Summary. The problem of recurrence of meningiomas is still relevant and not fully resolved. Further development of methods for the prevention of recurrence of menningiomas, which will reliably prevent the occurrence of tumor recurrence, continues.

   Target. For the prevention of recurrence of convexital meningiomas during their removal in order to increase radicality, it is proposed to excision the dura mater within a radius of 2.5 cm around the tumor growth zone in patients with mediobasal meningiomas (in particular, the wings of the main bone).

   Results. The preliminary results obtained suggest the possibility of preventing recurrence of intracranial meningiomas, both convexital – by increasing the radicality of resection, and mediobasal – by preoperative endovascular embolization of the adducting arteries of the tumor.

   Abstract: This work is devoted to the analysis of the reasons for the unsatisfactory results of surgical treatment of carpal tunnel syndrome. On the basis of literature data, as well as our own clinical observations, conclusions are drawn about the most common causes, the role of ultrasound examination in their detection and prevention is substantiated.

   Objective: To identify the causes of unsatisfactory results in surgical treatment of carpal tunnel syndrome.

   Materials and Methods: A retrospective assessment of 16 cases of unsatisfactory treatment results for carpal tunnel syndrome was carried out, requiring repeated surgical intervention in the period 2016–2019. In the study, there were 2 men (12.5 %), women – 14 (87.5 %), patients’ age from 35 to 72 years. Inclusion criteria: persistence of complaints (pain, impaired sensitivity, decreased strength in the hand) after 1 year of surgery for carpal tunnel syndrome, indications for surgical treatment. Exclusion criteria: the presence of degenerative-dystrophic changes in the cervical spine, no indications
for surgical treatment.

   Results: Among the reasons for the unsatisfactory results of treatment of the carpal tunnel syndrome were identified: incomplete dissection of the ligament (n = 11), non dissection of the ligament (n = 3), damage to the branches of the median nerve (n = 1), damage to the nerve trunk as a result of neurolysis (n = 1)). The regression of the severity of symptoms and functional dysfunction assessed on the SSS and FSS scales was: SSS – с 3,09–3,9 до 1,27–1,5, FSS – с 2,25–3,38 до 1,25–1,5, p < 0,05.

   Conclusion: The most common reason for unsatisfactory results of surgical treatment of carpal tunnel syndrome is insufficient knowledge of the anatomy and technique of surgical interventions. Repeated surgical interventions for decompression of the median nerve in the carpal tunnel give significantly worse results than primary decompression. The priority direction in the development of this topic should be the systematization of the available scattered data on the results of treatment of carpal tunnel syndrome and the creation of a unified algorithm for a personalized approach to diagnosis and the choice of a method of surgical treatment.

   Summary. The results of the treatment of head and neck malignancy metastases depend on the stage of the disease. Most (70–80 %) of patients are admitted to treatment in stages III and IV of the disease. Despite certain successes in the field of diagnosis and treatment of cancer patients, improved organization of oncological care, early diagnosis of metastases of malignant neoplasms of the head and neck, the results of treatment remain unsatisfactory. Tumor metastasis is one of the main causes of death for head and neck cancer patients. Tumor dissemination of these neoplasms occurs by lymphogenic route in 35–60 % of patients. Metastases in non-enlarged lymph nodes are found in 13 % of cases. In this regard, there is a need for timely treatment of the neck lymphatic system in patients with squamous cell carcinoma of the head and neck organs at such a time when regional metastases do not yet appear clinically. However, so far, the problem of the choice of medical tactics at patients with regional metastases of throat cancer remains up to the end unresolved. There is no consensus on the sequence of the radiation and surgical stages of treatment, on the indications for postoperative radiation. This situation requires the search for new effective approaches to the diagnosis and treatment of patients.

   Purpose of the study: to increase the effectiveness of diagnosis and treatment of patients with metastases of locally advanced hypervascularized malignancies of the head and neck by developing and introducing into clinical practice a new personalized technique – locoregional superselective angiography and super-selective chemoembolization of malignant volumetric formations.

   Material and methods: For the solution of this task 44 cases of the metastases of a planocellular malignant new growth of the head and a neck divided into 4 groups on classification of TNM – the I stage of development of MTS – T1N 0M0, the number of patients – 4 were studied; II – N 2N 03M0 – 7; III – T3N 03M0 – 18; IV – T4N 03M0 – 15. Superselective chemoembolization of the secondary tumor was performed on all patients.

   Results. In 44 observations, super-selective angiography and super-selective chemoembolization of a metastatic tumor were performed. Embolisate was a mixture of microparticles HepaSphere 50–100mm saturated with cytostatic moxorubicin (50 mg). The highest concentration of chemopreparation in the tumor and its metastases was observed during the first 9 days after super-selective chemoebolization, which amounted to 414 nmol\g, remaining high for the next 11 days (118.7 nmol\g) and even after 14–22 days (42, 46 nmol\g) remained in the therapeutic range. The relapse-free period in this group of patients was 18–28 months, and the three-year survival rate reached 75 %.

   Conclusion. A personalized method of super-selective chemoembolization of head and neck cancer by doxorubicin developed and introduced into medical practice in 34.1 % of cases was an independent method of treating tumor metastases with a good therapeutic effect. The highest concentration of chemopreparation in tumor metastases was observed during the first 9 days after super-selective chemoebolization.

   Summary. The processes occurring at the molecular, cellular and organismal level in the carcinogenesis and progression of tumors are far from understanding and require in-depth morphological studies. Currently, great
importance is attached to the study of not only the tumor itself, but also what occurs in tissues in close proximity to pathological focus.

   Aim of the study: determination of the volume of surgical intervention based on the pathomorphological features of the peritumorous zone of high-grade gliomas, considering the contamination of the herpes simplex virus.

   Materials and methods: archived biopsies of 748 high-grade glial tumors (glioblastomas) contaminated with the herpes simplex virus (HSV) in patients from 18 to 80 years old, operated on at the Republican Scientific and Practical
Center of Neurology and Neurosurgery (Minsk). To detect the herpes simplex virus (HSV) in tumors, an immunohistochemical (IHC) study was performed with antibodies to the HSV type I and II antigen. Antibodies to Ki‑67 were used to determine proliferative activity. Monoclonal antibodies to CD 34 were used to count the number of vessels (as an important factor in tumor progression). To identify inflammatory infiltration, an IHC study was performed with a set of monoclonal antibodies CD 45 (total leukocyte factor), CD 8 (T-lymphocytes), CD 20 (B-lymphocytes), and Plasmosel. To study apoptosis, IHC study with p53 and bcl‑2 was used. We also used unique data obtained from 6 deceased with glioblastoma aged 18 to 63 years by employees of the Russian Research Institute. prof. A. L. Polenov, a unique comprehensive study of GM macropreparations using postmortem MRI was carried out.

   Results. For glioblastoma, which proceeded against the background of exacerbation of chronic inflammation, the index of proliferative activity of the vascular endothelium is significantly higher than the index of proliferative activity of the tumor cell, as well as the ratio of growth factors such as bcl‑2 and p53 convincingly indicate the prevalence of the rate of division of the endothelial cell lining the vessels over the tumor, which manifested itself by an increase in the number of vessels in the tumor proceeding against the background of exacerbation of productive inflammation. At the same time, studies carried out with MRI of tumors during autopsy showed that around tumors of various histostructures, both intravital and postmortem, there is a zone of hyperintense MR signal on T2 WI and FLAIR PI, with fuzzy contours. On anatomical sections, the area of the hyperintense MR signal macroscopically represents an unchanged white matter of the brain or there was a slight flabbiness and paleness of the tissue.

    Conclusion. A targeted microscopic examination revealed structural changes in the brain substance in these zones, with histological signs of inflammation. Changes in the white matter detected in the peritumorous zone corresponding to the hyperintense MR signal in the T2 VI mode were expressed in the manifestation of alteration in the form of dystrophic changes and cell necrosis, demyelination and damage to nerve fibers. Morphologically, edema was manifested by the rarification (discharge) of the white matter with the development of spongiform structures and the formation of microcysts. Hyperplasia and reactive changes in glial elements were also found. The reaction from the local phagocytic system was manifested by an increase in the number of microgliocytes, their transformation into granular balls and an accumulation around the vessels. One of the most important components of the peritumorous zone of glioblastoma is the presence of proliferating vessels.

   Summary. 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.

   Surgical treatment of vertebral tumors refers to high-risk surgery. The frequency of intra-and postoperative complications in this category of patients is higher than in most spinal interventions and can reach 30 % or more. Thromboembolic complications occur in 1.7 % patients and make the greatest contribution to postoperative mortality.

   Summary. The weakness of skeletal muscles arising in patients receiving intensive therapy is attracting more and more attention of doctors of various specialties. Clinical and electrophysiological symptoms of critical illness polyneuropathy (PNMPCS) are insufficiently systematized. Despite conciliatory protocols, diagnostic criteria remain highly subjective. The reasons for the development, the symptoms of this variant of muscle weakness, are not sufficiently systematized. There are many questions about the relationship between paresis and paralysis due to focal lesions of the central nervous system (CNS) and PNMPCS, especially after removal of brain tumors.

   Purpose of the study: to study the effect of intraoperative fluctuations in systemic hemodynamic parameters on the function of striated muscles in patients with brain tumors.

   Materials and methods: To solve this problem, 49 cases were studied, divided into two groups, taking into account the instability of hemodynamics: parasagittal meningiomas – 15, basal meningiomas – 15, vestibular schwannomas – 19. The dynamics of neurological symptoms after surgery, taking into account the characteristics of anesthesia, instability systemic hemodynamics, intraoperative blood loss.

   Results. In patients of the first group, paralysis and paresis of skeletal muscles were symptoms of focal brain damage due to the effect of a tumor or vascular pathology. In the absence of complications after tumor removal, focal neurological symptoms regressed on the first day after the end of the operation. General muscle weakness in these patients was associated with the action of drugs used for anesthesia. One of the main criteria for the sufficiency of muscle strength, traditional in anesthesiology and resuscitation, is the possibility of spontaneous breathing. We considered prolonged muscle weakness in comparison with the first group in patients of the second group as a result of muscle hypo-reperfusion against the background of instability of the systemic circulation. An increase in the level of myoglobin in the blood indicates a violation of the permeability of the membranes of myocytes. Apparently, muscle weakness is a natural clinical manifestation of this condition.

   Conclusion. “Non-neuronal” factors and, in particular, disorders of systemic hemodynamics, play a significant role in the development of weakness of the striated muscles in the reoperative period in patients with brain tumors. Potentially, dysfunction of skeletal muscles may be accompanied by metabolic disorders associated, apparently, with increased permeability of muscle cell membranes under hypoperfusion-reperfusion conditions.

   Objective: To evaluate the effectiveness of negative pressure therapy for wound drainage in infectious and inflammatory diseases of the spine in comparison with other drainage methods.

   Methods: 108 patients were included in the study. Drainage of purulent foci using the NPWT system was carried out in 30 patients who were treated in a hospital from 2016 to 2018 inclusive. The average age of the patients was 57.8 years. Supply-lavage drainage and active aspiration drainage using a Redon-type system were performed in 78 patients. The average age of patients in this group was 54.9 years. The causative agents of the infection were: S. Aureus (93), Kl. Pneumoniae (4), E. Coli (8), A. B aumannii (3). The disease was diagnosed on the basis of clinical and laboratory data and the results of
radiological diagnostics (CT, MRI). The effectiveness criteria were: the duration of inpatient treatment, the wound healing time, the number of repeated surgical treatments (NPWT dressing change).

   Results: Good results were obtained in 100 patients: the duration of wound drainage in the study group was 4.3 ± 1.8 days from the onset of NPWT, in the control group – 12.4 ± 4.6 days (p <0.05). The average hospitalization period for patients in the study group was 46.6 ± 26.3 days, in the control group 33.8 ± 10.8 days. In all patients, against the background of antibiotic therapy, the indicators of the systemic inflammatory response returned to normal within 6–8 weeks.

   Conclusions: NPWT is an effective method of drainage of purulent foci in the treatment of infectious and inflammatory diseases of the spine and is not inferior in efficiency to other methods of drainage. At the same time, it allows the patient to remain mobile during the entire drainage period and facilitates patient care. Application of the NPWT method for drainage of purulent foci in the treatment of infectious and inflammatory diseases of the spine can shorten the drainage time.

   Summary. Meningiomas account for 37.6 % of all primary CNS tumors and 53.3 % of all benign CNS tumors. Dysfunction of the cranial nerves, cerebellar symptomatology, sometimes aggravated after removal of the tumor and require rehabilitation treatment.PURPOSE OF TH E STUDY: to evaluate the results of surgical and rehabilitation treatment of meningiomas of the posterior cranial fossa, taking into account the clinical and neurological manifestations, the volume and localization of the tumor, the degree of tumor resection.

   Materials and methods: The results of clinical examination, surgical treatment and rehabilitation of 66 patients with meningiomas of the posterior cranial fossa who were treated at the Department of Brain and Spinal Cord Tumor Surgery of the N. N. prof. A. L. Polenov for the last 3 years. Localization of meningiomas: 27 (41 %) – the posterior edge of the temporal bone pyramid, 8 (12 %) – the apex of the temporal bone pyramid, 15 (23 %) – the tentorium of the cerebellum, 9 (14 %) – the area of the greater foramen magnum, 6 (9 %)) – petroclival, 1 (2 %) – region of the cerebellar hemisphere.

   Results. All patients underwent surgical treatment: 42 (63.6 %) observations – total tumor removal, 17 (25.8 %) – subtotal, 6 (9.1 %) – partial, in 1 (1.5 %) case only biopsy of the meningioma of the greater foramen magnum, due to the involvement of the vertebral artery into the stroma of the tumor. After the rehabilitation treatment, a significant improvement in the state of the ICF domains was obtained: walking, self-care, dizziness.

   Conclusion. In most cases, meningiomas of the posterior cranial fossa can be removed totally without increasing neurological symptoms. In the event of a neurological deficit after tumor removal, rehabilitation treatment carried out in the early postoperative period can significantly reduce clinical symptoms and further continue treatment in rehabilitation centers. If the meningiomas are partially removed, it is recommended to carry out radiation therapy or stereotaxic radiosurgical treatment of the remaining part of the tumor. Patients after removal of benign brain tumors have a high rehabilitation potential, regardless of the location and degree of radicality of the neoplasm. Rehabilitation treatment is most advisable as early as possible from the moment of surgical removal of the tumor.

   Relevance. Comparison of the data on brain metabolism and the clinical picture of CCI against the background of pathological changes in the brain will make it possible to move to a new level of understanding of the essence of the pathological process, deepen knowledge about the pathogenesis of cerebrovascular diseases and determine the ways of targeted therapeutic and prophylactic effects.

   Purpose of the study. To perform clinical and neuroimaging comparison of the state of brain metabolism, cognition and emotional disorders in patients with chronic cerebral ischemia.

   Material and methods. An open, single-center, uncontrolled study was conducted with the inclusion of 36 patients with CCI, including 4 men and 31 women aged 50 to 88 years (average age 66 ± 4.8 years). Instrumental examination – triplex angioscanning of the vessels of the head and neck. The clinical evaluation included collection of neurological complaints, medical history, and neurological examination. Higher mental functions were assessed using scale methods. The conducted neuroimaging examination of patients included PET with 18-FDG.

   Results and discussion. According to the degree of accumulation of RFP, the patients were divided into two groups: with normal metabolism (11 patients) and with reduced metabolism (24 patients). In the group with hypometabolism, the appearance of focal neurological symptoms was noted. The data of comparative analysis on the scales show that in the group with normal metabolism, patients show higher indicators of mood stability, are less susceptible to depressive fluctuations, better sleep quality, and less pronounced asthenization. The atherosclerotic changes in the cerebral vessels
revealed in patients using ultrasound angioscanning confirmed the data obtained during the clinical neuropsychological and neuroimaging examination.

   Conclusion. CCI has not only neurological, but also a wide range of psychiatric manifestations: from mild – asthenic, to gross – cognitive impairment. Patients at the initial stages do not realize the problem, find themselves out of observation, do not receive proper treatment, which can lead to an increase in cognitive deficit, a decrease in the quality of life, and social functioning.

   Summary: This article is foccused on a retrospective single-center experience including patients who underwent surgery for trigeminal schwannoma tumors. This study is concentrating on clinical and neuroimaging features important for differential diagnosis, it reflects surgical technique, extent of resection, postoperative outcome.

   Methods: Current results of perioperative examination and surgical treatment of 21 patients who were treated in the IV department of RNSI over the past 10 years have been analyzed.

   Results: In 47.6 % of cases, total tumor removal was performed without a significant increase in focal symptoms.

   Objective: Studying the results of intraoperative diagnostics in neurovascular pathology by using the capabilities of a hybrid operating room.

   Materials and methods: The hybrid operating room concept encompasses simultaneous haemodynamic control, non-invasive and invasive diagnostics and immediate surgical and/or interventional treatment. Intraoperative diagnostics was performed in a hybrid operating room with the help of flat-detector computed tomography with intravenous contrast enhancement, perfusion, and selective cerebral angiography. For 5 years, 78 diagnostic procedures were performed in the hybrid operating room in 72 patients. 23 patients with cerebral aneurysms underwent intraoperative control using intravenous computed angiography and selective cerebral angiography. Control selective cerebral angiography was performed in 34 patients after combined removal of cerebral arteriovenous malformation. 15 patients with occlusive diseases of the brachiocephalic arteries underwent selective cerebral angiography and computed tomographic perfusion to assess the potential of the anastomosis and the dynamic change in the blood circulation before and after surgery.

   Results: As a result of using the methods of intraoperative diagnostics, 2 cases with incomplete clipping of the aneurysm neck, one case of the residual part of the arteriovenous malformation, and one case of intraoperative arteriovenous malformation rupture at the stage of endovascular embolization were revealed. As a result of intraoperative diagnostics, the effectiveness of extra-intracranial anastomoses was confirmed in 9 cases of occlusive diseases of the internal carotid artery, in 5 cases of Moya-Moya disease, in 8 cases of complex aneurysms.

   Conclusion: The hybrid operating room concept of intraoperative imaging in vascular pathology of the brain improves results and speeds up the diagnostic process during the operation, which gives advantages in the immediate assessment of the quality of the operation performed. The timely identification of possible complications allows you to change the type of operation without transporting the patient to another operating room.

   A clinical case of total removal of ventrolateral foramen magnum meningioma in the patient, who suffered an extremely severe coronavirus infection in accordance with the COVID‑19 classification is presented. The features of clinical observation and perioperative management of the patient with foramen magnum meningioma and «postcovid» syndrome are described.

   Gliomas are the most common CNS tumors in children with a prevalence of up to 30–35 % of all intracranial tumors. Children’s gliomas are mainly low-grade gliomas, which are classified as grade 1 or 2 according anaplasia to the WHO classification of CNS tumors. The use of modern genomic and epigenomic technologies for a detailed description of the genetic profile of brain tumors in children is a relatively new diagnostic approach. The targets for anticancer therapy have been identified due to discovery of some markers for poor prognosis of neuroepithelial tumors. So, the aim of this study
was to conduct a literature review of genetic markers with potential and confirmed clinical significance in the diagnosis and treatment of neuroepithelial brain tumors in children. To achieve this goal, we searched for scientific publications in evidence-based medicine databases. The article describes the characteristics of some most significant markers of brain gliomas with low malignancy in children and principles of their targeted molecular therapy.