Spasticity is one of the most common complications of spinal cord injury (SCI), the treatment of which is still an unresolved problem. Our goal was to develop an algorithm for personalized selection of patients for surgical treatment using spinal stimulation (SCS) and intrathecal baclofen therapy (ITB ).
We analyzed 28 cases of severe spastic syndrome in patients with SCI, aged 18 to 62 years, with an average age of 33.9 ± 12.9. The patients were divided into 3 groups: the control group that received conservative therapy; the SCS group and the ITB group. The results were evaluated using a modified Ashworth scale, Pen spasm frequency scale, reflex scale, and motor function scale 1, 3 and 6 months after surgery. The first stage was carried out trial SCS in case of positive result of the performed implantation of a pulse generator (14 patients), with a negative result, the patient was performed baclofen trial, the results of which have been implanted pump (14 patients).
As a result, over 6 months of observation obtained the significant decline in spasticity in both study groups compared to the control for all scales except the scale of motor function, where there were no recorded statistically significant changes.
Based on the results of 6-month follow-up, we can make a preliminary conclusion that step-by-step selection through test stimulation is an effective method of personalized treatment of spasticity. Patients who responded to the trial SCS maintain a stable result for a long period of time without detecting significant differences with those receiving ITB .

Objective: to study the results of surgical treatment of patients with spinal cord injury at the level of the cervical spine, operated by methods of anterior and posterior stabilization.
Materials and methods: A statistical analysis of the treatment of 49 patients with spinal cord injury who was performed anterior spondylodesis or pedicle screw fixation at the level of the cervical spine.
Results: Patients with severe myelopathy (according to the Japanese orthopedic Association’s vertebrogenic cervical myelopathy rating scale JOAm — 0–10 points) had a lower index recovery of neurological function than patients with moderate myelopathy (р=0,0001 for ACDF, р=0,04 for ACCF, р=0,002 for pedicle screw fixation). Blood loss in anterior cervical corpectomy and fusion (ACDF) is significantly lower than in pedicle screw fixation (p=0,002). The orthopedic effect of pedicle screw is significantly higher than ACDF, and angulation after pedicle screw fixation is less than after ACDF (p=0,003). A high inverse correlation coefficient was found between the subaxial injury classification (SLIC) index and the index recovery of neurological function, r= –0,75.
Conclusion: The technique of anterior stabilization of the cervical spine is less traumatic for the patient, while pedicle screw fixation provides more reliable stabilization of the spine for active rehabilitation of the patient.

Magnetic resonance imaging with diffusion tensor mode was performed in 75 VS patients. Results processing was perfomed by workstation «Advantage Workstation» 4.4 and diffusion tensor package from the «Functionool» software. In order to obtain more reliable results, the study was performed in patients with two variants of VS etiology: traumatic brain injury (TB I) and hypoxia. Outcome levels were evaluated 12 months after TB I and 6 months after non-traumatic brain injury. Prognostic significance of changes in the ratio of fractional anisotropy coefficient in the trunk and genum of corpus callosum in TB I was found. In patients with consequence of hypoxia, less significant changes of FA in the right posterior genum of the internal capsule were found. Received data allowed us to conclude that in our study, the DT MRI method had better prognostic significance in patients with a consequence of TB I than in patients with hypoxic brain damage.

It is known that vegetative state (VS)/unresponsive wakefulness syndrome (UWS) patients usually have oligo- or amenorrhea. In some cases, there is a resumption of the menstrual reaction a few months before consciousness restoration. This study contributes understanding of the mechanisms of formation of a stable pathological state of the brain, and may also help to develop approaches to the treatment of this category of patients. Research of sex hormones in 33 female with different etiology and duration of VS/UWS was conducted.
The aim of the study was investigation of the gonadotropic and ovarian in VS/UWS female patients. As a result of the conducted research, two forms of ovarian insufficiency were revealed: hypogonadotropic in 42.86 % and normogonadotropic in 57.14 %.

Objective : The evaluate of clinical outcomes, safety, and technical peculiarities of percutaneous full-endoscopic bilateral lumbar decompression of central spinal stenosis through uniportal approach.
Material and methods : Analyzed the results of percutaneous full-endoscopic bilateral lumbar decompression of central spinal stenosis through uniportal approach performed of 28 patients for the period 2016–2019. To evaluate the results of surgical treatment used the ODI questionnaire, VAS scale and McNab. The assessment was made before surgery, the next day, after 1, 6 12 and 24 months after surgery.
Results: The average severity of preoperative radicular leg pain for VAS after surgery decreased from 6.5±1.3 to 1.8±1.2 (mean difference [MD] 4.7, 95 % CI, p = 8.5 × 10–14) in next day; to 1.3±1.1 (MD5.2, 95 % CI 4.3 to 5.6, p <=1.1 × 10–15) after 1 month; to 1.4±1.2 (MD5.1, 95 % CI 4.2 to 5.7, p = 1.2 × 10–13) after 6 months; to 1.4±1.2 (MD5.1, 95 % CI 3.8 to 5.5, p < 9.5 × 10–12) after 12 months; to 1.6±1.3 (MD4.9, 95 % CI 4.0 to 5.3, p <=9.2 × 10–14) after 24 months after operation, respectively. «Excellent» and «good» results of treatment on a scale of McNab evaluated 25 (89,3 %) patients. The mean value of the ODI improved from 56.2±6.4 to 23.2±4.2 after 1 month (MD33.0, 95 % CI 29 to 34, p < 2.2 × 10–16); up to 18.6±3.2 after 6 months (MD38,0, 95 % CI 33 to 40, p < 2.2 × 10–16); up to 16.6±3.2 at 12 months (MD40.0, 95 % CI 36.0 to 41.0, p < 2.2 × 10–16), and to 20.4±3.4 (MD36.0, 95 % CI 33.0 to 39.0, p < 2.2 × 10–16) after 24 months surgery, respectively.
Conclusion: Percutaneous full-endoscopic bilateral lumbar decompression of central spinal stenosis through uniportal approach is safe and effective; avoids excessive unnecessary resection of bone tissue including the facet joint; can be prevent of instability of the spinal motion segment; facilitates early postoperative activation and recovery of the patient.

ВВЕДЕНИЕ. Наиболее частой спинальной патологией являются дегенеративно-дистрофические заболевания позвоночника, которые по распространенности не уступают сосудистой и онкологической патологиями. Прогресс в развитии спинальной хирургии привел к созданию множества различных систем для фиксации, реконструкции и протезирования пораженных сегментов позвоночника. Однако, несмотря на различные методы хирургического лечения дегенеративно-дистрофических заболеваний позвоночника, риск интраоперационных осложнений все еще является одной из главный проблем, привлекающих внимание нейрохирурга и ухудшающих результаты хирургического лечения.
ЦЕЛЬ ИССЛЕДОВАНИЯ. Определение безопасных зон для введения винтов фиксирующих конструкций в тела позвонков при декомпрессивно-стабилизирующих операциях на поясничном отделе позвоночника с учетом морфометрических исследований МРТ пояснично-крестцового отдела позвоночника.
МАТЕРИАЛЫ И МЕТОДЫ. Проведен анализ 60 пациентов с дегенеративно-дистрофическими заболеваниями позвоночника и/или с позвоночно-спинномозговой травмой, среди них хирургическое лечение по данной методике получили 12 пациентов. Использовалось морфометрическое исследование вен и артерий позвонков с целью определения бессосудистых зон. Оценка результатов выполненных операций на основе регресса клинических симптомов и отсутствии интраоперационных осложнений.
РЕЗУЛЬТАТЫ. По результатам морфометрического исследование была определена безопасная зона, которая находится на боковой поверхности тела позвонка между верхним краем тела позвонка и в пределах отступа на 1 см книзу от верхней замыкательной пластинки, вторая зона (нижняя) — между нижней замыкательной пластинки и в пределах 1 см кверху от края позвонка для введения винтов фиксирующей конструкции. По разработанной методике было прооперировано 12 пациентов с диагнозом позвоночно-спинномозговая травма или дегенеративно-дистрофическое заболевание позвоночника. В ходе операции определены анатомические ориентиры бессосудистой зоны введения винтов стабилизирующих систем в тела позвонков. В двух случаях из 12 отмечалось наличие кровотечения из эпидуральных вен.
ЗАКЛЮЧЕНИЕ. Разработанная нами методика установки опорных винтов фиксирующей конструкции в тела позвонков является безопасной по отношению к паравертебральным сосудам, так как выполняется вне расположения поясничных артерий и вен. Такой подход снижает риск интраоперационного кровотечения и образования послеоперационных гематом в зоне оперативного вмешательства.

The aim of the work is to conduct a comparative analysis of the functioning and limitations of life in migraine and epilepsy in women of reproductive age according to the parameters of the main spheres of life of the ICF on the model of «Job and employment».
Materials and methods. The study included 240 women of reproductive age from 18 to 45 years. The first group consisted of patients with verified epilepsy, the second group — with migraine. Clinical and neurological method was used. The following indicators were evaluated: employment, causes of unemployment, disability. The patient profile in the categories of ICF is filled in according to the results of the clinical interview, anamnesis method and analysis of the patient’s medical records, neurological examination data and instrumental studies.
Results. The cohort of patients with migraine compared to the cohort of epilepsy was characterized by later onset of the disease, older age but also a longer duration of the disease. 30 % (45/150) of patients in group 1 and 20 % (18/90) of group 2 did not work or study. 23 % of patients in group 1 had disabilities but in group 2–0 %. In the group of patients with migraine the disturbance of capacity prevailed in 2–3 points that are moderate and severe difficulties — in 33 % and 44 % of cases respectively. In patients with epilepsy significantly more frequent disturbance of capacity corresponded to 1 point and 3 points that are difficulties capacity were light in 33 % and severe in 42 % of patients. Moderate impairment of capacity in the performance of labor activity in the group of patients with epilepsy was in 18 % of cases.
Conclusion. The difference between potential ability and realization reflects the differences in the influence of factors of the real and typical environment, and thus indicates the direction of socio-economic development of the environment in order to more fully realize the individual. ICF is a useful tool for the formation of a personalized approach in the treatment of neurological diseases and biopsychosocial rehabilitation model.

Objective : to modify the surgical technique of nerve grafting applicable to distal branching of a nerve depending on topographic anatomical zone of injury.
Methods : the modified techniques of nerve grafting were based on experience of treatment of 34 clinical cases (38 nerve trunks) of nerve complete cut at the distal level. H. M illesi technique is the traditional way of grafting of nerve defects which is time consuming and technically difficult in case of distal nerve defects. A proposed modified nerve grafting technique principally doesn’t make much difference with H. M illesi technique. The technical differences connected with intraneural fascicular anatomy of each of three median, ulnar and radial nerves, shape and length of nerve defect in the area of distal nerve branching. Modified technique requires the proximal nerve stump dissection with identification of fascicular groups identical to terminal distally cut branches in order to prepare for grafting. Separate surgeon team has to make nerve graft harvesting which is identical to the shape and length of nerve loss. The prepared nerve graft sample after positioning on the injury side consecutively sutured proximally and distally cabling each fascicular proximal groups with the same motor or sensory nerve branches distally. Depending on anatomical features and type of nerve 3 invention patents were issued.
Results: late follow up were recorded on patients during 18 months to 18 years after reconstruction. The overall clinical recovery till level S3+, S4 of sensory and M4-M5 of motor functions were achieved in 82–85 % clinical cases depending on type of nerve.
Заключение : Modified nerve grafting techniques is more simple is comparison with the traditional H. M illesi technique. They allow to restore previous anatomy of nerve defects in the zone of distal branching on more high quality which were proved by achieved functional recovery results.

One of the complications of acute severe brain damage is the development of paroxysmal sympathetic hyperactivity syndrome (PSH). The high frequency and negative consequences-increased disability and mortality, make researchers around the world to study this syndrome, look for ways to prevent and treat it. The pathophysiology of PSH is not fully understood. Despite the fact that this syndrome has well-described symptoms, its diagnosis is associated with certain difficulties. First of all, differential diagnostics with other conditions is required. The use of scales and therapeutic approaches developed by Russian scientists, among others, seems to us useful and promising.

Background. Calcium pyrophosphate dihydrate deposition disease is a very crystal arthropathy characterized by calcium pyrophosphate crystal deposition in joint spaces, episodes of synovitis, and radiological features of chondrocalcinosis. It is characterized by the presence of crystal deposits that are birefringent under polarized light. Although these crystals are characteristically for some other crystals arthropathy. The relevance of the problem is due to the number of observations and the lack of a common understanding on surgical treatment tactics.
Case descriptions . We presented a clinical case of such a lesion, we performed an analysis of previously published works on this topic, followed by a discussion of the features of surgical treatment of such patients.
Conclusion. With a personalised approach to defining surgical tactics, the treatment of even such a rare pathology and diseases of this kind will not be a serious problem.

Vestibular schwannomas are common CNS tumors and one of the most often tumors, localized in posterior fossa. Despite their benign nature, treatment of vestibular schwannomas is challenging due to high frequency of complications, especially cranial nerves palsy. Microsurgical removal is main treatment option, but several approaches could be used for surgery, each differ from another by frequency and type of complications. Present paper includes case report of vestibular schwannoma removal through translabyrinthine approach, pros and contras discussed and brief literature review given.
Materials and methods. A case report of medium size vestibular schwannoma — up to 12 mm in diameter (II stage Koos, T2 Samii) with significant intrameatal extension. Symptoms are headache, peripheral vertigo. The patients feature is complete left-sided hearing loss after acoustic trauma. Tumor removal through translabyrinthine approach performed. During preoperational examination head CT with assessment of individual anatomy of pyramid, mastoid, jugular vein and sigmoid sinus performed. Extent of resection assessed by contrast-enhanced MRI a day after surgery. Follow up at time of paper submission — 6 months.
Results. Total tumor removal performed. At the earlier postop period moderate VII nerve palsy (III Brakmann, III FNGS2.0) developed, but declined to II 14 days after and completely regressed after 6 months of treatment. No other deficit identified. Subaponeurotic CSF collection disappeared by itself.
Conclusion. For selected patients translabyrinthine approach become real alternative to retrosigmoid in vestibular schwannoma surgery.

Arteriovenous malformations of the brain are a rare congenital vascular pathology. Treatment of this pathology involves a surgical, radiological method or conservative observation. In recent years, more and more works have been published on venous drainage of arteriovenous malformations. Many authors investigating this problem come to the conclusion that the angioarchitectural and hemodynamic features of the venous component of arteriovenous malformations can significantly influence the choice of the method and tactics of treatment in such patients. In this work, we tried to analyze the relationship between the features of venous drainage of arteriovenous malformations and the strategy of surgical intervention at the current stage of development of endovascular surgery.

Resume: presurgical embolization of the tumor bed is the widespread method of the blood loss prevention in surgery of spinal metastases, however, many aspects of the practical application are debatable to date. A review of available literature using a bibliographic database is carried out in this article. Inclusion criteria are: transarterial embolization, direct embolization, intraoperative blood loss, timing before surgery, embolic agent, hypervascular metastases, hypovascular metastases, complication. Additional searches were performed using references of the retrieved studies.

Summary. Treatment of patients with prolonged prosoplegia is an urgent problem in modern medicine and neurosurgery. For this group of patients, classical methods of facial muscle re-innervation are not effective, most often the reason for this is atrophia of facial muscles. The article provides a comparative analysis of various methods of surgical treatment of this pathology, based on modern literature.