OBJECTIVE: Analysis of literature data of modern neurosurgical techniques in the treatment of lumbar disc herniation; clarification of the features of surgical tactics and results during microsurgical, endoscopic methods and laser thermoplastic of the intervertebral disk.

METHODS: A retrospective analysis of the results of conventional microdiscectomy (228 cases), laser disc decompression (22 observations) and percutaneos endoscopic discectomy (4 observations) for lumbar disc herniation from 2016 to 2018.The results of surgical treatment was assessed according to the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), modified MacNab criteria, and morphometric data of MRI and CT scans during the preoperative and postoperative periods, as well as 6 and 12 months after surgery.

RESULTS: The result of the study was a comparison of the literature data with those obtained in our clinic in the treatment of patients using all the indicated methods. On our material, we received confirmation of the feasibility and perspectivity of using minimally invasive methods in the treatment of lumbar disc herniation with low probability of recurrence and repeated treatment for pain. Also agree with the statement that the techniques have limited application, especially with instability in the VMS and multilevel lesion.

CONCLUSION: Endoscopic discectomy, as well as laser disc decompression, are minimally invasive methods of treatment lumbar disc herniation, and have become an alternative to open lumbar microdiscectomy, as they allow minimizing surgical trauma, the effects of surgery, and quickly regress pain syndrome, contributing to early postoperative activation of the patient.

OBJECTIVE: Detection of main factors unsatisfactory surgical treatment patients with cubital tunnel syndrome.

MATERIALS AND METHODS: 121 patients with cubital tunnel syndrome were included in the study. All patients were treated surgically in Polenov Russian Research Institute of Neurosurgery, Almazov National Medical Research Centre, between 2014 and 2018 years. Anterior subcutaneous transposition of the ulnar nerve were carried out to 63 (52,1%) of these patients, submuscular transposition of the ulnar nerve –58 (47,9%) patients with cubital tunnel syndrome. None of represented patients were treated by decompression of ulnar nerve. In 15 cased had die patients’ negative outcomes as pain enhancement, worsening sensitivity and nerve conduction disorders (according electromyography). All surgically treated patients had been operated previously in other medical centers with negative and unsatisfactory outcomes.

RESULTS: Represented analysis enables to reveal the most common complications by surgical treatment patients with cubital tunnel syndrome.

CONCLUSION: The main factors of negative and unsatisfactory outcomes of surgical treatments patients with cubital tunnel syndrome in our study were inobservance of surgical treatment methods und choice functional unfounded surgical treatments.

INTRODUCTION: the study is devoted to an actual problem of the surgical treatment for patients with extensive and giant peripheral nerve sheath tumors of the extremities. The aim of the work is to improve the results of surgical treatment for patients with peripheral nerve sheath tumors. The article adhered to the WHO classification of 2016. One of the most difficult problems of treatment this pathology is the large and giant peripheral nerve sheath tumors, which make up from 5% to 20% of neoplasms of the peripheral nerves and are mainly divided into neurofibromas and malignant peripheral nerve sheath tumors according to histological characteristics. The defeat of several anatomical regions, the prevalence of the tumor, the gross involvement in the neoplastic process the internal organs and major vessels make it difficult to perform radical surgery with the removal of the affected tissues in a single unit.

METHODS: an analysis of comprehensive examinations and surgical treatments of 320 patients with peripheral nerve sheath tumors of the extremities who were treated at the prof. A.L. Polenov Russian National Research Institute of Physics. The classification of tumor sizes is proposed depending on the diameter of the nerve trunk affected by the neoplastic process.

RESULTS: the statistically significant dependence of the nerve trunk conduction disturbance on the histological structure and tumor size was revealed: tumors with small and medium sizes, predominantly neuromas, conduction disturbances are noted much less frequently than in cases with neurofibromas of medium and large sizes, in 75% of cases with large and giant tumor sizes (malignant peripheral nerve sheath tumors, neurofibromas) there is a complete violation of conductivity (p <0.001).

CONCLUSION: the issues of diagnostics, clinics, tactics of surgical treatment for patients with peripheral nerve tumors and relapse preventions are discussed. In cases of neurofibromas, large tumors predominate (p <0.001), in the group of malignant peripheral nerve sheath tumors, mainly giant tumors are observed (p <0.001). This statement is confirmed by a clear statistical dependence of the size of the tumor on its histological nature (p <0.001). The difficulty in developing adequate surgical tactics for extensive and giant peripheral nerve sheath tumors is due to the localization of the neoplasm on the “border of interests” of various surgical specialties (surgeons, oncologists, etc.), which requires the development of joint researches in this area.

The intention of the work was to study the subjective indicators of the readiness for neurosurgical treatment of patients with focal pharmacoresistant epilepsy. The study was performed on the basis of Polenov Neurosurgical Institute in 2019–2020.

The study included 53 patients with a verified diagnosis of focal pharmacoresistant epilepsy. Patients were interviewed on a specially designed questionnaire “Subjective readiness for surgical treatment of epilepsy”, including questions: psychology readiness for surgical treatment, the optimal age and age for neurosurgery intervention, according to the patient.

The readiness for surgical treatment of patients with epilepsy in a neurosurgical hospital was 94.3%. Due to the incomplete answers, a quantitative analysis was carried out in 45 patients. The 1st group consisted of 20 patients, the 2nd — 25. The average age in the cohort was 30.96 + 1.07 years. The duration of the disease until surgical treatment or the resolution of the issue of surgical treatment was 19.26 + 1.35 years. The duration of the disease and the optimal age for the operation, according to patients, differed from the age and duration of the disease at the time of stay in the clinic. According to patients, the optimal age of treatment was 18.66 + 1.3 years, and the optimal duration of the disease was 6.94 + 1.02 years, which is 2.8 times less than the actual experience of epilepsy.

The duration of the disease before hospitalization to a neurosurgical hospital is a manageable indicator. Our study demonstrated that patients are psychologically ready for surgical treatment long before the actual terms of the operation. It is necessary to raise the awareness of patients and primary care doctors about the possibilities and principles of the surgical treatment of epilepsy.

The paper is a review of modern literature on the etiology, risk factors for development, the prevalence of the adjacent segment degeneration (ASD) and the adjacent segment disease (ASd) after performing dorsal decompressionstabilizing interventions at the lumbar spine. The term ASD is understood to mean the presence of instrumentally confirmed degeneration of segments adjacent to the operated, accompanied by certain neurological symptoms. In the absence of clinical manifestations and the presence of only instrumental signs of degeneration of segments adjacent to the operated segment, the term ASd is eligible. The analysis of experimental and clinical studies studying the problem of ASD and ASd. The authors set out modern data on approaches to the treatment of ASd, as well as the rationale for choosing a rational treatment and diagnostic tactics for managing patients with the specified pathology. Relevant outstanding issues are identified, which necessitates further research in order to develop uniform clinical recommendations for the diagnosis and treatment of patients with ASD and ASd.

Haemorrhagic complications are associated with the highest mortality rate in the structure of complications in vestibular schwannomas surgery. However, these complications are usually mentioned only briefly in studies where the authors report the overall results of vestibular schwannomas removal operations. The article presents a literature review and a description of 3 clinical observations with postoperative cerebello-pontine angle hematomas. Based on the results of the analysis of the world experience in the treatment of patients with this type of complication, the risk factors were identified, and a set of surgical measures for the prevention of postoperative hemorrhagic complications in the surgery of vestibular schwannomas was proposed. We have submitted an original classification of the sources of postoperative hematomas and determined the decisive role of the earliest possible revision interventions in the treatment outcomes for this category of patients.

OBJECTIVE. Present the experience of surgical treatment of posttraumatic arterial aneurysm of the cavernous part of the right internal carotid artery, manifested by profuse nosebleeds.

MATERIALS AND METHODS. The work is based on a retrospective analysis of disabling an intracavernous arterial aneurysm from the cerebral bloodstream by trapping surgery after preliminary creation of a wide-angle anastomosis between the right external carotid artery and the right middle cerebral artery using an autoarterial graft. The functioning of the created extra-intracranial wide-light anastomosis and the patient›s clinical condition in the immediate postoperative period were evaluated.

RESULTS. The main parameters studied were: the presence of repeated nosebleeds, the presence of focal neurological symptoms in the patient in the postoperative period, and the functional state of broad-spectrum extra-intracranial anastomosis.

CONCLUSIONS. The possibility of successful treatment after open surgery in a patient with an arterial aneurysm of the cavernous part of the right internal carotid artery is presented. The operation made it possible to switch off the aneurysm from the cerebral bloodstream together with the internal carotid artery without the occurrence of cerebral ischemia after preliminary creation of a wide-angle anastomosis between the right external carotid artery and the middle cerebral artery using an autoarterial graft.

Cerebral disease of small vessels — a term referring to various pathological conditions and mechanisms that lead to damage to small vessels of white and gray matter of the brain, being an important cause of acute cerebrovascular accident, the development of cognitive impairment and complications of antithrombotic therapy. The article is devoted to the analysis of the differential diagnosis of cerebral amyloid angiopathy with other variants of cerebral disease of small vessels by the example of a clinical case. Is represented actual information on individual nosologies, Are described neuroimaging markers of cerebral amyloid angiopathy. Are examined the clinical manifestations of diseases, including cognitive impairment. Is highlighted the problem of making a diagnosis in this patient.

Gangliogliomas are mixed tumors of the central nervous system, consisting of well-differentiated neuronalglial elements of low malignancy (WHO Grade I). This category of tumors is characterized by slow growth, low morbidity and mortality. Gangliogliomas are found, as a rule, in children and young people; the most frequent localization is the temporal lobe, followed by the frontal, parietal and occipital lobes in frequency of occurrence. These tumors often manifest as epileptic seizures and account for approximately 40% of all epileptogenic tumors. It is known that timely surgical treatment in the volume of complete resection of ganglioglioma contributes to better control of seizures and improved longterm treatment results. As a result, the problem of early diagnosis of gangliogliomas and screening of molecular targets for therapy is very urgent. Considering the urgency of the problem, epidemiology and certain difficulties of primary clinical diagnosis, we present a description of a clinical case of an elderly patient with ganglioglioma.

To analyze modern methods and trends in the treatment of oligometastatic brain lesions using open surgery.

Patients with brain metastases, according to the canons of oncology, belong to the group of cancer patients with distant metastases, which requires an integrated approach to their treatment. The choice of the optimal method of treatment for metastases of tumors of various histological structures, localization, taking into account the prevalence of the extracranial process, is an unresolved task. Improving the quality of life, rapid regression of neurological symptoms, and achieving local control are the direct objectives of the neurosurgical service.

Cerebral metastasis surgery plays an indispensable role in the concept of multimodal therapy, but it is associated with an unusually high recurrence rate of over 50%. A number of retrospective studies conducted in the 1980s showed a better outcome for surgical resection in patients with a single brain lesion, good functional status and a controlled condition of the primary lesion. However, until now, despite the technical advances in the surgery of intracranial metastases, the prevention of local recurrence remains a challenge. Hence, a more detailed understanding of the mechanisms of local recurrence may lead to improved treatment strategies.