INTRODUCTION. The frequency of clinical manifestations of osteochondrosis of the cervical spine reaches 42 % of all clinical symptoms of the peripheral nervous system, and the development of osteochondrosis of the cervical spine does not depend on the professional affiliation of the patient and 80% of patients are affected by the roots of C6 or C7. Therefore, the analysis of clinical manifestations of cervical pain syndrome in patients with herniated intervertebral discs of the cervical spine to find ways to improve the effectiveness of surgical treatment remains relevant.

AIM. To analyze the clinical manifestations of cervical pain syndrome in patients suffering from hernias of the lower cervical spine to improve the results of their surgical treatment.

MATERIALS AND METHODS. The clinical data of 38 patients were evaluated, taking into account the data of the results of neuroimaging of the cervical spine with magnetic resonance imaging (MRI), spiral X-ray computed tomography (CT), questionnaires, as well as according to the examination standard, the severity of pain syndrome according to VAS in the cervical spine and in the upper extremities, the level of quality of life of patients associated with the index of movement restriction in the cervical spine Neck Disability Index (NDI). before the surgical intervention, in the early postoperative period (on day 10) and 6, 12 months after it.

RESULTS. According to the survey, among patients with single-level herniated discs of the cervical spine, women with a previously established diagnosis of osteochondrosis of the cervical spine, with protrusions of the lower cervical discs, who received conservative treatment, living in the city, engaged in sedentary work and intellectual occupation prevailed. In all patients, against the background of conservative treatment, the condition worsened in the fall, with increased pain, during the daytime, radicular pain syndrome was associated with an increase in neurological symptoms of prolapse (hypesthesia, muscle hypotrophy), however, in all cases it was not possible to establish a provoking factor of increased pain syndrome. All patients underwent classic retropharyngeal Clovard access, total microdiscectomy with bilateral foraminotomy, resection of the posterior longitudinal ligament with stabilization by cage and plate. Pain syndrome, assessed on the VAS scale, regressed completely on the 10th day of the postoperative period.

CONCLUSION. To improve the results of neurological deficit recovery after microsurgical removal of herniated intervertebral discs of the cervical spine, it is necessary to carry it out in a timely manner: with increased cervical pain syndrome, as well as the presence of radicular pain syndrome with an increase in neurological symptoms of prolapse.

AIM. To demonstrate a new method of ultrasound diagnostics of spinal dural arteriovenous fistulas (dAVF).

MATERIALS AND METHODS. The results of examination of 21 patients with spinal dAVFs were analyzed. All patients underwent ultrasound examination of the spinal canal.

RESULTS. Pathologic perimedullary vessels were detected in all cases, an ultrasound pattern of AV shunting was detected in 20 cases, and a pattern of venous flow was detected in one case; preliminary diagnoses were fully confirmed by spinal angiography.

CONCLUSION. Ultrasound diagnosis of spinal dAVF is a relatively simple and effective technique that allows to suspect the diagnosis already at the outpatient stage and to clarify indications for more complex and expensive methods of diagnosis verification.

High-grade gliomas are the most aggressive form of brain tumors; the average survival rate of patients with this diagnosis does not exceed one and a half years. Tumors occur with a frequency of three cases per 100 thousand population per year. Over the past 35 years, their number has doubled. Malignant gliomas are the third most common cause of death from neoplasms in the group of young people under the age of 35 years.

AIM. To study the possibilities of an integrated approach to solving the problem of developing criteria for the characteristics of the clinical course and early progression for patients with glioblastomas, taking into account the growth mechanisms of gliomas.

MATERIALS AND METHODS. Archival biopsies of 425 glioblastomas in patients from 18 to 80 years old, operated on at the Republican Scientific and Practical Center of Neurology and Neurosurgery (Minsk). Immunohistochemical markers were used to identify factors responsible for tumor growth rate. The number of vessels was determined, which was counted under the control of monoclonal antibodies to CD34; monoclonal antibodies CD45 (total leukocyte factor), CD8 (T-lymphocytes), CD20 (B-lymphocytes), P53 were used to identify inflammatory infiltration. Comprehensive studies of 6 deceased patients with glioblastoma aged from 18 to 63 years were also used using post-mortem MRI (Russian Research Institute named after Prof. A.L. Polenov). The studied tumors according to the WHO classification belong to glioblastoma NOS, when studies of mutations of the IDH1 and IDH genes were not performed.

RESULTS. The time of relapse-free period in patients with glioblastomas, as well as ten-year survival rate, were analyzed, problems arising in the diagnosis and treatment of patients in this category, problems arising during rehabilitation, as well as the legal framework that one has to face when conducting research in neurosurgery were studied, and points related to the risks of surgical interventions.

CONCLUSION. To achieve results in increasing the survival rate of patients with glioblastoma, an integrated approach is required to study the heterogeneity of the tumor, develop individual technologies for surgical interventions taking into account the mechanisms of tumor growth and its individual characteristics associated with the histological form in close connection with its molecular genetic characteristics. To reduce the percentage of disability, rehabilitation is required to be as individual as the approach to surgical intervention. By studying the possibilities of cellular technologies in cell cultures, new approaches to the treatment of glioblastoma may be identified. The development of legal support for surgical interventions for patients with highly malignant gliomas is a serious problem for implementation within the framework of the convergence of the legislation of the Republic of Belarus and the Russian Federation on ensuring equal rights of citizens of the Union State.

INTRODUCTION. The choice of a method for surgical treatment of ruptured tiny aneurysms (TA) is often associated with great difficulties, due to the presence of microsurgical clipping (MC) and endovascular occlusion (EO) of their advantages and limitations in use.

AIM. To compare the results of treatment of ruptured TA depending on the chosen method for exclusion from the bloodstream, identification of possible predictors of an unfavourable outcome of a disease.

MATERIALS AND METHODS. A retrospective analysis of the treatment of 79 patients with aneurysmal subarachnoidal hemorrhage (SAH) due to cerebral TA rupture was performed, which were divided into two groups. The first group included 43 patients, who underwent endovascular surgery, the second one included 36 patients who underwent MC of the aneurysm. The initial severity of the condition, the presence of comorbidities, the need for additional surgical procedures, and the frequency of surgical treatment complications were studied. The treatment results were evaluated at the time of discharge from hospital, after 6 and 36 months.

RESULTS. Patients included in both study groups were comparable in terms of initial severity. Short-term and long-term treatment outcomes in the EO group were slightly better than in patients who underwent MC. However, statistical analysis did not identify any significant differences between the compared methods. Survival analysis did not identify any statistically significant differences depending on the chosen treatment method either. Predictors of lethal outcome in case of rupture of the arterial vein were identified, which included the severity of the condition according to the H-H, Fisher, Graeb and GCS scales, as well as the presence of concomitant neurosurgical benefits and late complications.

CONCLUSIONS. EO and MC remain complementary methods for the treatment of ruptured TA. When choosing a treatment method, if it is possible to use both methods, priority should be given to intravascular interventions, especially in the presence of sub- or decompensated somatic pathology.

INTRODUCTION. This article highlights the data of neuroimaging diagnostics (computed tomography (CT), magnetic resonance imaging (MRI)) with the manifestation of acute transient hydrocephalus in 23 patients with subarachnoid hemorrhage.

AIM. The analysis of paraclinical and neuroimaging data and identification of signs characterizing intracranial hypertension syndrome of predominantly hydrocephalic genesis with the development of acute transient hydrocephalus.

RESULTS. The results of the study provided on the basis of the analysis of treated 23 patients with acute transient hydrocephalus on the background of subarachnoid hemorrhage predetermined the timely identification of its characteristic signs that complicated its course, which allowed us to establish direct indications for noninvasive monitoring of intracranial hypertension syndrome of a hydrocephalic nature in the acute stage of subarachnoid hemorrhage.

INTRODUCTION. Currently, significant progress has been achieved in the surgery of intracranial meningiomas. However, surgery of recurrent meningiomas has its own peculiarities and is more difficult in comparison with the removal of primary meningiomas. AIM. To describe the basic principles and peculiarities of surgical treatment of patients with recurrence and continued growth of intracranial meningiomas, to analyze the factors influencing the radicality of tumor removal, to present a clinical case of microsurgical removal of one of the most difficult localizations – meningioma of the region of the large occipital foramen – in case of its recurrence.

MATERIALS AND METHODS. The study was based on patients (n=105) with recurrence and continued growth of histologically verified intracranial meningiomas Grade 1–3, operated in the Department of Neurosurgery No. 4 of the Russian Neurosurgical Institute named after Prof. A. L. Polenov in the period from 2014 to 2022. We analyzed the data of operation protocols and intraoperative neurophysiological monitoring protocols of archival case histories and our own clinical observations of patients with recurrence and continued growth of intracranial meningiomas. The degree of radicality was evaluated intraoperatively by the operating surgeon, in the early postoperative period – according to the data of computed tomography with contrast and (or) magnetic resonance imaging of the brain with contrast enhancement.

RESULTS. The main factors influencing the degree of radicality in removal of intracranial meningiomas in cases of recurrence/extended growth were identified. The dependence of the degree of radicality of tumor removal on the use of additional intraoperative navigation technologies was analyzed. The main surgical techniques are described and the basic principles of surgery for recurrent meningiomas are formulated. The description of a clinical case of surgical treatment of a patient with recurrent meningioma of the foramen magnum region is presented.

CONCLUSIONS. The use of neuronavigation technologies during surgery for recurrent and continued growth of intracranial meningiomas increases the proportion of total and subtotal removal. The use of intraoperative neurophysiologic monitoring somewhat limits the radicality of surgical intervention, but in modern neurosurgery the results of surgical treatment are evaluated by functional outcome, we consider total resection of recurrent meningiomas within the physiologic tolerance as the most appropriate strategy of surgical treatment.

INTRODUCTION. Recurrent meningiomas surgery has its own features and is more difficult in comparison with the removal of initially identified meningiomas; previous repeated interventions and courses of adjuvant treatment irreversibly disrupt the plasticity and trophism of the head soft tissues, causing a high risk of wound liquorrhea. Extracranial spread of basal recurrent meningiomas also causes a high risk of postoperative liquorrhea. These factors certainly lead to the necessity of the convex and skull base plastic surgery.

AIM. To describe the basic principles and features of convex and skull base plastic surgery defects in recurrent meningiomas, to present a clinical case of microsurgical removal of recurrent intra-extracranial meningioma.

MATERIALS AND METHODS. The study was based on patients (105 cases) with recurrence and progression of intracranial meningiomas with Grade 1–3 according to histology, who were treated in the Department of Neurosurgery No. 4 of the Russian Neurosurgical Institute named after professor A. L. Polenov in the period from 2014 to 2022. A petrospective disease history and our own clinical cases analysis with meningioma recurrence and progression was performed. The result of the plastic surgery was assessed according to control imaging and clinical data: the presence/absence of liquorrhea in the early and long-term postoperative periods; assessment of functional and cosmetic outcomes (in cases of cranial convex plastic surgery).

RESULTS. The plastic surgery using a mesh titanium implant was performed in 12 (52.2 %) patients after recurrent convexital meningiomas (n=23) removal in cases of tumor infiltration and destruction of the calvarial bones. After recurrent skull base meningiomas (n=38) removal the plastic material placement on the skull base was performed only in 7 of 12 (31.6 %) patients in case of no dura mater defect; in case of a meningeal defect – in all 16 (42.1 %) patients; in case of a through defect – in 100 % of cases out of 10 (26.3 %) patients. The skull base plastic surgery made it possible to avoid postoperative liquorrhea in 96 % of patients with meningioma recurrence/ progression (p<0.001).

CONCLUSION. During convex plastic surgery after removal of recurrent meningiomas, it is necessary to take into account the high rigidity of the soft tissues of the skull, choose the titanium mesh implants with the largest radius angle, reconstruct the cranioplate yourself intraoperatively, and pay attention to the main principle of cranioplasty is to complete hermetically sealed closure of the cerebrospinal fluid spaces.

With the digital quantitative expression of clinical and neuroimaging manifestations of cervical osteochondrosis, changes in the patient’s life activity and violations of the patient’s functionally significant physiological conditions at various stages of rehabilitation medical measures, in the form of a total digital expression, it becomes possible to individually identify the percentage significance of the regression or progress of this complex from its initial digital meanings. Using these data, we have developed a method for “Evaluating the effectiveness of treatment measures for cervical osteochondrosis”. When using this method, not only these indicators are assessed in isolation, but also their total quantitative significance, followed by identification of the percentage dynamics of their regression or progress from the initial total quantitative assessment of the complex of identified disease disorders, the presence of which forced the patient to seek medical help.

This allows for a digital comparison of treatment results at all stages of medical rehabilitation measures, individually and more objectively than existing methods, to evaluate the result of treatment for cervical osteochondrosis, and the ability to monitor the dynamics of the disease.

INTRODUCTION. Hypersomnolence spectrum disorders in patients in the acute period of ischemic stroke are one of the least studied topics. At the same time, of particular interest is the search for a possible relationship between fatigue and sleep and wakefulness disorders with anxiety and depression spectrum disorders.

AIM. To assess the dependence of hypersomnolence, fatigue, emotional and affective disorders on the volume, localization of the lesion and subtype of ischemic stroke.

MATERIALS AND METHODS. The study included 44 patients. During the examination, the subtype, pool and volume of the stroke focus were recorded. Fatigue, drowsiness, anxiety, and depression were assessed using the FIS, FSS, HADS, BDI-II, ESS, KSS scales, and filling out a sleep diary. Statistical data processing was performed using the StatPlus Mac (USA), Statistica 10.0 (USA) software package. The level of significance in testing statistical hypotheses was assumed to be p<0.05.

RESULTS. Data were obtained that hypersomnolence was characteristic of patients with an unspecified subtype of IS and right-sided localization of the lesion, regardless of the volume of the lesion. In patients with an unspecified subtype of IS and right-sided localization of stroke, the severity of anxiety and depression was less than in groups with other subtypes and lesions of the left hemisphere. In patients with hypersomnolence, the severity of anxiety and depression was significantly lower. Fatigue was not found to be associated with stroke subtype, lesion size and location, or with the presence or absence of IDS.

CONCLUSION. The established relationship between hypersomnolence and the stroke subtype, the affected hemisphere, and the severity of anxiety and depressive disorders can serve as a guideline for assessing and predicting stroke outcomes and developing an individual patient treatment strategy.

The results of surgical treatment of patients with single-level spinal cord injury (PSMT) of the thoracolumbar spine in two groups of 35 people are presented. Clinical and X-ray examination was performed in representative groups. According to spiral computed tomography data, the effect of the calculated initial sizes of interbody gaps and the angle of deformation on the restoration of the size of the damaged vertebral body and closed decompression of the contents of the spinal canal was evaluated. In the main group, the developed method of preoperative planning was used for treatment, in which they tried to reproduce the calculated dimensions, and an improved method of spinal reposition. In the control group, the achieved sizes were retrospectively studied. The restoration of the calculated sizes of interbody gaps and the angle of deformation during surgery contributed to the restoration of the anterior and posterior dimensions of the bodies of damaged vertebrae with maximum decompression of the contents of the spinal canal, increased stability of osteosynthesis and reduced the number of complications. A comparison of long-term treatment outcomes to assess pain, economic and functional status on the R.G. Watkins scale showed the best treatment results for patients with thoracolumbar PSMT in the main group.

INTRODUCTION. Despite the modern achievements of medicine and scientific and technological progress in the treatment and prevention of traumatic disease, the number of patients with traumatic brain injury remains high. According to statistics, in Russia it is 600 thousand people a year, of which 50 thousand die and another 50 thousand remain disabled. The majority of such patients end up in multidisciplinary hospitals. The tactics of examination and treatment of patients with isolated or combined traumatic brain injury, especially severe in a city hospital, have their own characteristics and require further improvement to improve the quality of care provided.

AIM. To analyze the medical histories of patients hospitalized for emergency indications who are admitted with unreasonably diagnosed brain injuries at the prehospital stage; to develop an algorithm for routing patients with isolated and combined TBI in a multidisciplinary hospital starting from the admission department; optimize indications for hospitalization of victims for inpatient treatment; to develop methodological measures aimed at improving the quality of emergency medical care for patients with combined TBI.

MATERIALS AND METHODS. The analysis of 352 case histories of patients hospitalized in St. Petersburg State Medical Institution “City Mariinsky Hospital” for emergency indications with TBI (isolated and combined) during 7 months of 2021 and 2022 was carried out. We also analyzed 302 medical records of patients who were delivered for emergency indications, with unreasonably diagnosed TBI in the direction of hospitalization.

RESULTS. The groups of patients who are most often delivered with unjustified diagnoses of brain injury, the severity of the condition and impaired consciousness of which are due to either decompensation of chronic diseases, intoxication, or other causes, have been identified. These categories included elderly patients with decompensated chronic diseases, people under the influence of alcohol or people without a fixed place of residence. An algorithm has been developed for routing patients with isolated and combined TBI, starting from the emergency department (OSMP). Indications for hospitalization of patients with TBI of varying severity in conditions of round-the-clock admission of patients in a multidisciplinary hospital have been optimized. Methodological measures have been identified to improve the quality of medical care for victims with combined TBI by a multidisciplinary team of specialists. The work is illustrated by clinical observations of patients with isolated and combined traumatic brain injury.

CONCLUSION. The exclusion of patients with unreasonably diagnosed TBI from the flow of incoming patients at the pre-hospital stage, the implementation of the algorithm of transportation, examination, first aid in the emergency department, conducting training of the multidisciplinary team for the examination and emergency care of patients with combined trauma using a level 6 Apollo simulator robot in a shock ward contribute to reducing the length of time patients stay in the emergency room and thereby improve the quality of medical care provided to patients with TBI in an urban multidisciplinary hospital.

INTRODUCTION. Nasofrontal dermoid cysts (NFDC) are rare developmental abnormalities with a frequency of 1 case per 20 000–40 000 newborns. Differential diagnosis of NFDC is performed with congenital malformations located along the midline, including an epidermoid cyst, encephalocele, nasal glioma, and pericranial sinus. Taking into account the topographical diversity of the NFDC, patients with similar diseases are treated in the departments of ENT pathology, maxillofacial surgery, and only with intracranial spread or in cases of complex differential diagnosis with other neurosurgical diseases, they become the object of attention of a neurosurgeon. Due to the rarity of the occurrence of the disease, as well as the low awareness of neurosurgeons, difficulties often arise with the diagnosis of NFDC.

AIM. To conduct a retrospective analysis of patients with NFDC and compare their own treatment results with literature data.

MATERIALS AND METHODS. A retrospective analysis of clinical manifestations, CT, MRI and results of surgical treatment of 6 patients (3 boys and 3 girls) aged (36.83±58.61) (7–156) months operated in the period from 2017 to 2023 at the National Medical Research Center for Neurosurgery named after Academician N. N. Burdenko. The follow up was (55.97±62.68) months.

RESULTS. The article presents typical clinical manifestations of NFDC, justifies the use of CT and MRI studies in this group of patients, presents the main pathognomonic radiological signs, describesthe pathomorphological picture of NFDC. Various topographic variants of the nasofrontal DC are considered from the standpoint of embryological mechanisms of their development. Surgical treatment options are presented taking into account the topography of the NFDC with the analysis of own and literary data.

CONCLUSION. A detailed clinical examination of the patient with the detection of a dermal sinus fistula in the nasal region, as well as anamnesis data indicating infectious and inflammatory processes in the DC area with multimodal neuroimaging (CT, MRI) will allow with a high degree of probability to make the correct diagnosis and determine the optimal tactics of surgical intervention. The access and scope of surgical treatment depends on the topography of the DC as well as the location of the dermal sinus tract. In observations with intracranial DC arrangement, the use of combined intra-extracranial approaches has been shown to allow for their radical excision.

The article is devoted to the issues of peripheral nervous system lesions after a new coronavirus infection. Among the nosologic forms there are mononeuropathies, multineuropathies, as well as polyneuropathies, which are noted both in the acute period and in the development of the post-acute syndrome. A literature review is presented to establish a possible causal relationship between novel coronavirus infection and peripheral nervous system lesions.

Abstract Diffuse idiopathic skeletal hyperostosis or Forestier’s disease is a systemic, rare degenerative-dystrophic disease of the spine of unspecified etiology, characterized by ossification of the anterior longitudinal ligament of the thoracic, less commonly, cervical spine. This condition is more common in older patients and may be asymptomatic, except in cases of prolonged and severe course, accompanied by the development of dysphagia. To date, there are no uniform standards and recommendations for the management of patients with diffuse idiopathic skeletal hyperostosis, which significantly complicates the diagnosis and determination of the etiology of suddenly developing dysphagia in elderly patients. This paper presents a clinical case of a patient with Forestier disease, whose symptoms manifested as severe dysphagia; The features of diagnosis, course and surgical treatment of this disease are described.

Microsurgical treatment of complex cerebral aneurysms (CCA) is a current problem. Extended approaches are used for the clipping of the CCA, during which the anterior clinoid process (ACP) undergoes partial or complete resection. The indications for anterior clinoidectomy in CCA surgery were analyzed. A review of morphometric studies of the efficiency of resection of the ACP was carried out. An analysis of the evolution of various techniques for intradural and extradural resections was performed. It is relevant to perform further research aimed at: developing an algorithm for determining indications and individual preoperative planning of anterior clinoidectomy in CCA microsurgery; morphometric evidence of the efficiency of intradural and extradural resection of ACP; and describing the features of resection technique.

Calcifying aponeurotic fibroma (CAF), or juvenile aponeurotic fibroma, is a rare disease that was first described in 1953. KAF is a benign, usually single, non-metastasizing formation. The pathogenesis to this day remains completely unexplored, but the fibroblastic/myofibroblastic origin of this formation is assumed [2]. According to literature, CAF mainly affects the palmar fascia, tendons and aponeurosis of the extremities, in particular the hands and feet [3, 10, 11]. The main histological signs of calcifying aponeurotic fibroma are benign spindle-shaped cells, chondroid cells, multinucleated giant cells, hyaline, myxoid stroma and calcified residues, as well as the absence of mitotic activity [2, 12].

In this study, we report a rare clinical case of surgical treatment of calcifying aponeurotic fibroma with localization in the cervical spine area diagnosed in the Polenov Neurosurgery Institute in a man 23 years old.

The article presents a rare case of treatment of a patient with a closed complicated injury of the cervical spine after an untimely iatrogenic microperforation of the esophagus, who underwent five operations for purulent complications, which ultimately prevented the anterior supporting spinal fusion in the cervical spine. The patient’s data and the patient’s MRI are presented 17 years after the posterior fusion of the cervical spine in the absence of C4, C5 vertebrae.