Postoperative complications are the main reason for dissatisfaction with the surgical result. They cause extending of the patient’s staying in the hospital, increase the economic costs of the treatment, and sometimes they lead to disability and even death of patients. Creation of a unified tool for stratification of postoperative complications is relevant from the perspective of qualitative analysis of the impact of various factors on the outcome and duration of treatment, as well as objectification of the clinic’s functioning efficiency. Traditional scales, such as the Clavien-Dindo classification of postoperative complications, the Accordion system, do not take into consideration the peculiarities of neurosurgical patients and have no applied significance. With multidimensional examination (by Roy’s method), the main signs of severity of negative surgical results were formed and their gradation significance was assessed. The created scale for assessing the severity of complications in neurosurgery can be a good tool for a systematic, objective, reproducible comprehensive analysis in various institutions, doctors, as well as determination of periods of time for objectifying data, identifying predictors of undesirable postoperative phenomena, and developing recommendations for their prevention.

Research carried out in the Republic of Belarus shows that congenital deformities of the spine of various origins account for 2.5–7 % of all identified cases. Currently, the main assessment of the type of congenital malformation of the spine and the size of the main deformity arch is the radiation method of investigation. Monitoring the state of the spine in dynamics using this method during the growth and development of a child in order to predict the nature of the course of congenital spinal deformity takes a long time, which sometimes leads to irreversible negative consequences.

AIM OF THE STUDY: development of criteria for early surgery in the presence of severe congenital deformities of the spine in children based on the study of molecular genetics and biochemical markers.

MATERIALS AND METHODS. The studies were carried out in 52 patients with congenital spinal deformities. In this group, due to the progression of the disease, 24 children were operated on, which is 45 %. The trace element composition of blood (Zn, P, Ca, Cu), as well as the content of Se, Ag, Pb, Cd, was studied in 52 patients. As part of a genetic study in the same 52 patients, nucleated cells are isolated from the peripheral blood for subsequent DNA extraction. To determine polymorphisms of detoxification genes GSTT1, GSTM, GSTP1 (lle105Val), GSTP1 (Ala114Val).

CONCLUSION. The main molecular genetic markers in congenital spinal deformities are polymorphisms of detoxification genes, as well as their relationship with blood biochemical parameters and heavy metals in biological substrates. If there are at least two values in each of the conducted biochemical studies that are on the border of the reference or exceed them, and when carrying out a genetic study, the presence of one mutation in one of the detoxification genes, or its absence, is regarded as an aggressive course that needs surgical treatment. The question of the need for surgical treatment is raised taking into account clinical data.

Stereotactic radiosurgery of vestibular schwannomas is an effective method of treatment, comparable in its results to the surgical removal of these tumors. However, it is widely believed that radiosurgery is ineffective in treating cystic tumors.

THE AIM of this study was to investigate the patterns of changes in the solid and cystic vestibular schwannomas in the short-term and long-term period after radiosurgery.

MATERIALS AND METHODS: from April 2005 to December 2015, stereotactic radiosurgery was performed in 923 patients with unilateral VS. 333 people were available to assess the dynamics. The median follow-up was 55 months, the mean follow-up time was 60 months. Men 26.7 %, women 73.4 %. The median age was 48.2 years. The average initial tumor volume was 4.1 cm³ . The tumors were divided into 3 groups: 1^st – solid tumors without cystic inclusions (n = 147); 2^nd – cystic, with single or multiple small cysts, with thick walls (n = 147); 3^rd – with single or multiple thin-walled cysts (n = 39). The assessment of the dynamics of changes was carried out by volumetric comparison in each observation interval.

RESULTS: pseudo-progression of neuromas was observed in 1, 2 and 3 groups in 44 %, 48 % and 28.2 %, respectively. The mean duration of pseudo-progression was 6.8, 3.5, and 2.2 years, respectively. The 5- and 10-year progression-free survival rates in the groups were 80 %, 87 %, 97 % and 76 %, 76 %, 97 %, respectively.

CONCLUSION: radiosurgery of vestibular schwannomas is an effective and safe method of treatment, and the thinwalled cystic structure is a favorable prognostic factor for a shorter course of pseudoprogression and a high survival rate without progression.

INTRODUCTION: Severe traumatic brain injuries (STBI) are one of the leading causes of death and disability among the world’s population. One of the reasons for poor patient outcomes is underestimating the severity of the brain injury. The Glasgow Coma Scale (GCS) is used to assess the degree of consciousness depression in conditions of the neurosurgical intensive care unit (NICU). The current FOUR (Full Outline of UnResponsiveness) scale is better suited for assessing and monitoring patients in the ICU.

OBJECTIVES: The primary goal of our study is the assessment of the effectiveness and benefits of the FOUR scales in comparison with the GCS scale in NICU patients with STBI.

METHODS: Monitoring and assessment of patients were carried out at two clinical hospitals in NICU for three months by using both FOUR and GCS scales. Patients that were in deep medical sedation or had the lesion of the spinal cord were excluded from observation. The results obtained were summarized and analyzed.

Results: 21 patients were included in the study during the observation period. The obtained results were summarised and analyzed. The structure of diagnoses includes intracranial hemorrhage/cerebral contusion (n=11), subarachnoid hemorrhage (n=11), subdural hematomas (n=9), epidural hematomas (n=2), dislocation of the median structures more than 5 mm relative to the median line (n=4).

CONCLUSION: The use of the FOUR scales has several key advantages, such as higher predictive ability, linear relationship between assessment and outcome, assessment of brain stem structures.

Recurrence of cerebral aneurysms after surgical treatment is an urgent medical and social problem, being a possible cause and a significant risk factor for intracranial hemorrhage, despite the primary total embolisation of the aneurysm. Early risk assessment and diagnosis of reсurrence can help improve treatment outcomes for these patients.

PURPOSE: to describe a case of successful endovascular treatment of recurrent aneurysm of the ophthalmic segment of the internal carotid artery after occlusion with detachable coils.

CONCLUSIONS: Assessment of the stability of aneurysm mbolisation in the long-term period after endovascular intervention on a cerebral aneurysm is an integral part of the treatment process in this type of cerebrovascular pathology. The optimal tactics for the treatment of cerebral aneurysms, both primary and with signs of recurrence, is the reconstruction of the parrent vessel. In some cases, one of the methods for solving this problem is the use of flow-diverting stents.

THE AIM of the study is to describe clinical observations of patients with central nervous system lesions of infectious etiology and to analyze the tactics of examination and differential diagnosis with brain diseases requiring surgical treatment.

MATERIALS AND METHODS. There are two clinical observations of patients hospitalized for emergency indications at the St. Petersburg State Budgetary Healthcare Institution “City Mariinsky Hospital” presented. Оne of them – with suspected closed craniocerebral trauma (CCI), the other – with acute cerebrovascular accident (ACVI) of the ischemic type and occlusive hydrocephalus in the stage of subcompensation. As a result of the examination, in the first case, toxoplasmosis of the brain was diagnosed against the background of HIV infection in the AIDS stage, in the second – tuberculous meningoencephalitis.

RESULTS. The carried out diagnostic measures made it possible to make an accurate diagnosis in time and plan the treatment of patients correctly.

SUBSTANTIATION. A detailed study of the individual anatomy of the spine plays a key role in preoperative planning. To achieve this task, there is a growing interest in the use of individual 3D models of the spine in world practice. Regardless of the positive reviews about the use of individual biomodels of the spine, the question of scientific substantiation of the advantages of the technique remains open. In this regard, we consider it appropriate to conduct research on common typical pathological processes, such as degenerative lesions of the spine.

THE PURPOSE – the evaluation the efficiency of using an individual 3D model of the spine when performing transforaminal spinal fusion surgery in the lumbar region, depending on the individual experience of the surgeon.

METHODS. The study evaluated the effectiveness of using 3D models of the spine when performing a typical decompression-stabilizing operation using the TLIF technique in the lumbosacral region by a more experienced surgeon (more than 150 similar operations) and by a surgeon with isolated cases of performing similar independent operations. The results were evaluated on the basis of the criteria for the safety of implantation according to the Raneyama and AbulKasim methods, the frequency of repeated operations, the number of X-rays performed during the operation, the time of the operation and its individual stages. The obtained data were compared between groups and between surgeons.

RESULTS. The use of individual 3D models of the spine during transforaminal spinal fusion operations in the lumbar spine increased the safety of implantation for both surgeons, but the significance of the differences was greater for a surgeon with little experience. The use of an individual 3D model reduced the operation time and reduced the risks of repeated operations associated with screw positions. To a greater extent, this tendency was observed for beginner surgeons.

CONCLUSION. The using of individual 3D models of the spine in typical decompression-stabilizing operations on the lumbosacral spine is a useful tool for perioperative planning, which increases the safety of implantation, reduces the time of individual stages of the operation and radiation load.

Sinonasal polyposis is a painless polypoid growth of the nasal mucosa and paranasal sinuses. According to various sources, the prevalence of polyps to one degree or other ranges from 1 to 5 % in the population, according to epidemiological studies conducted in Russia, polypous rhinosinusitis was detected in 1–1.3 % of those examined, thus in our country from this disease over 1.8 million people can suffer.

The disease develops more often in adults and children over 15 years of age, in percentage terms more often in men. Reaching large sizes with an uncontrolled course, nasal polyps can squeeze, destroy and deform the nearest bone structures, increasing the risk of the formation of infectious processes in nearby organs, causing purulent complications (purulent meningoencephalitis, meningitis, brain abscesses). Despite the fact that at the present stage of development of medical care, the diagnosis and control of the course of nasal polyposis is not difficult, it is not always possible to achieve satisfactory clinical results of treatment. The reasons for this may be both low patient compliance and the peculiarities of the course of synonasal polyposis, for example, the rapid and aggressive growth of polyps. Considering the urgency of the problem, epidemiology and possible difficulties in the treatment of nasal polyps, we present a description of a clinical case of a middleaged patient with synonasal polyposis as part of the aspirin triad.

A novel coronavirus infection, COVID‑19, has been one of the most serious medical and social concerns in modern society for more than a year.

THE PURPOSE of the work was to present the research review as well as the first clinical experience with COVID‑19 vaccine Sputnik V for the prevention of coronavirus.

METHODS. The work is part of the «COVID‑19 and Epilepsy» initiative. The tolerance of immunization and its influence on epilepsy dynamics were being investigated in an observational study of epilepsy patients who had been immunized with COVID‑19 prophylactic vaccinations. This study used the keywords «epilepsy COVID‑19, immunization» to conduct a literature search in the Scopus and RSCI databases. A clinical case of vaccination tolerance in a patient suspected of having comorbid pathology of pharmacoresistant epilepsy.

RESULTS. Thirteen papers were included in the study, all of which described the first experiences of epilepsy patients being vaccinated. Clinical reports of worsening epilepsy following immunization are presented in two publications: seizure debut and status epilepticus. In the majority of the studies, there was no evidence of immunisation having a deleterious influence on epilepsy progression. After epilepsy surgery and concomitant pathology, a patient with focal pharmacoresistant epilepsy with 3-year remission received doses of the sputnik V vaccine with no adverse events and seizure remission was sustained.

CONCLUSIONS. The study of vaccination in epilepsy is characterised by relevance, internationality and breadth in research on the problem. The results of this study showed good tolerability of the Sputnik-V vaccine and with seizure remission in an elderly patient with comorbid epilepsy after neurosurgical management of epilepsy. The results will help practitioners to decide on the management of patients with epilepsy.

Further research is needed on the use of vaccination in epilepsy.

Lumbar microdiscectomy is one of the most common spine surgeries in the world. The problem of relapses of pain and neurological syndromes after such operations remains relevant. Relapses of pain syndromes can be caused by the occurrence of repeated hernia of the operated disc.

OBJECTIVE: To determine the risk factors for recurrent disc herniation in the lumbar spine after microdiscectomy.

Methods: To achieve this goal, a literature review was carried out using the PubMed and MEDLINE databases. The materials requested were “recurrent lumbar disc herniation” and “risk factors”.

FINDINGS: There is evidence (intermediate level II to IV) detailing perioperative risk factors for recurrent lumbar disc herniation. Risk factors were identified (such as the type of hernia, the type of surgery, smoking, the patient’s lifestyle, his physical activity in the postoperative period, age, gender, obesity, diabetes mellitus, biomechanical factors, changes in the Modic type), which may cause recurrence of disc herniation in the lumbar spine.

CONCLUSIONS: Multiple risk factors, including the type of hernia, the type of surgery, smoking, the patient’s lifestyle, his physical activity in the postoperative period, age, gender, the presence of obesity, diabetes mellitus, biomechanical factors, changes in the Modic type can contribute to the recurrence of disc herniation. The level of evidence for none of the investigated risk factors for recurrent disc herniation after microdiscectomy reaches class I. Additional studies are needed to provide a definitive answer on the influence of various factors on recurrent disc herniation.

In connection with the rapid development of new diagnostic and therapeutic technologies, locally advanced (MR) forms of malignant neoplasms of the head and neck (MNOGN) stages III–IV are still one of the most urgent and unsolved problem of clinical ocology. The article provides an overview of the available literature in bibliographic databases, which testifies to the continuing trend of an increase in the incidence of malignant tumors of the head and neck.

As it turned out, there are currently few data devoted to the study of the role of chemoebolization of malignant tumors of the head and neck. However, almost all of these authors believe that superselective endovasal chemoembolization of a tumor in patients with MNOHS can lead to a significant improvement in their quality of treatment and life. An additional study of the problem was carried out according to the references of the found articles.

Surgery is widely accepted as an effective therapy for selected individuals with medically refractory epilepsy. Numerous studies have reported seizure freedom in 53–84 % of patients after temporal lobe resections. Risks of serious surgical complications have decreased over years to drop below 1 % for temporal lobe resections. Some recent series challenge the classic view that a normal MRI is associated with worse outcome, an important finding given the greater proportion of MRI-negative patients considered for epilepsy surgery. In this review, we consider the outcomes of epilepsy surgery and review studies of neurological and cognitive sequelae, psychiatric and behavioral outcomes, and overall healthrelated quality of life.