The factors of humanity and its modern controversies from the point of view of neuroethics are analyzed based on a 65-year clinical experience of the author and 40-year experience of Moscow institute — Center of neurosurgery.

Alongside with clinical and technological training of a physician, the author specially stresses the important role of ethical education and its potential for proper doctoring and restoring the moral principles in medicine, including neurosurgery and other neurosciences.

Glial tumors have been and continue to be the most frequent tumors found in neurosurgeon practice. Each year, thousands of publications complement doctors’ insights into the tactics and methods of their treatment. Given the rapidly growing body of information on the subject, the development of common approaches to the problem is an important contribution to the work of a medical practitioner. In the framework of the VII Annual Conference of Neurosurgeons of the North-West Federal District in 2020 leading specialists in the field of glial tumors treatment recorded uniform and relevant approaches. It based on the latest scientific evidence and personal experience for specialists of different profiles.

One of important tasks of surgical treatment of patients with spinal metastases is to restore stability of the affected segment in order to relieve pain and improve quality of life. The results of surgical treatment of patients using 3-D video-assisted technology have been analyzed. 3D video-assisted surgery is effective and safe method for tumor removal and spine stabilization. This treatment option improves quality of life and relieves pain, so it can guide decisions in favor of surgery.

OBJECTIVE: The evaluation of the clinical results and technical features of the Percutaneous full-endoscopic discectomy for foraminal LV–SI herniation with cranial migration by interlaminar contralateral approach.

MATERIAL AND METHODS: Analyzed the results of percutaneous full-endoscopic discectomy for foraminal LV–SI herniation with cranial migration by interlaminar contralateral approach performed of 6 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 7.6±1.1 to 1.2±0.8. The average ODI improved from 66.2±5.4 до 19.2±2.8 after 1 month; up to 14.2±2.2 after 6 months; to 15.2±2.2 after 12 months and to 15.2±2.2 after 24 months after surgery, respectively According to the McNab scale, all patients rated the treatment results “excellent” and “good”.

CONCLUSION: Percutaneous full-endoscopic discectomy for foraminal LV–SI herniation with cranial migration by interlaminar contralateral approach is a safe and effective method; provides the most optimal trajectory of endoscopic approach; facilitates early postoperative activation and recovery of the patient.

On the basis of the Department’s of neurosurgery and normal anatomy of the Military medical Academy n. a. S. M. Kirov the study is devoted to the development of a domestic static interspinous implant with the aim of using it to stabilize the vertebral motor segment after lumbar microdiscectomy. In addition to the interspinous implant itself the necessary devices for its installation have been developed and the technology of stabilization the vertebral motor segment after lumbar microdiscectomy on cadavers has been tested.

OBJECTIVE: To study the main parameters of retroperitoneal access for total prosthetics of the intervertebral discs in the lumbar spine to reduce the risk of complications and the morbidity of surgical access, taking into account surgical risk areas.

MATERIAL AND METHODS. The study included 110 patients operated on from 2017 to 2020 (72 men, 38 women) in the neurosurgical department of FGKU «1586 VKG» of the Ministry of Defense of Russia. The average age of the patients was 44,9 ± 15,4 years. According to the localization of access to the lumbar spine, patients were divided as follows: LIII–LIV — 8 (7,3 %), LIV–LV — 46 (41,7 %), LV–SI — 56 (51 %). Using special tools (protractor, ruler, caliper — compass, compass gauge, device for installing cages in the lumbar spine), the main parameters of retroperitoneal access were determined intraoperatively. The anthropometric parameters of the studied patients were determined. The morphometric characteristics of the location of the veins (inferior vena cava, left common iliac veins) in relation to the intervertebral discs were studied.

RESULTS. The main parameters of retroperitoneal access for prosthetics of the intervertebral disc in the lumbar spine were studied for each operated level. In particular, for the LIV–LV level, the length of the skin incision was 100 (80; 120), the length of the surgical wound was 95 (80; 100), the thickness of the subcutaneous fat layer was 37.5 (30; 45), and the depth of the wound to the spine was 110 (80; 130), the depth of the wound to the spinal canal is 142.5 (125; 172), the angle of surgical action in the horizontal plane at the level of the spine is 50 (44; 54). Based on the anthropometric data of the studied patients, the optimal skin incisions were determined to perform retroperitoneal access. A study was made of the location of the inferior hollow, left common iliac veins with respect to the intervertebral discs, taking into account these anatomical differences, a classification system was developed.

CONCLUSIONS. The obtained data can be used in planning retroperitoneal access to the lumbar spine in order to reduce the morbidity of the operation.

With a complete anatomical break of the nerve trunk, often, in order to restore its integrity, an epineural suture is performed. The latter, in turn, is inevitably associated with the tension of the nerve trunk in order to overcome the emerging diastasis. As a rule, overcoming diastasis up to 5 cm does not lead to excessive tension of the nerve trunk. Depending on the individual topographic and anatomical relationships of a single nerve trunk, in certain cases, overcoming diastasis even less than 5 cm can be accompanied by a significant tension, which can lead to a violation of its blood supply. In this case, even a perfectly performed epineural suture from a surgical point of view may not lead to positive results. One of the factors of unfavorable outcome of surgical treatment may be a violation of intra-trunk blood flow in the postoperative period.

This article evaluates the possibility of using intraoperative fluorescent angiography in reconstructive surgical interventions on nerves, in order to assess the adequacy and effectiveness of intra-trunk blood flow as one of the factors of the outcome of surgical treatment. During operations for neuropathies of various origins with the presence of neurotmesis, intraoperative fluorescent angiography was performed with simultaneous recording of the tension force. After restoring the integrity of the nerve trunk, repeated fluorescent angiography was performed to assess the safety of adequate effective blood flow. The study found that intraoperative angiography allows you to determine the safety and, equally important, the adequacy and effectiveness of blood flow in the nerve trunk, while being an affordable and easily feasible technique. Thanks to this technique, it becomes possible to assess the quality of the comparison of nerve stumps along the axis, excluding the possibility of their «twist», to study the mechanisms of compensation of blood supply to the nerve after microsurgical epineural suture.

The article is devoted to the urgent problem of reconstructive surgery in patients with severe craniofacial trauma using modern diagnostic methods and materials for plastics of defects of the cranial vault and base of the skull.

Pial arteriovenous fistulas are a rare cerebrovascular pathology, known as a direct fistula between the cerebral artery and the vein located in the subarachnoid space without the presence of an intermediate vascular node between them. The incidence of this pathology is only 1.6 % of all vascular malformations. Over the past 7 years at the Polenov Russian Scientific Institute of Neurosurgery at the Department of Vascular Pathology of the Brain, among 864 patients, only 3 patients with pial arteriovenous fistulas diagnosed in the adult period were identified. A case of one-step successful exclusion of a fistula from the bloodstream has been demonstrated.

Intradural meningiomas account for 25 % to 46 % of all primary spinal tumors. For intradural extramedullary formations, ascending disturbances of sensitivity are characteristic; the boundaries are determined by the level of tumor lesions of the spinal cord and the degree of involvement of the spinal cord diameter. With the destruction of motor fibers in the anterior or lateral columns of the spinal cord, conductive motor lesions occur, localized below the level of the lesion. Prolonged asymptomatic course of the disease, the gradual development of clinical symptoms can lead to an untimely diagnosis. Taking into account the urgency of the problem, the frequency of occurrence and certain difficulties of primary clinical diagnosis, we present a description of a clinical case of a patient with an intradural extramedullary formation of the thoracic spine.

The actual problem of neurology and neurosurgery is the study of pathogenesis, improvement of diagnosis, treatment of brain tumors. Great importance is attached to issues of differential diagnosis of neurological pathology during pregnancy, early detection of brain tumors, which can be the cause of maternal mortality, prematurity, fetal loss syndrome. Clinical practice shows that complaints of a pregnant woman for headache, fatigue, nausea and vomiting during the first trimester of pregnancy are often considered by obstetrician-gynecologists and, often, by neurologists as manifestations of toxicosis; with the development of visual impairment, altered consciousness, convulsive seizures in the second half of pregnancy and in the postpartum period as preeclampsia, eclampsia, which greatly complicates timely diagnosis and rational treatment. In this regard, the purpose of the publication was to review the survey data from 5 cases of diagnosis of a brain tumor during pregnancy in patients admitted to a multidisciplinary hospital, and a review of the literature.