ABSTRACT. Traction injuries are most common sciatic nerve traumas and one of the most up-dated treatment methods for these patients is surgery followed with nerve stems electrostimulation.

OBJECTIVE. Compare short-term outcomes of surgeries using electrostimulation techniques for patients with closed traction injuries of sciatic nerves.

MATERIAL AND METHODS. 20 patients with closed traction injuries of sciatic nerve were surveyed. The research design suggested collecting and processing of data of the main and the comparison groups. The ODI score and VAS scale as well as electrophysiological indicants (M response, AF, PSW, MUAP) were employed to assess patients’ repeat clinical neurological status.

RESULTS. On Day 14 of the surgeries pain syndrome attenuation was observed in patients of both the main and the comparison groups, its regress dynamics being greater in patients of the main group. The data of M responses remained low in all patients but the trend for the increase of amplitude indicants appeared. In the comparison group the amplitude augmentation was smaller and did not exceed 9.4 percent for peroneal nerve or 12 percent for tibial nerve. In the main group the amplitude augmentation made 51% percent for peroneal nerve and 44.2 percent for tibial nerve. The budding MUAPs in posterior thigh muscles were registered for 10 patients of the main group but in just 2 patients of the comparison group thus attesting to the efficiency of two-level electrostimlilation method. Application of two-level electrical neuromodulation method allows improving short-term outcomes of surgeries for patients with closed traction injuries of sciatic nerves due to prompt pain syndrome reduction in the postoperative period as well as positive dynamics of electrophysiological indicants attesting for its high efficiency.

AIM OF THE STUDY — substantiation of molecular genetic markers of the study to determine the severity of the course of congenital spinal deformities and address issues related to the choice of treatment tactics for this category of patients.

MATERIALS AND METHODS. Based on the analysis of the clinical and radiological features of various types of congenital malformations in 50 patients, a molecular genetic study was conducted to determine the detoxification gene polymorphisms GSTT1, GSTM, GSTP1 (lle105Val), GSTP1 (Ala114Val) and gene mutations responsible for the growth rate and structure of the vertebrae and intervertebral discs — genes NOXD, RUNX2, CHST3, DLL3, MESP2, LFNG, HES7, and also studied the biochemical parameters of blood: Zn, P, Ca, Cu, Se, Ag and heavy metals (Pb, Cd) in biological substrates (blood serum).

RESULTS. In 23 operated children, a genetic study revealed the absence of a detoxification gene in 20 cases, which coincided with changes in the biochemical composition of blood in at least two reference values of the elements. If in each biochemical study there are at least two values located at the border or outside the reference, and when conducting a genetic study, the presence of “mutant” alleles in one of the detoxification genes in the same cases, or their complete absence, we can evaluate the course of the disease as aggressive, requiring surgical treatment. The question of the need for surgical treatment should be posed taking into account clinical data. In the presence of mutations in the genes responsible for the growth rate and structure of the vertebrae and intervertebral discs — the RUNX2, CHST3, DLL3, MESP2, LFNG, HES7, HOXA11, HOXD13 genes, the attitude to the indications of emergency surgery for such a patient should be as careful as possible, since the above genes are responsible for the development of connective tissue, which may entail the presence of another congenital pathology, not demonstrative, but sharply increasing operational risks.

CONCLUSION. 1. The main molecular genetic markers for congenital spinal deformity are detoxification gene polymorphisms, as well as their relationship with blood biochemical parameters and heavy metals in biological substrates. 2. The accuracy of the method is 86.9%. It can be used in deciding on the choice of treatment for congenital spinal deformities.

OBJECTIVE. Evaluation of the experience of using a differenced approach in the choice of approach in multiple aneurysm surgery using the concept of keyhole surgery.

MATERIALS AND METHODS. The work is based on a retrospective analysis of the use of minimally invasive approaches in the surgery of multiple aneurysms in 11 patients in the period 2015–2018, including patients in the acute period of subarachnoid hemorrhage as the second step of the operation. Тhеrе were evaluated functional and cosmetic outcomes of keyhole approaches, outcomes for mRs and the Glasgow outcome scale.

RESULTS. The main parameters evaluation were: numbness of the supraorbital region, the function of the frontal branch of the facial nerve, hyposmia, infectious complications and CSF leakage. 9 patients had an outcome in the Glasgow V outcome scale (81.8%), and 2 — IV (18.2%). According to the modified Rankin scale: in 9 patients the outcome was 1 (81.8%), in 2 patients — 2 (18.2%). Cosmetic and functional outcomes from traditional approaches were also evaluated.

CONCLUSIONS. The clinical outcome is determined by the patient’s initial condition. Taking into account the results of our research, the concept of keyhole is considered as one of the options in the treatment of multiple aneurysms with adequate selection of patients.

BACKGROUND AND PURPOSE: Prognosticating patients following mechanical thrombectomy has proven challenging for clinicians within the last decade. Several scoring paradigms have subsequently been developed with the aim of aiding providers in predicting outcomes in patients status post neuro-intervention for acute ischemic stroke. The purpose of this study is to develop and validate a condensed algorithm to predict outcomes in patients 90 days post thrombectomy for acute ischemic stroke of the proximal anterior circulation.

METHODS: A retrospective chart review of 75 patients who presented to our institution with emergent large vessel occlusion of the anterior proximal circulation was performed. Five independent variables, Age, Initial NIHSS & TICI, Post-Thrombectomy NIHSS & TICI, delta NIHSS, were identified and regressed logistically upon binary outcomes defined by functional status according to the modified Rankin scale. The data was validated using JROCFIT and JLABROC4 programs for fitting receiver operating characteristic curves using the maximum likelihood fit.

RESULTS: A statistically significant relationship was identified in two of the five independent variables analyzed in the study. Post-thrombectomy NIHSS and Age were found to be the strongest independent predictors of functional status at 90 days post-neurointervention for acute ischemic stroke. The data was validated with ROC curves and area under the curve (AUC).

CONCLUSIONS: The binary logistic regression model in our study accurately predicts 90 day outcomes in patients status post mechanical thrombectomy for acute ischemic stroke. Post-thrombectomy NIHSS and age are the only mandatory covariates required to make an accurate prognosis in these patients.

RATIONALE: In 2019, WHO published a global report on the global burden of epilepsy. The severe course of epilepsy with status epilepticus (SE) according to population studies is 6.2 / 100,000 people. SE is a formidable complication of epilepsy with high mortality, aggravating the course of the disease.

Patients with a neurosurgical profile are distinguished by a younger age, a more severe course of pharmacoresistant epilepsy.

OBJECTIVE: to study the frequency and characteristics of epileptic status in temporal and extra-temporal forms of epilepsy in patients with a neurosurgical profile.

METHODS: The results of the pre-surgical diagnosis of 110 patients of the Clinic of the Polenov Neurosurgical Institute with temporal and extra temporal forms of pharmacoresistant epilepsy. All patients underwent a comprehensive clinical and neurophysiological examination with the definition of indications for neurosurgical intervention. Particular attention was paid to the study of patients with SE in history.

RESULTS: The study included patients at a neurosurgical hospital with focal forms of epilepsy. The first group includes patients with temporal lobe form of epilepsy — 83 patients (75.5%). The second group (of extra temporal epilepsy) combines patients with frontal, parietal, and occipital forms — 27 patients (24.5%). All observations were characterized by a long course of the disease and one of the predictors of the development of SE is the duration of epilepsy. Duration of the disease is an important characteristic — it characterizes the formation of pharmacoresistant forms of the disease and side effects during prolonged treatment with antiepileptic drugs.

CONCLUSION: Patients at a neurosurgical hospital are characterized by the most severe course of pharmacoresistant epilepsy, in some cases complicated by SE. A history of SE in a patient for an epileptologist should become an earlier pre-surgical diagnosis in a specialized category of patients.

Sterotactic biopsy (STB) is the basis for the diagnosis of deep brain lesions. STB is the most common stereotactic procedure. The most frequent complications are hemorrhage STB. The risk of hemorrhage varies from 0.9%–59.8% according to various authors. The paper analyzes the frequency and structure of hemorrhagic complications in STB, identifies prognostic high-risk factors and proposes preventive measures to reduce the number of hemorrhages. The last decade is characterized by intensive development of minimally invasive surgical technique and its wide introduction into clinical practice of neurosurgical hospitals. Both in our country and abroad during this period there is a significant increase in the use of stereotactic techniques. This applies to both functional stereotactic interventions and operations performed in patients with focal pathological formations of the brain.

MATERIALS AND METHODS. The indicators of 15 patients with pharmacoresistant forms of epilepsy were evaluated, who, along with the constant intake of antiepileptic drugs, were administered AMSC BM and a comparison group consisting of 20 patients. The effectiveness of treatment after AMSC BM transplantation was evaluated in 10 patients after 6, 12 or more months from the beginning of the treatment according to the clinical condition and EEG data.

SUMMARY. These data confirm the safety and prospects of using AMSC BM for the treatment of patients with pharmacoresistant epilepsy. It was found that the course therapy AMSC BM can be achieved significant improvement in patients with primary and secondary generalized seizures, complex partial psychomotor paroxysms

THE AIM OF THE STUDY was to develop a method for the treatment of epilepsy using autologous mesenchymal stem cells of bone marrow (AMSC BM), assess their safety and effectiveness.

The epilepsy is a common neuropsychiatric disease. The persisting social prejudices regarding diseases of the nervous system, especially epilepsy, and neglect of the pathopsychological side of the disease, significantly reduce the possibility for the full implementation of rehabilitation measures after surgical treatment. This article presents the results of a study evaluating psychopathological disorders and suicidal intent in patients with epilepsy at the stage of pre-surgical preparation.

OBJECTIVE: to assess the characteristics and severity of disorders of the psychopathological spectrum in patients with a pharmacoresistant form of epilepsy in a neurosurgical hospital.

MATERIALS AND METHODS. We examined 107 patients with an established diagnosis of epilepsy in the conditions of a neuropsychiatric and neurosurgical hospital. Depending on the profile, the beds are divided into 2 groups. A clinical and psychological examination was carried out with verification of the psychopathological state and a psychometric study.

RESULTS. Our study revealed that patients with a neurosurgical profile are characterized by a wider range of psychopathological disorders, and the severity of these conditions. The structure of mental disorders is dominated by psychotic spectrum disorders. The indicated psychopathological framework requires the removal of patients in need of neurosurgical treatment as a separate risk group for the formation of suicidal intentions, especially at the stage of social rehabilitation after surgery.

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.

A spinal cord subependymomas are uncommon, benign (1–2% of spinal cord tumors), slow-growing tumors with the Ki-67 proliferation index less than 1,5% (WHO grade I). Due to their rarity and lack of characteristic clinicoradiological features, there is limited information currently available regarding their preoperative diagnosis and optimal management strategy. In this case report, we discuss a rare case of multiple spinal cord subependymoma with high level of the proliferative rate. Article provides a literature rewiew on this spinal cord tumor.

Meningiomas associated with intracranial aneurysms are very rare. The co-existence of both lesions is not only a diagnostic challenge but also has difficulties surgical treatment. This article presents a case of experience in successful surgical treatment the 70-year-old woman with coexistent anterior cranial fossa meningioma and unruptured anterior communicating artery aneurysm. Аnalyzed the scientific literature, which describes the features of diagnosis and rational surgical treatment of such a combination. It was decided to conduct a two-step surgery: endovascular treatment of aneurysm with intravascular stent followed by the resection of meningiomas without cancellations of dual antiplatelet therapy.

Aneurysms of the extracranial part of the internal carotid artery are quite rare. They may be practically asymptomatic, however, have a high risk of rupture, development of arterial embolism and cerebrovascular insufficiency. Interventions for this pathology are performed by both vascular operations and neurosurgeons (interventional neuroradiologists). Evidence-based protocols for the treatment of such aneurysms are currently lacking. The etiology of dissecting aneurysms of the extracranial internal carotid artery includes traumatic injuries, connective tissue dysplasia and atherosclerotic changes of the vascular wall. We are conducting a clinical observation of a 55-year-old female patient with a giant dissecting aneurysm of the extracranial segment of the right internal carotid artery, caused by elongated styloid process (stylocarotid symptoms, “Eagle syndrome”), successfully cured by implanting a flow deverting stent Silk +.

The article presents current literature data on the etiology and clinical epidemiology of spinal cord injury (SCI). The issues of world and Russian statistics of spinal cord injuries and the annual increase of SCI incidence in adults and children are discussed in details. The author describes SCI causes, factors which affect its frequency in children of different age, possible techniques for preventing it. The author also outlines national systems for data collecting on trauma incidence in USA, Canada, Australia, and European countries. She compares them with the system of pediatric trauma data collecting in Russia.