AIM OF THE STUDY is to assess the influence of unruptured brain AVM’s angioarchitecture on cognitive functions and quality of life.

MATERIALS AND METHODS. Cognitive functions and quality of life in 40 patients with unruptured supratentorial AVMs and 50 normal controls were assessed. Results of neuropsychological testing were correlated with anatomy of AVMs.

RESULTS. Cognitive impairment was found more than in 30% of brain AVM cases. Predictors of cognitive impairment are follow: diameter of AVM > 3 cm, participation of 2 and more sources of blood supply, deep drainage and venous outflow disruption. Assessment by SF-36 questionnaire found increase of anxiety and decrease of quality of life in patients with AVM. Venous obstructions and involvement of ECA branches are negative prognostic factors for cognitive impairment.

CONCLUSION. Medium/large size AVM and existence of deep drainage or venous obstacles are predictors for cognitive impairment in patients with unruptured AVM’s. Presence of AVM decreases quality of life by restriction of activity and high level of anxiety.

The most frequently reported risk factors for pseudarthrosis formation after spinal fusion are old age, overweight, autoimmune connective tissue disorders and tobacco smoking, nevertheless bone radiodensity as a prognostic factor has not been sufficiently studied.

THE AIM OF THE STUDY. To evaluate impact of risk factors on quality of bone fusion formation in patients with degenerative diseases of the lumbar spine treated with TLIF and PF procedures.

MATERIALS AND METHODS. The results of surgical interventions using TLIF (transforaminal interbody fusion) and PF (posterior fusion) were investigated in 93 patients. By the end of 12 months after surgical intervention anterior and posterior fusion was assessed using CT. Using logistic regression analysis patient’s age, tobacco smoking, cardiovascular diseases and vertebral bodies cancellous bone radiodensity impact on quality of bone fusion was estimated.

THE RESULTS. Only a decrease in bone radiodensity of vertebral bodies in Hounsfield units (p=0.0033) patient’s age (p=0.0146) affects interbody fusion formation. The only detected factor that has a statistically significant influence on posterior fusion formation was patient’s age (p=0.01457).

CONCLUSION. Bone radiodensity decline is a considerable risk factor for pseudarthrosis formation after interbody fusion, however no correlation between this parameter and quality of posterior fusion was detected. Posterior and interbody fusion is less likely to get formed in elderly patients. When using TLIF technology for lumbar spine degenerative pathology treatment, it is beneficial to supplement it with a posterior bone fusion, especially in patients with impaired bone quality.

Aneurysm of the extracranial internal carotid artery (ICA) is a rare disease. Timely recognition of the extracranial ICA aneurysm is extremely important from the point of view of the early appointment of conservative therapy and surgical correction of the lesion. At the same time, the clinical diagnosis of such aneurysms is often complex. The mathematical model developed by us predicts the type of extracranial aneurysm of the internal artery and has sufficient sensitivity and specificity, which allows it to be used for practical purposes for differential diagnosis between distal and proximal aneurysms of the extracorporeal department of the ICA and the choice of diagnostic and therapeutic tactics.

INTRODUCTION: Idiopathic normal-pressure hydrocephalus (iNPH) is a pathological process in the brain including widening of CSF-containing spaces and Hakim-Adams syndrome. Among different scales allowing us to select shunt- responsive patients, we chose iNPH RadScale that ranges different radiological signs, some of them are of high specificity for iNPH, and others are common for all kinds of hydrocephalus.

OBJECTIVE: assessment of MRI radiological signs of iNPH RadScale in patients with iNPH, other forms of hydrocephalus and hydrocephalus-associated disorders to determine the correlation between iNPH diagnosis and presence of iNPH RadScale signs.

METHODS: we used preoperative brain MRI of 175 patients to assess radiological signs in them, 117 of them have iNPH, 58 — other forms of hydrocephalus. The iNPH RadScale contains 7 radiological signs, maximum 12 points. We used СЫ-square criteria and Pearson’s correlation to compare each of the radiological signs between the groups.

RESULTS: Only 2 radiological signs have got very strong correlation with iNPH: focally enlarged sulci (r=0,874, р<0,001) and Sylvian fissures dilation (r=0,917, p<0,001), and medium level of correlation for high-convexity tightness (r=0,323, p<0,05). Other radiological signs had the equal occurrence in both groups of patients (r<0,3, p>0,05). There was no significant difference (p<0,05) in iNPH RadScale score between the groups because of heterogeneity of the secondary hydrocephalus’ group.

CONCLUSION: iNPH RadScale has 4 signs common for all forms of hydrocephalus and 3 signs which have high specificity for iNPH. Thus, we can conclude that DESH-syndrome and locally dilated convexital sulci can highly likely confirm the iNPH diagnosis.

Based on the analysis of the results of molecular-genetic and biochemical research, as well as methods of radiation diagnosis, surgical technologies for treating children with severe congenital deformities of the spine will be planned. The publication justified the conduct of such studies in view of the clinical picture with congenital deformity of the spine. Solving the problem as a whole will provide timely assistance to patients of this category, and will also provide an opportunity to predict the occurrence of congenital spine pathology.

RESEARCH OBJECTIVE was development of a way of surgical access through the channel of a spinal nerve with preservation of a ligamentum flavum for the purpose of prevention of development of the epidural cicatrical adhesions. The analysis of efficiency of a way of access through the channel of a spinal nerve for prevention of epidural cicatrical adhesions et patients with hernias of lumbar disks is carried out. Conclusions: the way of access through the channel of a spinal nerve developed and patented by us owing to the small invasiveness, and a possibility of preservation of a ligamentum flavum, reduces a possibility of development of epidural cicatrical adhesions in epidural space.

OBJECTIVE: a comparative analysis of the results of standard neurolysis and neurolysis in combination with the use of an anti-adhesion membrane and endoneural stimulation of the nerve in the treatment of patients with closed intra-trunk traumatic radial nerve palsy.

MATERIALS AND METHODS: 29 patients were observed with traumatic radial nerve palsy at the middle third level of the shoulder, of which 12 patients (group 1) underwent neurolysis, and 17 patients (group 2) underwent neurolysis with the additional use of an anti-adhesions membrane and epineural intra-and postoperative stimulation of the radial nerve. All patients before the operation, 1, 3 and 6 months after the operation, underwent a clinical and neurological examination, evaluation of daily activity limitations using the method “Measuring functional activity limitations due to hand injury and treatment results” (“DASH”), electroneuromyography.

Conclusions: neurolysis in combination with the use of an anti-adhesion membrane and electrostimulation during traumatic intra-trunk injuries of the radial nerve in the middle third of the shoulder contributes to a better recovery of muscle strength and arm function than one neurolysis.

Treatment of patients with prolonged disorder of consciousness (PDC) remains an actual problem. Presence of hyperkinetic syndrome in PDC patients increases the duration of hospital treatment. Aim of our research was development of treatment protocol for PDC patients with hypertensive syndrome. Results of use of volatile anesthetic sevoflurane in 11 PDC patients with persistent hyperkinetic syndrome are presented. When evaluating the results of therapy on the scale of hyperkinesis developed at RNSI, hyperkinesis was completely cured in 2 patients, the severity of hyperkinesis on the scale decreased by 3-7 points in 6 patients, the effect of therapy in 3 patients was not observed. The positive effect (disappearance or reduction of the severity of myoclonias) was persistent: clinical effect was evaluated immediately after the end of the «therapeutic anesthesia» session, the next day and 1 month later. Thus, volatile anesthetic sevoflurane can be effective in the treatment of persistent hyperkinetic syndrome in PDC patients.

Comparative analysis of the effectiveness Aminomethylbenzoic acid and Tranexamic acid at 47 patient on spine surgery showed that the reduction of blood loss and coagulation in Aminomethylbenzoic acid similar to Tranexamic acid.

PURPOSE OF RESEARCH. To improve the results of treatment of wounded with gunshot wounds of the spine and spinal cord at the stage of specialized medical care in mountainous desert areas.

MATERIAL AND METHODS. The analysis of treatment of 23 wounded with gunshot wounds of the spine and spinal cord, among which the syndrome of complete impairment of the spinal cord was revealed in 5 wounded (21.9%), the syndrome of partial impairment of conductivity — in 4 (17.2%) and without neurological deficit — 14 wounded (60.9%). All the wounded were carried out spondylography. In the acute period 20 were operated, in the early period — 3.

RESULTS AND DISCUSSION. Through the application of active flow-wash drainage using local hypothermia and epileptogenic of antibiotics was not a single case of complications from the gunshot wounds. In our observations, there were no cases of spinal instability after a gunshot wound, except for injuries to the cervical spine. Cases of significant improvement in the condition of the victims were noted in isolated injuries of the spine, accompanied by compression of the spinal cord. The mortality rate was 3.6%, which was associated with an increase in the frequency of concomitant injuries. Perioperative factors affecting the outcome of treatment in these conditions are discussed.

SUMMARY. In case of damage compression of the spinal cord and compensated condition of the wounded, primary surgical treatment of wounds should be performed in an emergency. In the case of combined injuries urgent surgery is indicated to eliminate the threat to life. The operation on the spine is performed only after the stabilization of the general condition of the wounded. The use of flow-washing drainage and antibiotic therapy contribute to the favorable flow of gunshot wounds to spine and spinal cord.

The article presents a review of the literature due to post-intensive care syndrome (PICS). The distinguishing of PIT syndrome as a separate pathology, according to some authors, is like a recognition that intensive therapy can be considered an unintentional iatrogenic damage that occurs as a result of increasingly aggressive medical and surgical interventions. The PIT syndrome is usually consists of a group of symptoms: neuromuscular (polyneuropathy of critical conditions, respiratory neuropathy, dysphagia); cognitive (impaired memory and attention, impaired control functions), mental (post- traumatic stress injury, depression); violations of daily activity (reduced tolerance to physical exertion, muscle weakness). According to the practice of previous researches each patient in the ICU should conduct an assessment of the cognitive, mental and physical signs of dysfunction. The assessment should include past history, screening and routine testing and the consultation of other clinicians.

Patients with malignant ischemic stroke (MIS) represent a special group of patients with an with acute cerebrovascular accident (CVA) and it occurs in 10-15% of cases in the general population of stroke patients [17-25]. Under MIS, it is understood that it is stroke with a vast area of cerebral ischemia with the formation of post-ischemic edema and the presence of lateral and / or axial displacement of the brain [22, 25, 26]. Mortality in patients with MIS is 70-80%, and disability among survivors — 80% [17-21, 23, 24, 26, 28-34].

The search for the most effective methods of treatment of this category of patients is a debatable issue.

The paper presents a clinical observation of patients with malignant ischemic stroke due to cardiogenic embolus of the left internal carotid artery (LCA). Admission to the hospital outside the «therapeutic window», more than a day from the onset of the disease, makes it impossible to apply reperfusion methods. Moreover, delays in seeking medical care and hospitalization led to the development of cytotoxic and vasogenic cerebral edema, community-acquired pneumonia, hypoxia, hypotension, hypermetabolism syndrome and hypercatabolismand the necessity to compensate respiratory functions (mandatory MV mode).

Due to the extremely unfavorable condition of the patient, the implementation of early decompression craniotomy was combined with the use of 96-hour craniocerebral hypothermia, which allowed to stabilize and then improve the patient’s condition. The patient is switched to spontaneous breathing, metabolism, volemic status, gas exchange and acid-base balance have normalized, partially regressed focal neurological symptoms, cognitive disorders. At the moment, a rehabilitation course has been carried out in a specialized inpatient department of the FSCC RR, 3 stages of rehabilitation is recommended.

Thus, the patient with a malignant ischemic stroke was not only able survive, but also, with the already extensive ischemic brain damage, neurological disorders was minimized.