BACKGROUND. Traction injuries are relevant in the general structure of brachial plexus traumas, and microsurgical neurolysis is a commonly used method for comprehensive treatment of patients with closed traction injuries of brachial plexus. Along with surgical interventions various electrostimlilation techniques are applied for the trunks of brachial plexus, although their results still remain contradictory.
RESEARCH OBJECTIVE. To perform comparative analysis of the outcomes of surgical treatment that involved electrostimlilation methods for patients with traction injuries of the trunks of brachial plexus.
MATERIALS AND METHODS. 20 patients with traction injuries of the trunks of brachial plexus made the scope of the research. The outcomes were estimated in both the main and the comparison groups. The patients were treated with one-level as well as two-level electrical neuromodulation methods. The outcomes were evaluated using data of clinical neurologic status research in dynamics and electrical physiological monitoring. 
RESULTS. In the patients of both the main and the comparison groups on Day 14 of the surgeries pain abatement was observed, its dynamics being most prominent in the main group. Despite M-responses of all patients being rather low, the obvious tendency for the rise of amplitude range was recorded. In the main group the emerging motor units in upper extremities were registered suggesting the initial stage of reinnervation in peripheral sensomotor structures. 
CONCLUSION. Application of two-level electrical neuromodulation method ensured better short-term results of surgical treatment for patients with traction injuries of brachial plexus based on the regress of pain syndrome and positive dynamics of electrophysiological indicants.

The article presents results of a study of prognostic factors, the features of the manifestation and kinetics of the re- current neuroepithelial brain tumors in children. The authors performed a prospective analysis of data obtained in 121 consecutive patients diagnosed at Polenov Neurosurgical Institute (branch of Almazov National Medical Research Centre) between 2008 and 2018 with a biopsy-proven NET. As a result of a prospective study, data were obtained on the clinical neuroimaging features of the re-growth of NET, factors were identified that affect the frequency of progression of NET in pediatric patients. The results of applying the Collins’ law in the primary and repeated recurrence of NET in children are obtained. The kinetics of growth of cerebral neuroepithelial neoplasms in children was assessed using virtual 3D modeling.  

INTRODUCTION. Neuroepithelial tumors occupy a leading position in frequency of occurrence, and relapse after or during combination treatment is inevitable in most cases. The lack of consensus on the indications and effectiveness of surgical treatment of recurrent gliomas served as the basis for the analysis of the results of surgical removal of recurrent gliomas.
THE AIM. Assess the effect of surgical removal of recurrent gliomas on overall life expectancy.
MATERIALS AND METHODS. A comparative analysis of overall survival among patients with recurrent gliomas of various degrees of malignancy (Grade II, III, and IV) was carried out in the surgical treatment groups for relapse (main) — 117 patients and conservative treatment (control) — 129 patients. All patients were treated in the Clinic of Neurosurgery of the Military Medical Academy from 1998 to 2018 inclusive.
RESULTS. With an increase in the degree of malignancy from Grade II to Grade IV in the main group, overall survival decreased from 84.9 months (Q1-Q3 = 61.1–132.8) to 26.4 months (Q1-Q3 = 14.9–50, 3). For patients of the control group — from 57.8 months (Q1-Q3 = 15.8 — not calculated) to 15.8 months (Q1-Q3 = 10.0–30.3), respectively. Among the completed cases in the surgical treatment group, life expectancy was statistically significantly increased by 40 months for patients with Grade II tumors compared with the control group (p <0.05) and clinically significant for patients with Grade IV and III tumors by 8.9 and 5, 9 months, respectively (p> 0.05).
CONCLUSION. Microsurgical recurrent glioma is a favorable factor for increasing the overall life expectancy in some patients with recurrent gliomas of any degree of malignancy. In case of gliomas of a low degree of malignancy, an additional basis for surgical intervention for relapse is to clarify the histological diagnosis in the development of relapse.

ANNOTATION: surgery robotization around the world is in active process. In neurosurgery, this process primarily develops in the direction of stereotaxis. The development of the first Russian robotic stereotactic manipulator «ORBITA» is currently underway.
OBJECTIVE: determination of the principle of operation, medical, technical requirements and general working characteristics, and also preparation for serial production of an automated manipulator for stereotactic brain surgery.
MATERIAL AND METHODS: an experimental sample of the robotic manipulator «ORBITA» has been developed, which is a compact, articulated structure consisting of several kinematic nodes with six degrees of freedom. The manipulator was tested on a phantom in a neurosurgical operating room. The manipulator is controlled using an external optical neuronavigation system.
RESULTS: the mechanical, medical and technical characteristics of the described robotic manipulator meet the requirements for manipulators of frameless navigation systems to enable stereotactic operations.
CONCLUSION: the characteristics of the device allow its use in all types of stereotactic operations on the brain, including biopsies, intracerebral implantation of electrodes, as well as stereotactic destruction of intracerebral tumors and subcortical structures in functional neurosurgery. 

The article is devoted to resistant forms of epilepsy in children caused by impaired brain development. The analysis of data on the significance of certain genes in the formation of each of the main stages of proliferation and differentiation, migration or late neuronal organization. Clinical demonstrations of patients with different genotypic and phenotypic heterogeneity are presented.

Parasitic brain lesions (helminthiases) are currently found in our country more and more often, which may be associated with increased migration in recent years. Frequently they have a tumor-like course, which dictates the need for differential diagnosis with brain volumetric formations. But in the case of verification of a parasitic lesion, the question of identifying a specific pathogen arises. Among the main group of helminthiases that affect the nervous system (cysticercosis, echinococcosis, nematodosis, coenurosis), the most significant and common is cysticercosis. Cysticercosis — helminthiasis, which is the most common helminth infection of the nervous system. The causative agent is the larvae of the pork tapeworm. Cysticerci can be located in the brain parenchyma, subarachnoid space, ventricular system or spinal cord. The most common clinical manifestations of the disease are epileptic seizures, but some patients have focal neurological symptoms, intracranial hypertension or decreased cognitive function. Neuroimaging signs of neurocysticercosis, as well as immunological diagnostic tests are not specific and can be observed in other diseases of the nervous system. Accurate diagnosis is possible after analyzing and comparing the clinical symptoms, brain MRI data and the results of immunological tests with epidemiological data. In connection with the aforementioned difficulties of diagnosis, a description of the clinical case of neurocysticercosis in a middle-aged patient who was treated in the neurology department of the treatment and rehabilitation complex of the N. V. A. Almazov is given. 

The team of authors highlights in the work an integrated approach in the treatment of brain formations using endoscopy and stereotaxis, describes the possibility of using minimally invasive interventions including cases of impaired cerebrospinal fluid dynamics.
PURPOSE: to improve the results of treatment of patients whose disease was complicated by developing of a number of pathological conditions, to avoid repeated opened interventions by using minimally invasive techniques.
METHODS. Some observations are described when endoscopy and stereotaxis were used to diagnose and correction of conditions that developed during the blastomatous process. In one case the endoscopic removal of the subependymal giant cell astrocytoma of the left lateral ventricle was done. The second case is the stereotactic diagnostic which made it possible to verify the blastomatous process and to avoid the wrong treatment tactic followed by antitumor therapy.
RESULTS. In both cases there were no complications during the operation and in the postoperative period. Verification of the pathological process was achieved which made it possible to identify the blastomatous process and to continue its correct therapy (stereotaxis) as well as safe total minimally invasive tumor removal (endoscopy). The using of minimally invasive surgery methods get it possible to reduce the hospitalization period and to avoid unnecessary surgical trauma. Both patients were socially adapted after surgeries.
CONCLUSIONS. Optimal ways and methods of using neuroendoscopy and stereotaxis as well as their interaction allow to avoid repeated open interventions for tumors of the brain by intraventricular and paraventricular localization. Based on the obtained data, optimization of algorithms of using stereotaxis and endoscopy in the complex treatment of brain tumors has been proposed. 

the Purpose of this review was to generalize the current understanding of the mechanisms of dysphagia formation in focal brain damage. Dysphagia is a violation of the movement of a food lump from the mouth to the esophagus. Swallowing disorders often occur in acute disorders of cerebral circulation, reducing the quality of life of patients. A number of complications during the early recovery period of stroke are associated with dysphagia. The study of the pathophysiological prerequisites of post-stroke dysphagia was made possible by the development of neuroimaging technologies, primarily transcranial magnetic stimulation and functional magnetic resonance imaging. Understanding the neural mechanisms of swallowing disorders will help in the development of evidence-based rehabilitation technologies. 

INTRODUCTION. The objective of this trial was to evaluate the efficacy and safety of Cerebrolysin in treating patients after moderate to severe traumatic brain injury (TBI) as an adjunct to standard care protocols. The trial was designed to investigate the clinical effects of Cerebrolysin in the acute (neuroprotective) stage and during early and long-term recovery as part of a neurorestorative strategy.
MATERIALS AND METHODS. The study was a phase IIIb/IV single-center, prospective, randomized, double-blind, placebo-controlled clinical trial. Eligible patients with a Glasgow Coma Score (GCS) between 7 and 12 received study medication (50 ml of Cerebrolysin or physiological saline solution per day for 10 days, followed by two additional treatment cycles with 10 ml per day for 10 days) in addition to standard care. We tested ensembles of efficacy criteria for 90, 30, and 10 days after TBI with a priori ordered hypotheses using a multivariate, directional test, to reflect the global status of patients after TBI.
RESULTS. The study enrolled 142 patients, of which 139 underwent formal analysis (mean age = 47.4, mean admission GCS = 10.4, and mean Baseline Prognostic Risk Score = 2.6). The primary endpoint, a multidimensional ensemble of 13 outcome scales, indicated a “small-to-medium”-sized effect in favor of Cerebrolysin, statistically significant at day 90 (MWcombined = 0.59, 95 % CI 0.52 to 0.66, P = 0.0119). Safety and tolerability observations were comparable between treatment groups.
CONCLUSION. Our trial confirms previous beneficial effects of the multimodal, biological agent Cerebrolysin for overall outcome after moderate to severe TBI, as measured by a multidimensional approach. Study findings must be appraised and aggregated in conjunction with existing literature, as to improve the overall level of insight regarding therapeutic options for TBI patients. The widely used pharmacologic intervention may benefit from a large-scale observational study to map its use and to establish comparative effectiveness in real-world clinical settings. 

Metastatic lesions of the spine are common. Surgical treatment is indicated in most cases with this pathology. The most effective treatment is a combination of surgical and radiation therapy. Currently, there is no single approach to the treatment of metastases in the spine. The article provides a review of the literature on the diagnosis and treatment of metastatic spinal lesions.