RESEARCH OBJECTIVE: to demonstrate the ability of dorsal fixation in the surgical treatment of patients with subaxial unstable injuries of the lower cervical spine.

MATERIALS AND METHODS: results of the surgical treatment of 17 patients with subaxial unstable injury of the lower cervical spine are analyzed. All patients underwent complex physical intrascopic examination, surgical intervention made of the dorsal access, estimation of long-term results was presented.

RESULTS AND THEIR DISCUSSION: The received data testifies to relative safety and effectiveness of transarticular dorsal fixation with the absence of negative influence on biomechanical characteristics of cervical spine.

Conclusions: We assume that the most reasonable is the use of transarticular dorsal fixation in the surgical treatment of patients with subaxial unstable injuries of cervical spine together with deformities of the middle and dorsal vertebral structures. Along with the reliable polysegmental fixation the preference should be given to technologies protecting the segments.

THE AIM OF THE STUDY was to evaluate the effectiveness and improve the results of headache treatment in patients with NSAID after endovascular occlusion of the aneurysm. The study included 88 patients, depending on the method used for multimodal pain control, the following groups were formed: I — dexketoprofen or paracetamol; II — gabapentin plus dexketoprofen or paracetamol; III — transdermal therapeutic system, the active substance of which is fentanyl, plus dexketoprofen or paracetamol. The reserve drug in all three groups was tramadol. The adequacy of the methods was judged by analgesic ability, using the Visual-analogue scale, and by the degree of influence on the level of consciousness, using the Richmond scale of sedation and agitation. When evaluating the effectiveness of the methods, it was found that the multimodal approach to pain control using combinations of gabapentin and dexketoprofen / paracetamol or transdermal fentanyl plus dexketoprofen / paracetamol is the most acceptable for this category of patients.

In this report we analyzed 4 cases with refractory epilepsy and congenital deformity of skull bones. Seizures, results of long scalp EEG-monitoring and preoperative imaging presented possible relationship of bone deformity and epilepsy. Two patients underwent frontal decompressive surgery and had positive outcomes. There are some reports of epilepsy and deformity of skull bones in the literature. Therefore the relationship between epilepsy and deformity of skull bones can be possible.

Arteriovenous malformations (AVM) of the brain are often complicated by intracranial hemorrhages. Endovascular treatment with non-adhesive compositions is one of the main methods of AVM therapy. The aim of our work was to improve the results of endovascular treatment of AVM, reducing the risk of embolism of normal blood vessels. The results of the use of adenosine-induced cardioplegia in the structure of anesthetic support for endovascular surgery in 13 patients with cerebral AVM are shown. In all patients, the use of this technique was effective; with no cardiovascular and respiratory complications. Thus, the use of adenosine-induced cardiopathy can be an effective and safe method in patients with AVM.

At the present stage of the development of medicine, there are many studies devoted to pathological changes in the spinal canal, the causes of their occurrence, which lead to various clinical and orthological manifestations, however, there are no attempts to fit them into one classification structure. From the point of view of a practitioner, it is extremely important to determine the direction of compression, the rate of its development, severity, reversibility, the possibility of correcting this condition with various therapeutic or surgical methods. In this regard, it is necessary to create a consolidated classification of pathological conditions of the spinal canal of various origins and introduce a nosological term, namely, deformations of the spinal canal (DSC), which includes a broader concept than “stenosis”, which will generalize and systematize pathological changes in the spinal canal. This classification will allow scientists and practitioners to navigate in a variety of different pathological conditions and be used as a means to establish connections between them.

Based on the analysis of literature data and our own experience, we have developed and proposed for use a consolidated classification of duodenum. The creation of the classification of the duodenum was based on a combination of unity, namely unity on localization (spine and spinal canal), unity on the fact of the presence of a violation of the integrity of the spinal canal caused by various reasons. This also included unity in the presence of the direction of the deforming factor (front, side, back, etc.), unity in the presence or absence of an effect on the neurovascular structures of the spinal canal. Therefore, this classification allows you to combine and systematize violations of the shape and integrity of the spinal canal, give them clinical and morphological assessments, and also help determine the tactics of treatment.

Facial nerve dysfunction is a frequent complication (rate of 3 to 35%) in the surgery of cerebellopontine angle (CPA) tumours, which significantly affects patient’s quality of life. In this study, we report our experience with hypoglossal to facial nerve anastomosis (HFA) for facial reanimation. Retrospective data were collected from 26 patients who underwent HFA. The efficiency of reinnervation was assessed by the May scale, the quality of life was assessed by the Facial Disability Index (FDI). The mean time from removal of the CPA tumour to the reanimation surgery was 11.5 months (min = 2, max = 84). Patients (n = 22, 84.62%) presented total facial nerve dysfunction as assessed by the House-Brackmann scale. Most patients (80.7%) achieved satisfactory outcome assessed by the May scale (grades III–V). The mean score of the FDI physical function subscale was 49.2. The mean score of the FDI social function subscale was 66. In our series no significant difference was found between the subgroups of different timing of facial nerve reinnervation surgery and the surgical outcomes as assessed by May scale and the quality of life of patients assessed by the FDI questionnaire (p = 0.1 and p = 0.8, respectively). Reinnervation is an effective technique for facial nerve reanimation in management of complications of skull base surgery. Using the hypoglossal nerve as a donor nerve has shown acceptable results in restoring the facial nerve function and ensuring a good patient’s quality of life.

INTRODUCTION. Acute symptomatic seizures (ASS) are also known as situation-related seizures — a term recommended by experts of the International League against Epilepsy (ILAE, 2010) aiming to define clinical seizures occurring in close temporal relationship with an acute central nervous system stroke. Such seizures are considered to be an acute manifestation of the stroke and may not recur when the underlying cause has been removed or the acute phase is over

OBJECT. To develop clinical and neurological criteria for the differential diagnosis of epileptic seizures from ASS at the onset of ischemic stroke.

METHODS. 72 patients with ischemic stroke hospitalized in the regional vascular center on the basis of the SPb State Budget Healthcare Institution “Municipal Hospital of the Saint Martyr Elizabeth“ in the period from 12.24.2017 to 04.05.2019. All patients were examined by neurological examination, laboratory and radiological research methods, the history of the disease and life was studied. Statistical analysis was performed using IBM SPSS Statistics v.24.

RESULTS. 47 people made up a group with a confirmed diagnosis of an ASS at the onset of ischemic stroke and 25 patients with ischemic stroke without acute symptomatiс seizures.Incidence of ASS at the onset of ischemic stroke was 1.55% (47 patients out of 3024 with ischemic stroke), of them, 55.3% of patients had only seizures, 17.0% had seizures combined with weakness of extremities, 8.5% had a combination of seizures with speech disorder and in 19.1% — a combination of all three signs. Primary risk factors for ASS for patients with ischemic stroke are: cardioembolic stroke subtype (34%) and cortical localization on CT of the lesion (21.4%).

CONCLUSIONS. The frequency of acute symptom seizures in the debut of ischemic stroke is lower in strokes as a whole, but seizures was dominated in the neurological status. The main risk factors for acute symptom attacks in patients with ischemic stroke were cardioembolic stroke subtype and cortical localization of the focus.

The developed algorithm of examination of patients with acute symptom attacks in the debut of AI was necessary for the optimization of management tactics when entering the hospital.

OBJECTIVE: Current guidelines can’t come to the conclusion concerning extracranial-intracranial bypass surgery (EICMA) in patients with symptomatic internal carotid occlusion (ICA).

METHODS: We performed prospective study of EICMA for 79 patients with acute ischemic stroke and symptomatic occlusion of ipsilateral ICA. Patients divided in two groups, according to the interval between the onset of symptoms and surgery: < 14 days or > 14 days. Also we stratified them in groups with one barrel STA-MCA bypass, two barrel STA-MCA bypass and deep STA-M2 bypass inside the Sylvian fissure.

RESULTS: Our study showed no significant difference in the 30-day combined stroke and mortality rate depending on whether EICMA was performed early or later than 14 days after the ischemic index event. Anyway, dynamic of NIHSS criteria was better in the early surgery group (p = 0,049). We didn’t find significant difference between cortical M4 (one or two barrel) or deep STA-M2 bypasses in regards to the perioperative reccurent stroke but we noticed a strong correlation between diameter of STA and the type of the performed bypass (cortical or deep) 30-days after the surgery.

CONCLUSION: Early extracranial-intracranial bypass surgery doesn’t increase 30-days rate of morbidity or mortality. Deep STA-M2 MCA bypass inside the Sylvian Fissure was safe and more preferable.

Osteomyelitis of the cranial bones of tuberculous etiology is a rare disease. Among patients with tuberculous osteomyelitis of different localization, it occurs in 0.2–1.3% of cases. Tuberculous damage to the bones of the skull may be complicated by intracranial abscesses, venous sinus thrombosis, meningitis, which can be fatal. Treatment of this disease in HIV-infected patients in the AIDS stage with hepatitis C and B is a difficult problem. It has its own characteristics and requires treatment planning with the participation of various specialists, especially when planning a surgical intervention.

Endoscopic discectomy, as well as laser disc decompression, are minimally invasive methods of treatment lumbar disc herniation, and have become an alternative to open lumbar microdiscectomy, as they allow minimizing surgical trauma, the effects of surgery, and quickly regress pain syndrome, contributing to early postoperative activation of the patient. There is a review of domestic and foreign literature devoted to the experience of application of various minimally invasive methods at treatment of lumbar disc herniation.

BACKGROUND: Overall survival (OS) of untreated patients with glioblastoma (GB) typically does not exceed 2–4 months. Radiation without surgery prolongs OS up to 5 months and chemotherapy enables further prolongation up to 5–26 months (depending on MGMT status). In particular cases both modalities exert very long-lasting responses leading to survival times of the patients far beyond average values. These cases are thought to be at least in part characterized by very high sensitivity of the tumor to cytostatics which is due to certain individual molecular features of malignant cells.

METHOD AND CASE REPORT: 39 years old male patient was diagnosed with glioblastoma with mutation IDH1(R132H) on the basis of stereotaxic core biopsy specimen histologic (microscopic appearance, endothelium proliferation, necrosis) and IHC (GFAP+, Ki-67 18–20%) features. Mutations in IDH1 (exon 4) and IDH2 (exon 4) were tested by High Resolution Melting Analysis (HRMA) with subsequent sequencing. MGMT mRNA expression was assessed by RT-PCR in formalin fixed paraffin embedded tumor tissue. The expression level of the gene in this case appeared to be one of the lowest among series of more than 250 brain tumors which were evaluated in our laboratory (∆Ct=7,7).

RESULTS: The patient undergone 70Gy radiation (proton therapy) and 15 cycles of temozolomide monotherapy with a complete response to therapy. Until now the patient is still alive and response is ongoing. Progression-free survival is 9 years 2 months up to date and OS — 10 years 2 months.

CONCLUSIONS: We propose that in this case remarkably low expression of MGMT (which is when highly expressed considered to be the powerful tool for tumor cell recovery after temozolomide treatment) caused unprecedented suxcess of radiochemotherapy without surgery with 10+ years ОS.