INTRODUCTION. Chronic insomnia is a common sleep disorder characterized by difficulty initiating or maintaining sleep, as well as early morning awakenings. Despite its clinical significance, diagnosis remains challenging due to discrepancies between subjective complaints and objective sleep parameters. In addition to polysomnography (PSG), resting-state functional magnetic resonance imaging (rs-fMRI) has recently gained increasing attention allowing it to assess neurophysiological changes associated with insomnia. A comprehensive assessment of chronic insomnia pathophysiology including PSG, rs-fMRI, and validated sleep questionnaires may become the key to developing personalized approach to diagnosis and treatment.

AIM. The study aims to conduct a comprehensive assessment of objective sleep characteristics and brain functional activity in patients with chronic insomnia using polysomnography, resting-state functional MRI, and validated sleep questionnaires, in order to identify neurophysiological features of the disorder and clarify subjective complaints and objective findings correlation.

MATERIALS AND METHODS. Current study included 47 patients diagnosed with chronic insomnia after a somnologist appointment at Almazov National Medical Research Centre (St. Petersburg). All participants underwent single-night PSG using Embla N7000 (Natus, USA) and SOMNO HD (SOMNOmedics, Germany) devices, with scoring performed according to AASM 2.5 criteria. Structural and functional MRI scans were performed at 3.0 T. Functional data was analyzed using MathLab R2024b and CONN toolbox.

RESULTS. Patients with chronic insomnia demonstrated significantly higher scores on ISI (Insomnia Severity Index), PSQI (Pittsburgh Sleep Quality Index), and ESS (Epworth Sleepiness Scale) compared to the control group (p<0.001), indicating pronounced subjective sleep complaints. However, contrary to expectations, polysomnographic data revealed better sleep parameters among insomnia patients, including higher sleep efficiency and longer total sleep duration, along with shorter sleep latency, fewer microarousals, and reduced wake time after sleep onset (p<0.05). These findings suggest sleep-state misperception (paradoxical insomnia) in a subset of patients. Resting-state fMRI revealed increased connectivity within the default mode network and heightened sensorimotor cortex activity in the evening, along with enhanced activation of language and executive networks in the morning. These findings reflect dysregulation of sleep-wake transitions and underscore the need for a comprehensive approach to the diagnosis of chronic sleep disorders.

CONCLUSION. The study findings indicate a discrepancy between subjective complaints and objective sleep parameters in chronic insomnia, suggesting the presence of sleep-state misperception (paradoxical insomnia). Altered brain functional activity supports chronic hyperarousal and highlights the importance of a comprehensive approach to diagnosis and treatment of this disorder.

INTRODUCTION. Mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS) is a major cause of drug-resistant temporal lobe epilepsy; the relationship between hippocampal morphology and clinical-EEG features/network configuration remains insufficiently characterized. We aimed to compare clinical presentation and scalp EEG in MTLE-HS with and without structural hippocampal changes.

MATERIALS AND METHODS. Ninety-five adults (18–45 years) with MTLE-HS were included (eligibility per ILAE2017; seizure classification per ILAE-2024). All underwent long-term video-EEG; scalp EEG was graded using a six-category scale. Cohorts: MRI-positive structural hippocampal change (n=66) and MRI-negative variants (n=29). We compared seizure phenotypes and scalp EEG patterns and analysed correlations of EEG “severity” with age, age at onset, and disease duration.

RESULTS. Three seizure phenotypes were identified; two-type combinations predominated (58 %), whereas all three cooccurred only with structural hippocampal compromise (c2=7.166; p<0.05). Scalp EEG distributions differed between subgroups (c2=11.610; p<0.05); structural cases more often exhibited complex network configurations, including independent bitemporal foci. In the structural subgroup, EEG “severity” inversely correlated with current age and age at onset, but not with disease duration; overall, EEG abnormality magnitude was independent of illness duration.

CONCLUSION. Hippocampal integrity shapes clinical-EEG phenomenology in MTLE-HS and, when structurally compromised, is associated with a more complex epileptic network (including independent bitemporal foci). The independence of EEG severity from disease duration supports integrated use of clinical, neuroimaging, and neurophysiological data for presurgical planning.

INTRODUCTION. Primary multiple cerebral tumors of various histological types are a rare form of neuro-oncological pathology. In the literature, there are only a few references to various combinations of cerebral tumors in the form of individual clinical cases and series of observations.

MATERIALS AND METHODS. We analyzed 40 cases of primary multiple cerebral tumors of various histological types in patients treated at the Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre (St. Petersburg) from 2011 to 2024.

RESULTS. The following combinations of synchronous tumors were identified: meningioma + schwannoma – 16 (57 %) cases; glioma + meningioma – 3 (10 %) cases; pituitary adenoma + glioma – 2 (6 %) cases; glioma + schwannoma – 2 (6 %) cases; glioma

+ ganglioglioma – 1 (3 %) case; ependymoma + meningioma – 1 (3 %) case; lymphoma + meningioma – 1 (3 %) case; pituitary adenoma + schwannoma – 1 (3 %) case; pituitary adenoma + meningioma – 1 (3 %) case; schwannoma + ependymoma – 1 (3 %) case; hemangioblastoma + meningioma – 1 (3 %) case. The combinations of metachronous tumors were as follows: meningioma

+ schwannoma – 3 (23 %) cases; pituitary adenoma + meningioma – 3 (23 %) cases; meningioma + ependymoma – 2 (14 %) cases; pituitary adenoma + schwannoma – 1 (8 %) case; medulloblastoma + meningioma + ependymoma – 1 (8 %) case; schwannoma

+ ependymoma – 1 (8 %) case; glioma + meningioma – 1 (8 %) case; teratoblastoma + malignant tumor of the peripheral nerve sheath – 1 (8 %) case.

CONCLUSION. According to our data, the number of patients with this pathology is 0.58 % of all patients with brain tumors requiring surgical treatment. The course of the disease is not specific. In most cases, the disease debuts with the detection of two tumors of different histological types (65 %), in the absence of extracerebral oncological history (95 %). Male gender (p=0.025), the presence of neurofibromatosis (p<0.001) and associated spinal neoplasms (p<0.001) are associated with an earlier onset of the disease. Metachronous tumors occur on average earlier (39 versus 56.5 years; p=0.042) and are associated with worse outcomes (Karnofsky 70 versus 85 %; p=0.023). The survival and functional status of patients are affected by the degree of malignancy of neoplasms (p<0.001, p<0.001); age at the time of first detection affected only the survival of patients (p=0.021). The best prognosis of the disease is observed when schwannoma is combined with other types of tumors (p=0.040), and the worst in patients with gliomas (p<0.001). No reliable improvement in disease outcomes has been proven with radical surgical removal of all synchronous tumors (p=0.703).

INTRODUCTION. At the present stage, the technique of subgaleal drainage is often used in pediatric neurosurgery in the treatment of posthemorrhagic hydrocephalus (PHH). There is a need to generalize the experience of using this technique in premature infants, taking into account the technical capabilities, mechanisms of dysfunction and the effectiveness of drainage to restore cerebrospinal fluid dynamics.

AIM. Analysis of cases of application of the subgaleal drainage technique in the modern algorithm of PHH treatment in premature infants.

MATERIALS AND METHODS. The article summarizes the experience of using subgaleal drainage in the treatment of PHH in 246 premature infants, all operations were performed during the period from 2000 to 2024 (Crimea, Russia). The options for performing subgaleal drainage are considered, and the method with the mechanisms of PHH correction is characterized. In 94 children, the author’s technique of simultaneous removal of cerebrospinal fluid from the ventricles into the subgaleal pocket and subarachnoid space (SAS) was used.

RESULTS. Ventriculosubgaleal drainage provided relief of intracranial hypertension, decompression of the ventricles with the elimination of their dynamic occlusion, and prolonged sanitation of cerebrospinal fluid from blood and protein. There was a significant increase in PHH compensation with simultaneous removal of cerebrospinal fluid from the ventricles to the subgaleal pocket and SAS (p<0.001) due to the elimination of occlusion and restoration of cerebrospinal fluid circulation while maintaining craniospinal compliance.

CONCLUSION. The data obtained make it possible to expand the possibilities of restorative treatment of PHH with the evolution of the surgical approach from subgaleal drainage to a complex of ventricular drainage into the subgaleal pocket and SAS, to improve the technical capabilities and efficiency of drainage

AIM. To compare degenerative changes in facet joints (FJ) and intervertebral discs (IVD) following different surgical approaches for uncomplicated thoracolumbar spine fractures.

MATERIALS AND METHODS. This (2009–2022) retrospective single-center study analyzed 108 patients with A2-C type fractures (AOSpine classification). Outcomes of percutaneous/open transpedicular fixation (TPF) with/without decompression, anterior and combined fusion were evaluated. Degenerative changes in FJ and IVD were graded using Pathria and Park classification systems.

RESULTS. Ankylosis occurred in 67.9% of cases at fracture level, more frequently with open TPF (OR=3.17). Anterior fusion showed 40.9 % ankylosis rate at adjacent upper level (OR=15.87 vs TPF). Adjacent segments: Long-segment TPF increased ankylosis risk 5-fold (OR=5.11).

CONCLUSION. Percutaneous TPF minimizes FJ ankylosis and is preferable for temporary fixation. Open TPF with FJ decortication promotes spontaneous fusion. Anterior fusion carries higher risk of adjacent segment degeneration. Implant removal should be considered within 2 years post-TPF.

AIM. To investigate correlations between intracranial pressure and arterial and venous cerebral blood flow (CBF) in patients with moderate to severe traumatic brain injury (TBI) and after surgical removal of intracranial hematomas.

MATERIALS AND METHODS. Patients with moderate to severe TBI (53 women; 74 men) were divided into 3 groups: group 1 (moderate TBI), group 2 (severe TBI without surgery), and group 3 (severe TBI after surgery). All patients underwent perfusion computed tomography (PCT), which was used to measure arterial and venous cerebral blood flow (CBF) in the supraclinoid sections of both internal arteries (CBF in ICA) and in the superior sagittal sinus (CBF in SSS). The obtained data were analyzed using parametric and nonparametric statistics. The significance level was accepted as p<0.05.

RESULTS. In Group I, the left and right ICA CBFs correlated significantly with each other (p<0.0001) and with the SCD CBF (p=0.048). In Group II, the left and right ICA CBFs also correlated (P<0.0000001), but not with the SSS CBF. In Group III, the ICA CBF on the side of the removed hematoma did not significantly differ from the contralateral ICA CBF (P=0.680) and did not correlate with the SSS CBF.

CONCLUSION. Increasing TBI severity is accompanied by arterial and venous CBF uncoupling in the supratentorial vessels. Further research is needed to identify the mechanisms underlying this dissociation.

INTRODUCTION. In the surgery of tumors in the lateral cistern of the pons, damage to cranial nerves reaches 40%, with the auditory nerve being the most frequently injured. The most common damage and early clinical symptoms of the auditory nerve are typical in patients with vestibular schwannomas. Modern neurosurgery is pursuing functionally preserving surgeries (preserving the functions of cranial nerves) in conjunction with a high degree of radicality.

AIM. To implement surgical strategies aimed at preserving hearing function in patients with lateral pontine cistern tumors. To conduct a functional hearing assessment in patients depending on the strategy of surgical treatment.

MATERIALS AND METHODS. A total of 56 patients with diagnosed vestibular schwannomas were treated. The age of the patients ranged from 18 to 59 years, with a mean age of (21.43±2.7) years. There was a predominance of women – 38 (67.8 %), compared to men – 18 (32.2 %). The tumors were predominantly located on the left side – 30 (53.5 %) and on the right side – 26 (46.5 %). The duration of the disease varied from 6 months to 1.7 years. The sizes of the tumors were determined using magnetic resonance imaging (MRI) and ranged from 18 to 55 mm. All schwannomas were classified according to Koos and

1. The main criterion for patient selection was the preservation of functional hearing according to the Gardner – Robertson scale of I–II degree. All patients underwent scheduled surgical treatment with mandatory intraoperative multifaceted monitoring. A standard retrosigmoid approach was used. The positioning of the patient on the operating table was tailored to the individual criteria of each patient.

RESULTS. Out of 56 patients, functionally significant hearing was preserved within the Gardner – Robertson I–II scale in 46 patients. The first group consisted of 30 (53.5 %) patients without an intracanalicular component of the tumor. The second group included 26 (46.5 %) patients with an intracanalicular component. All patients were discharged in a compensated state with a Karnofsky score of 80–90. Follow-up was conducted for 33 patients over a period ranging from 3 months to 1 year.

CONCLUSION. We have established two directions in our work: surgical tactics in hearing-preserving techniques and multifunctional intraoperative neurophysiological monitoring. The preservation of hearing directly depends on the initially functionally useful level of hearing, with speech discrimination not lower than 50 %, and a threshold of frequency perception not higher than 30 dB.

INTRODUCTION. Occipitospondylodesis or craniovertebral fixation is a common technology for surgical treatment of various pathological processes in the area of the first and second cervical vertebrae, leading to instability of the craniovertebral joint.

AIM. Analysis of the possibilities of using computer navigation in performing occipitospondylodesis with screw fixation of cervical vertebrae in tumor pathology.

MATERIALS AND METHODS. On 3 frozen head-neck human specimens the insertion of screws of C1–C4 vertebrae was simulated. From the posterior approach 6 patients with metastatic lesions of C1-C2 vertebrae were operated with the implementation of screw occipitospondylodesis.

RESULTS. In patients with tumors of the upper cervical vertebrae, implantation of screws at the C1–C2 level was not relevant during occipitospondylodesis. Using only preoperative CT data for vertebral registration required registration of each vertebra. In cadaveric material, when installing screws in the lateral masses of the vertebrae, the use of computer navigation was not required, in contrast to the installation of pedicle screws. In 2 patients operated on using the free-hand technique, asymptomatic malpositions of 2 (12.5 %) screws in the lateral masses were detected; when using computer navigation, no malpositions of screws in the lateral masses and pedicles were detected.

CONCLUSION. The use of computer navigation during occipitospondylodesis surgery in patients with craniovertebral tumors and the lack of extensive experience in screw fixation in the cervical spine is justified both for transpedicular fixation and for installing screws in the lateral masses of subaxial vertebrae, as it allows avoiding asymptomatic malpositions.

INTRODUCTION. The relevance of the study is due to the constant conduct of military conflicts and high-tech local wars around the world using modern cluster munitions and various missiles. At the same time, the number of injuries to large nerves of the extremities has increased, often with the formation of large defects in the nerve trunks. One of the ways to restore the anatomical integrity of damaged nerves is to connect the proximal and distal ends of the nerve using conduits of various sizes made of biodegradable materials of biological and synthetic origin.

AIM. To evaluate the possibility and effectiveness of restoring tissue innervation lost in trauma after replacing extensive nerve defects with polycaprolactone–based conduits with collagen gel and silk fibroin filaments in an experiment on laboratory animals.

MATERIALS AND METHODS. In an experiment on 10 laboratory animals (rats), a simulation of an extensive sciatic nerve defect was performed, followed by its replacement using polycaprolactone with collagen gel and silk fibroin filaments. The results of the functional state of the restored nerves in the postoperative period were evaluated experimentally by clinical, electrophysiological and morphological methods.

RESULTS. When analyzing the behavior of laboratory animals in the postoperative period, it was found that after 1.5 months after surgery, the animals almost fully used the limb, where the sciatic nerve conduit was performed. Based on the results of stimulation electroneuromyography in animals of the experimental group, the restoration of M responses was noted, the amplitude of which increased. After euthanasia of animals during conduit sampling in the area of experimental surgery, there were no pronounced scar-adhesive changes around it, in addition, signs of implant biodegradation were noted. Morphological examination revealed the complete germination of axons from the proximal end of the sciatic nerve to the distal one.

CONCLUSION. When replacing the defect of the ends of the experimentally damaged nerve with a conduit consisting of polycaprolactone with collagen gel and silk fibroin filaments, we established the germination of axons from the proximal end of the sciatic nerve into the proximal one. Reactions of the surrounding tissues at the site of conduit implantation in the form of signs of inflammation and the formation of rough scars were not revealed, signs of implant biodegradation were noted. A conduit made of polycaprolactone with collagen gel and silk fibroin filaments can be used to replace defects in nerve trunks. 

INTRODUCTION. It is well known that diabetes mellitus (DM) is not only one of the leading risk factors for the development of ischemic stroke (IS), but also the cause of its adverse outcomes. Along with this, with IS in people with diabetes, slow regression of cerebral edema is observed. Despite the availability of clinical recommendations for the treatment of IS and diabetes, disability and mortality in the group of patients with a combination of these diseases remains high today. Meanwhile, since the 2000s. A number of studies have demonstrated the benefits of using Glibenclamide in the treatment of cerebral edema associated with IS. However, we did not find any studies in the available literature that assessed its effectiveness in treating stroke in people with diabetes.

AIM. Improving the effectiveness of treatment of patients with type II diabetes mellitus undergoing ischemic stroke.

MATERIALS AND METHODS. An assessment of clinical and functional outcomes, as well as changes in the size of cerebral ischemic zones based on magnetic resonance imaging data, was conducted in 67 patients with type 2 diabetes during the acute phase of non-lacunar IS. Glibenclamide was used in the treatment of the main group of patients. Stroke treatment in the comparison group was conducted in accordance with generally accepted clinical guidelines and standards.

RESULTS. In a cohort of patients with type 2 diabetes mellitus treated with glibenclamide, the median change in the severity of neurological deficit according to the National Institutes of Health Stroke Scale (NIHSS) by the end of treatment was 5 points; the Rivermead Mobility Index reached 9 points; the Barthel Activity of Daily Living Index increased to 75 points; the relative number of functionally independent patients was 30.8 %. In the standard treatment group, the stroke severity according to the NIHSS scale decreased by only 2 points; the Rivermead Mobility Index reached only 7 points; the Barthel Activity of Daily Living level increased to only 55 points; the relative number of functionally independent patients reached only 17.1 %. The size of ischemic brain damage according to MRI results in the glibenclamide group decreased by 67.1 %, in the standard treatment group – by 11.6%.

CONCLUSION. The differences revealed between the groups indicate the ability of Glibenclamide to exert a protective effect in ischemic injury and improve the outcomes of the acute period of non-lacunar ischemic stroke in individuals with type 2 diabetes.

INTRODUCTION. Acute audiovisual disorders are a common clinical manifestation in patients with vestibular symptoms. This condition is caused by damage to both the central and peripheral structures of the vestibular analyzer, which leads to significant diagnostic difficulties.

MATERIALS AND METHODS. We review the current literature and our own clinical data on the anatomy of the anterior inferior cerebellar artery, the clinical manifestations and possible causes of stroke in the anterior inferior cerebellar artery basin, and the differential diagnostic signs of damage to the central and peripheral vestibular structures. Two clinical cases are presented.

RESULTS. The article discusses acute ischemic damage in the anterior inferior cerebellar artery basin as a cause of audiovisual disorders, the main clinical manifestation of which is a combined lesion of auditory and vestibular function.

CONCLUSION. the main differences in the vascular etiology of otoneurological structures damage and additional clinical tests for confirming the peripheral nature of vertigo are formulated

INTRODUCTION. Cerebral palsy (CP) is the leading cause of motor impairment in childhood and calls for comprehensive rehabilitation approaches whose effectiveness must be objectively verified. Resting-state functional MRI (rs-fMRI) provides new opportunities to explore neuroplastic changes elicited by therapy.

AIM. To evaluate the impact of a rehabilitation course employing a neuro-orthopedic suit on clinical outcomes and resting-state functional connectivity in children with spastic forms of CP.

MATERIALS AND METHODS. Thirty children with spastic diplegia (Gross Motor Function Classification System, GMFCS levels II–III; mean age (8±3) years) were enrolled in a prospective study. All participants completed a 4-week rehabilitation program using the “Atlant” suit. Clinical assessments (GMFM-88, Modified Ashworth Scale, MACS, SATCo, goniometry) and rs-fMRI (Siemens 1.5 T) were performed before and after the course. Seed-based analysis focused on the sensorimotor network (SMN); intraand inter-network connectivity changes were examined. Statistics included paired t tests and Pearson correlation.

RESULTS. After the 4-week intervention, significant improvements were observed on all principal clinical scales: total GMFM-88 scores increased, spasticity on the Modified Ashworth Scale decreased, manual ability (MACS) and trunk control (SATCo) improved, and joint range of motion increased on goniometry (all p<0.05). rs-fMRI revealed strengthened functional connectivity between key SMN nodes (primary motor cortex and supplementary motor area) and a reduction of pathological hyperconnectivity between the SMN and the default mode network (DMN). Enhancement of SMN connectivity correlated with motor gains (r=0.65, p<0.01).

CONCLUSION. Use of the rehabilitation suit leads not only to clinical improvement but also to favorable reorganization of functional brain networks in children with CP. Resting-state network analysis is a sensitive tool for objectifying rehabilitation effects and elucidating mechanisms of neuroplasticity.

INTRODUCTION. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is the standard treatment for degenerative spinal stenosis. When autologous bone graft is not feasible, the domestic xenogeneic material BioOst may serve as a potential alternative.

AIM. To compare clinical and radiological outcomes of BioOst, autograft, and the foreign analog Orthoss in MIS-TLIF.

MATERIALS AND METHODS. A prospective study enrolled 159 patients divided into three groups: BioOst (n=56), autograft (n=52), and Orthoss (n=51). Clinical outcomes were assessed using NRS-11, ODI, and Macnab criteria. Radiological evaluation (CT-based) included: pseudoarthrosis, fibrous block, bone fusion, and interbody space height.

RESULTS. No statistically significant differences were observed in clinical outcomes or complications (p>0.05). Bone Fusion rates: BioOst – 87.5 %, autograft – 90.4 %, Orthoss – 80.4 % (p>0.05). Interbody height assessment revealed: BioOst and autograft demonstrated statistically equivalent results. A trend toward difference between BioOst and Orthoss (p=0.09), though not statistically significant, with BioOst showing superior performance (<50 % regeneration: 42.9 vs 56.9 % for Orthoss).

CONCLUSION. BioOst exhibits efficacy comparable to autograft. While statistical analysis showed no significant intergroup differences (p>0.05), the observed trend favoring BioOst over the foreign analog supports its recommendation as an alternative osteoplastic material for MIS-TLIF.

INTRODUCTION. The number of surgeries for degenerative-dystrophic lesions of the spine increases every year. However, there are methods of orthobiological therapy that allow avoiding surgeries and their consequences in patients with lumbar radiculopathy due to disc herniation.

AIM. To evaluate the efficacy and safety of platelet rich plasma (PRP) injections in patients with compression radiculopathy due to lumbar disc herniation, and to evaluate the effect of PRP on the resorption of lumbar disc herniation.

MATERIALS AND METHODS. The study included 100 patients with lumbar radiculopathy due to disc herniation. The efficacy of transforaminal PRP injections at the level of the herniation was assessed. Pain syndrome was assessed using the Numeric Rating Scale (NRS), and quality of life was assessed using the Oswestry Disability Index (ODI). The size of the disc herniation was assessed using MRI data before treatment and 4 months after the PRP therapy course.

RESULTS. The CRS index decreased by 85 %, the quality of life index improved by 67,6 %, and disc herniation resorption was observed in 82 % of patients.

CONCLUSION. PRP therapy is an effective and safe method for treating patients with lumbar radiculopathy associated with intervertebral disc herniation, and promotes accelerated resorption of intervertebral disc herniation as the main pathogenetic factor in compression radiculopathy, i.e. it can be used as a pathogenetic therapy for this pathology.

INTRODUCTION. Cavernous angiomas are a common cerebrovascular pathology, the second most common after cerebral aneurysms. They are often asymptomatic and manifest with a convulsive syndrome or hemorrhage, which can be external focal and intracapsular. In the acute period of external focal hemorrhage, the cavernoma is often not visible according to MSCT and MRI data until the hematoma is lysed.

AIM. The aim of the work is to determine the differential criteria of cavernous angiomas with thrombosed aneurysms based on clinical cases.

CLINICAL CASES. In case of intracapsular hemorrhage, the cavernoma loses its typical structure and also causes difficulties in neuroimaging diagnostics. Particular difficulties arise in case of intracapsular ruptures of cavernomas at the base of the brain, near the arteries of the Willis circle, when they can easily be confused with completely thrombosed aneurysms. The article presents two clinical cases of intracapsular ruptures of cavernous angiomas of the mediobasal parts of the temporal lobe, which were differentiated from completely thrombosed aneurysms. No reliable neuroimaging criteria for distinguishing completely thrombosed aneurysms from cavernous angiomas have been identified. Sometimes these pathologies can only be differentiated intraoperatively.

CONCLUSION. According to observations, it has been found that it is advisable to consider round formations adjacent to the cerebral vessels, not visible on angiography and not accumulating contrast agent, first of all as completely thrombosed aneurysms, until another pathology is proven.

INTRODUCTION. Dysphagia is a feeling of obstruction to the normal passage of ingested food. The average duration of the swallowing disorder without determining its cause is (2.8±0.7) years, which is associated with difficulties in interpreting clinical symptoms of patients in primary care institutions. Therefore, it is necessary to remember about the existence of rare causes of dysphagia. One of them is Forestier’s disease – diffuse idiopathic skeletal hyperostosis.

AIM. To present an analysis of the clinical and diagnostic features of dysphagia in DF based on a clinical case.

CLINICAL CASES. This work presents an analysis of the clinic and diagnosis of dysphagia in an older patient. The peculiarity of this clinical case is the monosymptomatics of Forestier’s disease, the patient noted only the presence of dysphagia and associated suffocation, without complaining of back pain, upper extremities, etc. The non-specificity of clinical manifestations made diagnosis difficult, despite the severity of the dysphagia phenomenon. This confirms the need to describe clinical cases of DIGS in order to raise awareness among doctors.

CONCLUSIONS. The description of such clinical cases is necessary for the formation of alertness about the rare causes of dysphagia in doctors. The described clinical case demonstrates that the search for the cause of dysphagia requires a thorough analysis of the anamnesis, clinical picture, instrumental and laboratory studies.

Trigeminal neuralgia is a polyetiological type of facial pain, the causes of which may be vascular-radicular conflict, aneurysms and arteriovenous malformations, brain tumors, multiple sclerosis, craniocerebral trauma, herpes infection, traumatic dental interventions. Despite the fact that trigeminal pain is a relatively rare special case of prosopalgia, a marked decrease in the performance and quality of life of patients provides grounds for developing optimal solutions to this problem in the shortest possible time.

Aim – to identify the main problems that arise at various stages of managing patients with trigeminal neuralgia. Publications of domestic and foreign authors on this issue were studied on the PubMed and eLibrary resources.

The issues of patient routing, drug treatment with carbamazepine drugs, and various methods of physiotherapy are considered. Particular attention is paid to the effectiveness of surgical treatment, its priority use in some types of trigeminal neuralgia. Difficulties in managing patients with trigeminal neuralgia can arise at various stages due to the polyetiology of the disease. At the present stage, trigeminal neuralgia is a problem that requires an interdisciplinary approach, a high level of clinical training of doctors, and a priority choice of treatment tactics depending on the cause of the disease.