intraoperative exposure to tumor tissue located proximal to the dural sac and nerve roots. Patient conditions were evaluated prior to surgery, one day postoperatively, and before hospital discharge (days 7–10). Severity of motor deficits was quantified on a five-point scale. Assessment of sensory deficits incorporated examinations for changes in both superficial and deep sensory modalities, as well as the categorization of disturbances (segmental versus conductive). The Frankel scale facilitated the evaluation of surgical outcomes and quality of life across both groups in pre- and postoperative phases. Data analysis was performed utilizing the standard Statistica 10.0 software package.
RESULTS. The findings reveal that motor deficits were observed in 55 of 60 patients (91.7 %). By the 10th postoperative day, regression of motor deficits occurred in both groups, with 16.7 % of the control group and 26.7 % of the experimental group demonstrating improvement. Additionally, the prevalence of motor deficits diminished overall. Sensory disturbances were initially identified in 58 (96.7 %) of the patients. By the 10th postoperative day, sensory deficits of varying severity persisted in 22 (73.3 %) patients in the experimental group and 23 (76.7 %) patients in the control group. A month postoperatively, regression of sensory deficits was notable: 96.7 to 46.7 % in the experimental group and 96.7 to 60 % in the control group, yielding statistically significant results. Radicular pain syndrome was initially present in 41 (68.3%) patients, encompassing 19 (63.3 %) in the control group and 21 (73.3 %) in the experimental group. By the 10th postoperative day, radicular pain syndrome regressed in 47 (78.3 %) of the total cohort, with persistence in 13 (21.7 %) patients; in the control group, pain persisted in 6 (20 %) patients, while in the experimental group, it persisted in 7 (23.3 %) patients. Notably, functional outcomes in the experimental group, utilizing laser interstitial thermotherapy, were significantly superior compared to the control group by day 10 post-surgery. Specifically, 4 (13.3 %) patients in the experimental group achieved good outcomes, 16 (53.3 %) satisfactory outcomes, and 10 (30.3 %) poor outcomes. In contrast, the control group yielded good outcomes for 2 (6.7 %) patients, satisfactory outcomes for 8 (26.7 %), and poor outcomes for 20 (66.6 %) patients. The employment of surgical lasers in lumbosacral tumor resections resulted in reduced hemorrhage, with estimated blood loss of (210.5±20.6) ml in the experimental group compared to (350.0±21.3) ml in the control group, and (498.7±75.9) ml versus (910.5±97.6) ml overall.
CONCLUSION. The application of the LAHTA-MILON laser, in contrast to conventional surgical methodologies, diminishes traction and trauma to the spinal column and its nerve roots, leading to reduced severity of neurological symptoms and enhanced quality of life in the postoperative period.

INTRODUCTION. Minimally invasive methods of treatment of herniated intervertebral discs of the cervical spine are described, the gold standard in the case of symptomatic herniated disc of the cervical spine has become anterior decompression and spinal fusion of the cervical spine, which is one of the most frequently performed procedures in the cervical spine. Longlasting preoperative symptoms in patients with herniated disc subsequently lead to worse surgical results in terms of quality of life.
AIM. To study the dynamics of quality of life in patients operated on for herniated intervertebral discs of the lower cervical spine, taking into account the duration of preoperative conservative therapy, according to the questionnaire “Index of vital signs in neck pain”.
MATERIALS AND METHODS. 38 patients with diagnosed single-level herniated intervertebral disc of the lower cervical spine without concomitant other compression factors of the spinal root or spinal cord in the lower cervical spine (C5-C6 or C6-C7), operated between 2019 and 2022, were under observation. The full information about the presence of a herniated intervertebral disc, its shape, size, condition of the spinal cord and spinal cord was obtained only from MR tomography. The quality of life of patients was assessed using The Neck Disability Index (NDI) questionnaire. The questionnaire includes 10 sections: intensity of neck pain, self-care (washing, dressing, etc.), lifting objects, reading, headache, concentration, performance, driving, sleep, rest and leisure, before surgery, 5 days after surgery and a year after surgery.
RESULTS. The indicators for assessing the quality of life according to the questionnaire NDI indicate that surgical treatment after confirmation of the presence of a herniated intervertebral disc of the cervical spine, which led to the development of pain syndrome and cervical myelopathy, statistically significantly led to an improvement in the quality of life of patients.
CONCLUSION. In patients with single-level herniated intervertebral disc of the lower cervical spine, timely surgical treatment statistically significantly led to an improvement in the quality of life of patients.

INTRODUCTION. In the treatment of patients with failed back surgery syndrome (FBSS), especially in older age groups burdened with concomitant multi-organ pathology, the method of spinal cord stimulation (SCS) is increasingly used.
AIM. To show the effect of spinal cord stimulation on pain syndrome and on cardiovascular function.
MATERIALS AND METHODS. The study included patients with chronic vertebrogenic pain syndrome who had previously undergone reconstructive surgery on the spine and had concomitant cardiovascular pathology that carries high surgical risks.
RESULTS. The obtained data demonstrated not only the neurological and analgesic effects of spinal cord stimulation, but also positive neuromodulatory effects on a number of important parameters of the cardiovascular system, such as the functional class of heart failure, heart rhythm disturbances, and pulmonary artery pressure.
CONCLUSION. SCS shows a high degree of effectiveness in achieving an analgesic effect, improving the quality and duration of life in patients with FBSS who are not considered candidates for repeated surgical intervention. This approach forms a new multidisciplinary principle of patient treatment with the participation of specialists in neurosurgery and cardiology.

The case of successful treatment of a patient who underwent COVID-19-associated acute ischemic stroke against the background of combined vascular pathology in the form of hemodynamically significant stenoses of extracranial sections of both internal carotid arteries and saccular aneurysm of the M1 segment of the right middle cerebral artery bifurcation is described. The technique of simultaneous microsurgical treatment of aneurysm and stenosis from the ipsilateral side followed by microsurgical reconstruction of the stenosed carotid artery from the contralateral side was applied. Clinical and functional outcomes were positive: reconstruction of internal carotid arteries on both sides and aneurysm clipping without intra- and postoperative ischemic and hemorrhagic complications were achieved. Immunohistochemical study of the removed atherosclerotic plaques revealed positive expression of S-protein antigen of SARS-CoV-2 localized in fibroblasts and smooth muscle cells, as well as in macrophages infiltrating the plaque.

INTRODUCTION. Study of epidemiology of hydrocephalus cases is currently problematic issue due to its abundance, high levels of associated mortality and negative socio-economic consequences.
AIM. Perform a dynamic analysis of epidemiological characteristics of progressing hydrocephalus cases in kids in Republic of Tatarstan from 1995 to 2022.
MATERIALS AND METHODS. We analyzed medical histories of 1288 kids with different forms of progressing hydrocephalus cases, that currently live in Republic of Tatarstan.
RESULTS. From 1995 to 2022 we observed a statistically significant growth of hydrocephalus cases from 2,76 to 5,05 per 100 000 kids. From 2013 to 2022 we observed a tendency that hydrocephalus cases became more abundant from 61,93 to 67,31 cases per 100 000 kids. We observed significant increase in appearance of pathology in boys (60.9 %), than in girls (39.1 %). The most common cause of hydrocephalus cases during the time of the study were intracranial non-traumatic hemorrhage (36.1 %) and tumors of central nervous system (29.2 %).
CONCLUSION. Rates and spread of hydrocephalus cases in kids in Republic of Tatarstan from 1995 to 2022 gradually increases. It is most common in boys and in kids that are aged from 28 days to 3 month. Statistically significant factors are intracranial non-traumatic hemorrhage and tumors of central nervous system.

Gunshot wounds and traumas of the skull and brain (GSW) are associated with a high-risk group for the development of infectious complications, including craniocerebral, organ and systemic complications. This publication presents a clinical experience in the management of infectious complications in a victim with a gunshot penetrating craniocerebral wound. The microbiological landscape of complications was represented by both standard microflora (Acinetobacter baumannii CARB (PR), Klebsiella pneumoniae CARB+ESBL (MDR), Streptococcus oralis) and non-standard microflora. Elizabethkingia anophelis was detected for the first time in the sputum of a wounded person under hospital conditions. These are aerobic immobile Gram-negative bacilli that do not form spores, isolated from the gut of the mosquito Anopheles gambiae. This microbe can cause meningoencephalitis and is characterized by resistance to natural antibiotics such as ampicillin, chloramphenicol, kanamycin, streptomycin and tetracycline. A positive effect of the ongoing complex treatment, including intra-arterial and intravenous administration of antibacterial drugs, was achieved.

INTRODUCTION. The extensive application of various neuroimaging technologies has led to the identification of a significant number of pediatric incidental brain findings with unclear prognostic factors. Some of these findings exhibit radiological features consistent with neoplastic processes, presenting considerable challenges in clinical management.
AIM. This study aims to systematically review and assess current approaches to the management of pediatric patients with incidentally discovered brain lesions (incidentalomas).
MATERIALS AND METHODS. A systematic review was conducted using the eLibrary, PubMed, and Medline (NCBI) databases. The search focused on studies involving incidentally discovered brain tumors (incidentalomas) in children. The literature was analyzed in terms of the frequency of incidentalomas, diagnostic methods, management strategies, and the risk of malignant transformation, up to August 2024.
RESULTS. A total of 2,213 articles were reviewed, of which 78 were full-text articles. Ultimately, 42 articles were included in the final analysis. Incidentalomas of the brain were identified in 0.2 to 5.7 % of pediatric neuroimaging studies and were found to represent a heterogeneous group of lesions, with low-grade gliomas being the most commonly diagnosed.
CONCLUSION. While most pediatric brain incidentalomas exhibit a relatively benign course, some may progress, with rare cases of malignant transformation observed. As such, careful and ongoing monitoring of patients with these incidental findings is warranted.

Surgical interventions accompanied by placement of stabilizing transpedicular systems are widely used for thoracolumbar spine pathology. 
Due to the morphology of the vertebrae and proximity of vascular and nerve structures, installation of screws leads to a rather high risk of postoperative neurological complications. Intraoperative neurophysiological monitoring is used in spine surgery for a more accurate and safe insertion.
Currently, there is no consensus in clinical neurophysiology as to which technique of IONM should be considered the most optimal due to different views on the choice of muscles to be tested and the technique of placing recording electrodes.
This article presents a clinical case of surgical treatment of a thoracolumbar spine fracture using an optimized modality of intraoperative neurophysiological monitoring of transpedicular screw placement.

AIM. To describe the clinical observation of a rare complication in the form of the formation of a decompensated form of subdural hygroma in a patient after decompressive stabilizing intervention at the L4-L5 level.
CLINICAL CASE. Patient N., 63 years old, complained of pain in the posterolateral surface of the right lower limb. History of endoscopic decompression of the spinal canal at the place of residence for spinal canal stenosis at the L4-L5 level in 2021 and 2022. According to the Lumbosacral Spine MRI: multifactorial stenosis of the spinal canal at the L4-L5 level with compression of the L5 root by the discosteophyte complex.
Intraoperatively, a defect of the dura mater was obtained without damage to the arachnoid membrane and there was no leakage of cerebrospinal fluid.
On the 3rd day after surgery, the patient began to complain of an intense headache, on the 5th day during verticalization, an episode of loss of consciousness was noted. A CT scan of the brain was performed, according to the results of which pneumocephaly is determined subdurally and along the sickle of the brain. On the 14th day, the patient showed decreased alertness to moderate stupor, and hypertensive dislocation symptoms. According to CT of the brain, a subdural hygroma of the left frontal region with a volume of 150 cm3 and a transverse dislocation to the right by 13 mm was detected. The following surgical intervention was performed: microsurgical removal of the subdural hygroma in the left frontal region with a volume of 1, Stuckey ventriculocisternostomy 1. After 1 day, negative dynamics were noted: according to CT of the brain, an increase in the subdural hygroma to 120 cm3 with a transverse dislocation of up to 16 mm. A repeated surgical intervention was performed in the volume of subdural-peritoneal shunting. The postoperative period was satisfactory. On the control CT of the brain the volume of subdural contents decreased to 10 cm3, transverse dislocation to the right to 3 mm. The patient was discharged in satisfactory condition on the 21st day.
CONCLUSION. The present clinical observation is of great interest due to rare formation of this complication during decompressive-stabilizing interventions on the spinal column. When clinical symptoms of intracranial hypotension appear, it is necessary to stay alert and conduct clinical and instrumental diagnostics to exclude the formation of this complication.

Fibrous dysplasia (FD) is a rare bone disorder in which normal bone tissue is replaced by fibrous tissue. Concomitant vascular abnormalities are described extremely rare. The present observation represents a combination of polyossal FD on the background of McCune – Albright syndrome (MAS) with intraossal arteriovenous skull base fistula. The paper presents pathogenesis of visual disorders, possibility of diagnosing such combined malformations and surgical treatment options.
The aim is to describe a rare clinical observation, to analyze the literature of the FD and vascular developmental abnormalities combination.
The article presents a clinical observation of a patient with polyossal FD on the background of MAS and intraossal arteriovenous fistula.
The presented observation describes a rare combination of polyossal FD on the background of MAS and intraossal arteriovenous fistula, the genesis of the combination of which remains currently unknown. If signs of the aneurysmal bone cyst development appear in patients with FD, it is possible to introduce CT-AG studies into the preoperative study plan and resolve the issue of the need for selective angiographic examination and possible embolization of pathological vessels before open resection of pathological bone tissue. 

INTRODUCTION. Chiasm-sellar meningiomas tend to grow into the optic canal along one or more of its walls, compressing the optic nerve. Therefore, decompression of the optic nerve is one of the main step of surgical treatment of patients with this pathology. In the structure of surgical treatment of patients with chiasm-sellar meningiomas, there are two main minimally invasive surgical approaches (supraorbital, SOA and minipterional, MPA), which have limitations in decompression of the optic nerve.
AIM. Comparison of the effectiveness of SOA and MPA in the structure of surgical treatment for patients with chiasm-sellar meningiomas spreading into the optic canal.
MATERIALS AND METHODS. The study carried out a systematic literature review of publications investigating surgical limitations of the SOA and MPA to the walls of the optic canal. The work was carried out in accordance with the recommendations of PRISMA 2020. Online databases such as Pubmed, Google Scholar and elibrary.ru were used to search for published works. For each publication evaluated the type of study and its result: limitations of surgical approaches for visualization of the optic canal. A total of 8 publications were analyzed.
RESULTS. In the analysis of publications, the “blind” zones of the optic canal were identified when performing each of the considered approaches. When performing MPA, direct visualization was mainly inaccessible to the medial wall of the ipsilateral optic canal. When performing SOA, the tangential viewing angle relative to the anterior cranial fossa limited the visualization of the lower wall and the lower region of the medial and lateral walls of the ipsilateral optic canal.
CONCLUSION. MPA provides a preferential access to chiasm-sellar region and is the method of choice for surgical treatment of the chasm-sellar meningiomas spreading into the optic canal. SOA provides a preferential access to anterior cranial fossa and is the method of choice for medially located chiasm-sellar meningiomas. Direct visualization of the largest number of walls of the optic canal, along which the meningioma spreads, makes it possible to remove the tumor with a lower risk of deterioration of visual functions in the postoperative period.

Rett syndrome is a progressive neurodegenerative disease caused by a mutation in the MESP2 gene. To make a diagnosis, the main and additional criteria of the disease are used, as well as molecular genetic methods confirming the mutation. This article presents a clinical case of Rett syndrome, describes the main approaches to therapy and features of patient curation.