SUMMARY PURPOSE: to discuss the historical aspects of the development of cerebral aneurysm surgery.
METHODS: the study is based on a review literary sources from the middle of the XIX century to the present time in the public domain.
RESULTS: an attempt was made to systematize knowledge and highlight the main stages in the development of surgical treatment of cerebral aneurysms. In the historical aspect, the development of diagnostic methods, instrumental studies, surgical techniques has been examined.

GOAL OF RESEARCH is to compare the effectiveness and assess the advantages and disadvantages of percutaneous endoscopic interlaminar discectomy and microdiscectomy in patients with overweight.
MATERIALS AND METHODS: The response to treatment of 20 patients with intervertebral disk disease L_IV–L_V with overweight in the 2018–2019 timeframe who underwent microdiscectomy L_IV–L_V (group 1) and percutaneous endoscopic interlaminar discectomy L_IV–L_V (group 2) on the basis of Polenov Neurosurgical Research Institute, branch of the Almazov National Medical Research Centre and Multidisciplinary Pirogov clinic have been analyzed. The duration of surgical measure, period of hospital treatment, pain severity according to VAS in preoperative and postoperative period have been evaluated.
RESULTS: The average severity of preoperative radicular and axial pain according to VAS decreased from 7.8±1.2 and 3.7±1.3 to 1.6±0.5 and 2.0±0.5 in the first group and from 7.6±1.3 and 3.8±1.4 to 1.4±0.5 and 1.6±0.3 in the second group. The average duration of surgical intervention in the first group made 90 minutes (60–120 minutes), in the second group — 52 minutes (35–80 minutes). Patients of the first group could be out of bed in 10 hours (up to 18 hours), patients of the second group — in 3 hours after surgery. The average length of stay in hospital of patients in the first group made 5 full days, in the second — 3 full days.
CONCLUSION: Percutaneous endoscopic interlaminar discectomy in patients with overweight is as effective as standard microdiscectomy and allows to achieve regression of radicular pain syndrome. At the same time the use of technique of percutaneous endoscopic interlaminar discectomy can reduce the duration of surgical intervention and surgical injury, and so ensure immediate mobilization of the patient, which helps to prevent complications in patients with overweight.

Surgery of tumors of the chiasmal-sellar region is one of the most urgent problems of modern surgery. At the current level of development of endoscopic technique, the most actively used endoscopic endonasal transsphenoidal tumor removal. This method is the least traumatic, better tolerated by patients and is characterized by a lower incidence of complications. However, even this surgical access is not devoid of certain drawbacks. Since the first attempt to remove the tumor by transsphenoidal access, one of the most important tasks has been to create an effective recovery of the cell floor for the prevention of postoperative liquorrhea and meningitis. Nasal liquorrhea is a fairly common condition in transsphenoidal interventions. It is a feature of this type of surgery and is characterized by a fairly high frequency in both intra — and post-operative period. Liquorrhea is considered an extremely dangerous and serious condition due to the threat of infection of the liquor system and the development of secondary meningitis. Lumbar drainage is one of the methods used to prevent the growth of intracranial hypertension and the treatment of nasal liquorrhea in patients operated on for tumors of the chiasmal-sellar region. The use of this method is not mandatory and is used depending on the approaches taken in a particular medical organization. The different frequency and risks of lumbar drainage after these surgeries are described.

BACKGROUND: Recent clinical trials have established that treatment of acute ischemic stroke secondary to large vessel occlusion with mechanical thrombectomy leads to improved revascularization and functional outcomes. However, there has been little research into expanding the application of mechanical thrombectomy into stroke secondary to small and medium vessel occlusions, which can still produce significant morbidity.
OBJECTIVE: Is to evaluate the outcomes of patients treated with mechanical thrombectomy for acute ischemic stroke secondary to more distal vessel occlusion and to highlight process times from door to intervention in a center that receives patients from rural and underserved areas.
DESIGN AND METHODS: We retrospectively reviewed the electronic medical record of 38 patients admitted to Sanford Health Cerebrovascular Service in Fargo, ND between March 2015 and May 2017 who underwent endovascular intervention for acute ischemic stroke secondary to a small caliber vessel occlusion using devices designed for thrombectomy in small arteries.
RESULTS: At admission, 10 patients had a baseline NIHSS score of more than 10 (26.31%), 14 patients had a baseline NIHSS score of more than 6 (36.84%), the average NIHSS score at admission was 14.61. The average NIHSS score change was — 4.94 after intervention using mechanical thrombectomy. Successful recanalization was achieved in 94.74% of cases. Ninety-day postoperative Modified Rankin Scale (mRS) scores were used as functional outcome measurements and the data were available for 34 patients. The percent of patients achieving mRS of two or less was 56%. Large percentage of patients transferred from outside facilities, the median time from last known normal to arrival in the emergency department was prolonged to 200 minutes. The median time between emergency department arrival and recanalization was 91 minutes.
CONCLUSION: Given the high rates of revascularization, reductions in NIHSS scores, and 90-day mRS scores, mechanical thrombectomy may be reasonably extended to patients with occlusion of smaller, more distal vessels.

OBJECT: to analyze the clinical and MRI characteristics of c in patients with malignant course to predict the development of the disease.
METHODS: Two groups of patients with multiple sclerosis were formed: malignant and benign multiple sclerosis. All patients underwent an assessment of the anamnesis, the severity of neurological disorders, magnetic resonance imaging in the debut and during treatment of the disease.
FINDINGS: The duration of the first remission was significantly shorter in patients in the first group. On the first MRI, significantly more T2 foci were observed in patients with malignant multiple sclerosis. Also, in the first group, spinal cord lesions were significantly more often diagnosed.
CONCLUSIONS: Thus, the most significant predictors of the malignant multiple sclerosis were motor disorders at onset, short first remission, more than 20 foci of demyelination on MRI at onset of the disease, the presence of focal lesions of the spinal cord substance.

OBJECTIVE: To study the technique and evaluation of the clinical results of a percutaneous fully endoscopic selective rhizotomy of the medial branch in patients with chronic lumbar pain associated with facet syndrome.
MATERIAL AND METHODS: From February 2017 through February 2019 percutaneous endoscopic rhizotomy of the medial branch of the posterior branch of the spinal nerve in the lumbar spine was performed in 33 patients with chronic back pain associated with facet syndrome. In total, denervation of 69 facet joints was performed: 1 joint (destruction of 2 adjacent medial branches on one side) in 9 cases; 2 joints, one on both sides (destruction of 2 adjacent medial branches on each side) in 10 observations; 2 joints on one side (destruction of 3 adjacent medial branches on one side) in 8 cases; 4 facet joints, 2 on each side (destruction of 3 adjacent medial branches on each side) in 6 observations. To evaluate the results of endoscopic rhizotomy, the ODI questionnaire, VAS and the McNab scale were used. The assessment was made before the operation, the next day, 1, 6, 12 and 24 months after the operation. Statistical analysis of VAS back, ODI indicators before and after surgery in dynamics was performed using the Statistica 7.0 program and Microsoft Excel 2007.
RESULTS: The average severity of preoperative radicular leg pain and back pain for VAS after surgery decreased from 7.5±1.4 and 3.8±1.2 to 1.4±1.2 and 3.5±1.3 in next day; to 1.7±1.4 and 3.2±1.1 after 1 month; to 1.5±1.3 and 2.8±1.4 after 6 months; to 1.6±1.2 and 2.0±1.3 after 12 months; to 1.6±1.2 and 2.0±1.3 after 24 months after operation, respectively (p<0,05). “Excellent” and “good” results of treatment on a scale of McNab evaluated 96,1% patients. The mean value of the ODI improved from 66.4±7.2 to 20.5±3.2 after 1 month; up to 13.6±2.1 after 6 months; up to 12.4±2.3 at 12 months, and to 12.4±2.3 after 24 months surgery, respectively (p<0,05). The average duration of hospitalization of 18±1.4 hours (from 8 to 24 hours). The average severity of preoperative back pain for VAS after surgery decreased from 6.8 ± 1.2 to 3.5 ± 1.2 the next day; up to 2.8 ± 1.3 after 1 month; to 2.2 ± 1.2 after 6 months, to 2.0 ± 1.2 after 12 months and 3.2 ± 1.3 24 months after surgery, respectively (p <0.05) (Fig. 3). On the McNab scale for up to 6 months, treatment results were “excellent” rated by 8 (28.6%) patients, “good” by 15 (53.6%) patients, “satisfactory” 4 (14.3%), “unsatisfactory” — 1 (3.6%) patient. The average ODI value improved from 62.4 ± 6.2 to 20.4 ± 3.2 after 1 month; up to 14.8 ± 2.1 after 6 months; to 12.5 ± 2.1 after 12 months and to 18.4 ± 2.3 24 months after surgery, respectively.
CONCLUSION: Percutaneous endoscopic lumbar facet joint denervation significantly reduced the severity of back pain and improved the quality of life of our patients with chronic back pain for up to 24 months. Endoscopic rhizotomy of the medial branch is a safe and effective alternative treatment method that provides long-term relief of chronic facet pain, especially in patients after microsurgical decompression operations on the spine and previously undergoing insufficiently effective RFA.

The article is devoted to the problem of reconstructive surgery in patients with severe traumatic brain injury using modern methods and materials for plastics of defects of the skull and soft tissues of the head.

GOAL: evaluate the effectiveness of the pulse radiofrequency in treatment of the pudendal nerve neuralgia.
MATERIAL AND METHODS: 44 patients with pudendal neuralgia were included in the study. The Nantes criteria were used for selection of the patients to PRF ablation. The results were assessed by visual analogue scale VAS. 0–2 — excellent, 3–4 — good result, over 5 — poor result. The result were evaluate at 3,6,12 months after ablation.
RESULTS: 18 patients (40,9%) had excellence result, 17 (38,6%) — good result and 9 (20,4%) had no any improvement.
CONCLUSION: Pulse radiofrequency ablation of pudendal nerve in patients suffered from pelvic pain is effective and safety method.

The article presents modern literature data on the consequences and complications of spinal cord injury (SCI) in patients at all stages of recovery. The authors discuss definitions of the terms «SCI consequences» and «complications during SCI course». They underline the need to have a clear distinction between these terms. The authors also background the necessity to revise the current classification of SCI complications which was proposed in 1994.

Primary multiple cerebral tumors (PMTC) are diagnosed more and more often in various neuro-oncological clinics. According to statistics, the share of PMCO is 7% of the total number of all primary multiple tumors. Descriptions of the PCVC of various histotypes are rarely mentioned — in the form of single clinical observations or small samples of patients. In particular, combinations of glial tumors with medulloblastoma, sarcoma, teratoma, craniopharyngioma, pituitary adenoma and neuroma are described. Synchronous germinomas, pleomorphic xanthoastrocytomas, juvenile pilocytic astrocytomas associated with type 1 neurofibromatosis are described in the pediatric population.
This article provides a review of the literature, classification and management of patients with PMTC, and also describes three clinical observations of patients with primary multiple cerebral tumors of various histological structures: a combination of vestibular schwannoma and meningioma, vestibular schwannoma and glioblastoma, pituitary adenoma and meningiomas.

The desire at the present stage to minimize surgical brain injury in the conditions of blastomatous lesions poses the task of neurooncologists to use minimally invasive techniques to verify the pathological process. However, there is still no consensus on the use of a particular technique for intervention. The analysis of modern literature over the last decade shows that the direct assessment of neoplastic tissue is still relevant despite scientific and technical achievements in the implementation of diagnostic non-invasive methods. Marginal point of view considers the using of minimally invasive surgery as well as stereotactic procedures using navigation systems. The aim of this work is to compare features of the use of minimally invasive methods (stereotactic and endoscopic) of study of pathological processes of the brain at the present stage of development of neurosurgery. A retrospective analysis of the literature devoted to this topic is carried out.

THE AIM OF THE STUDY was to describe the clinical observation of metastatic (secondary) lesions of the central nervous system (CNS) in primary mediastinal (thymic) B-large cell lymphoma (PMVCL).
MATERIAL AND METHODS. The patient was treated in the neurosurgery department of the Mariinsky City Hospital in St. Petersburg. Her full diagnosis was composed of primary mediastinal (thymic) B-large cell lymphoma (PMVKL) with massive damage to the mediastinum, lung tissue, axillary lymph nodes on the right, spleen, kidneys, adrenal glands, retroperitoneal patients. lymph nodes, right ovary, stage IV B, combined treatment (6 courses of PCT according to the R-EPOCH scheme, a course of remote radiation therapy (3D CRT) — stage 1 — cervical-supraclavicular region on the left, initially affected mediastinal lymph nodes, sternum, soft tissues of the anterior chest wall, stage 2 — locally to the residual conglomerate in the retrosternal zone) Metastatic damage to the substance, membranes of the brain with extracranial spread. The patient was taken to a hospital with suspected head injury. MSCT, MRI of the brain with contrast enhancement were performed and additional MR sequences were included in the study protocol: contrast MR perfusion (PWI), diffusion-tensor imaging (tractography (DTI), spectroscopy (MRS). Volumetric formations were found in the projection of the parietal lobe) with intra- and extra-cerebral parasagittal localization with destruction of the right parietal bone. Taking into consideration the medical history and signal characteristics, the metastatic nature of the changes in MRI and MSCT from mediastinal lymph was suspected.
RESULTS. The extracranial part of the volumetric formation in the right parasagittal parietal region was removed in order to verify the structure of the tumor. The performed immunohistochemical study confirmed metastatic (secondary) damage to the central nervous system (HSCV) of primary mediastinal (thymic) B-large cell lymphoma.