The article presents brief historical information about the creation of a specialized hospital of the Institute of Surgical Neuropathology in Leningrad and its further transformation into the Polenov Russian Research Institute of Neurosurgery. The article presents data on the establishment of the institution, its directors and the importance for the creation of a neurosurgical service in the country.

Anaplastic glioma although more favorable than glioblastoma even after complex treatment, mostly progress and transform into glioblastoma when they reoccur. The aim of this research was to study the clinical, survival rate and factors influencing the transformation of anaplastic glioma to glioblastoma.
We retrospectively studied from 2002 to 2020, patients with anaplastic glioma, whose tumors transformed into glioblastoma. We studied the clinical and the overall survival. A total of 101 patients with anaplastic glioma of which 29 transformed into glioblastoma were studied with an average age of 48 years and comprising of 17 men 12 women. The mean time to transformation of glioblastoma was 31 months. Overall survival was 44.50 months. The survival rate after transformation was 13.5 months. The transformation of anaplastic glioma into glioblastoma affects the treatment protocol of patients, since transformation is most often detected after the histology of re-resection has been confirmed. Treatment of anaplastic glioma should be individualized, taking into account molecular markers, age, and degree of resection. Further research should also focus more on the prevention or early treatment of transformed gliomas.

Numerous studies of the pathogenesis of meningiomas, frequent changes in the tumor suppressor genes CDKN 2A, p14ARF and CDKN 2B in the 9p21 region, as well as gene amplification in the 17q23 region. The value of prognostic markers of proliferation, especially MIB‑ 1, was noted. Ki‑67 antibodies do not fully solve the problem of predicting tumor recurrences. A comparative analysis of the results of an immunohistochemical study of the nuclear expression of the Ki‑67 proliferation index with diffuse nuclear expression of the Cyclin-D 1 protein in patients with recurrent meningotheliomatous meningiomas was performed. It turned out that in the structures of meninotheliomatous meningioma, there is a pronounced nuclear expression of the Cyclin-D 1 protein in 50 % of tumor cells. At the same time, the structures of meninoteliomatous meningioma showed insignificant nuclear expression of the index of proliferative activity Ki‑67 within 3 % of cell nuclei. The results obtained indicate a high prognostic value of the nuclear expression of the Cyclin-D 1 protein in predicting relapses of meningotheliomatous meningiomas.

The combination of Alzheimer’s disease in vascular dementia leads to an increase of cognitive impairment and ataxia and worsens prognosis. Translingual neurostimulation has been used to improve dynamic and static balance and gait of several years. A non-pharmacological intervention program for symptoms of dementia can help for neuropsychiatric symptoms. To study the dynamics of cognitive impairment and the quality of life of patients with mixed dementia, depending on the methods of patient care. Methods: Cohort study of 80 cases, from March 2019 to January 2020, moderate and severe cognitive impairment and previously established diagnoses of chronic cerebrovascular ischemia (without any notes about dementia). The quality of life (EQ‑5D VAS) increased in the group 1 in 100 % of cases 23 ± 4.7 points. In the group 2, changes in the quality of life were not statically significant, the average value decreased by 2±0.7 points (p=0,73). The improvement in the stabilometry was confirmed by a statically significant improvement in the mean values of Berg balance scale and dynamic gait index. The use of translingual neurostimulation (PoNS ™) with physical exercises under the control of stabilometry with biofeedback system (H. M otion Lab ™) in patients with high risk of falling can improve gait and balance, including patient with dementia.

Purpose . To investigate the acceptability, efficacy, and effect duration of translingual neurostimulation (TLNS) plus standard therapeutic exercise program (TEP) to improve motor skills in children with cerebral palsy (CP).
Me thods. Participants aged 2–17 years (n = 134) diagnosed with spastic diplegia CP with coordination and mobility symptoms were enrolled at Sestroretsk City Hospital № 40. Participants were offered one of two treatment regimens: either TEP plus TLNS with the Portable Neuromodulation Stimulator (PoNS™) – experimental arm or TEP alone (control).
The treatment course continued for ten days (2 weeks, excluding two weekend days). In the experimental group and TEP, TLNS was applied twice a day, 20 minutes each during exercises, morning, and afternoon, at least 3 hours between sessions. Assessments before and after therapy courses measured spasticity, balance, and motor skills. Either treatment could be repeated several times (6–12 months between courses). All children were assessed before and after a course round of therapy using standard scales for spasticity, balance, and motor skills (Ashworth scale, Berg scale, Gross Motor Function Classification System, Functional Movement Screen). Results: Both groups of patients showed improvement; however, the improvement was significantly more significant in the experimental group across all scales, observed in all ages, and largely sustained for 6–12 months.
Conclusions . TLNS plus TEP can be considered as a novel and promising strategy to improve neurorehabilitation outcomes in children with CP, offering broad implications for the development and use of TLNS in CP.

Object: to analyze the clinical and MRI characteristics of cin patients with malignant course to predict the development of the disease.
Methods: Two groups of patients with multiple sclerosis were formed: malignant and benign multiple sclerosis. All patients underwent an assessment of the anamnesis, the severity of neurological disorders, magnetic resonance imaging in the debut and during treatment of the disease.
Findings : The duration of the first remission was significantly shorter in patients in the first group. On the first MRI, significantly more T2 foci were observed in patients with malignant multiple sclerosis. Also, in the first group, spinal cord lesions were significantly more often diagnosed.
Conclusions : Thus, the most significant predictors of the malignant multiple sclerosis were motor disorders at onset, short first remission, more than 20 foci of demyelination on MRI at onset of the disease, the presence of focal lesions of the spinal cord substance.

Background. Comparative analysis of approaches to the surgical treatment of postoperative hemorrhagic complications (POH) in brain tumor surgery is difficult due to the lack of a generally accepted definition of the term postoperative haematoma, the absence of unified indications for revision interventions. There are two cardinal surgical tactics in POH surgery: “waiting” with conversion to surgical treatment and early revision surgical treatment. The emerging trend in medicine to reduce the length of stay in the intensive care wards requires a careful analysis of the time intervals for the formation of the POH.
Objective . The aim was to determine the advantages of the strategy of early revision surgical treatment in comparison with the “waiting” tactic with conversion to surgical treatment of neurooncological patients with significant POH; to establish a reasonable period of stay of patients of the specified profile in intensive care unit wards.
Methods. The retrospective study included 48 neurooncological patients who were reoperated because of POH. The time intervals T1, T2, T, reop were calculated for each clinical case. All patients were divided into 2 groups: in group 1, the strategy of early revision intervention was used, in group 2, “waiting” conservative tactics were used, followed by conversion to revision intervention. Outcomes were estimated using a modified 5-point Glasgow Outcome Scale.
Results. When using the strategy of early revision intervention, significantly better outcomes were obtained (Mann-Whitney test, p value = 0.006717). The median outcome in the 1st group is moderate disability, in the 2nd group is severe disability. Based on the calculation of time parameters, a rational observation period for patients in the intensive careunit was established – at least 2 days, a diagnostic algorithm for the POH was determined.
Conclusion. Our data obtained indicate the advantages of the strategy of early revision intervention. When choosing an approach to the surgical treatment of POH, it is necessary to be guided by the principle of interpreting doubts in favor of reoperation. Reducing the length of stay of neurooncological patients in intensive care unit will lead to belates detection of POH and worsening of disability and postoperative mortality rates.

The article presents an analysis of errors and complications in 268 patients with spinal cord injury (PSMT ) of the thoracic and lumbar regions, who were treated with transpedicular osteosynthesis. During the follow – up period up to 10 years, 37 (13.8 %) unsatisfactory results were revealed: fractures of the metal structure – 24 (8,9 %) cases; carrying screws past anatomical landmarks – in 3 (1,11 %) patients, cutting screws and migration of structural elements – in 3 (1,11 %) cases; inflammatory process in deep tissues – 3 cases; cerebrospinal fistula-in 1 (0,37 %) patient. An analysis of the literature and a comprehensive system of prevention of errors and complications will improve the results of treatment of patients with complicated fractures of the thoracic and lumbar spine.

Pain syndrome is one of the most important problems of modern medicine. Despite the development of new painkillers, the development of physiotherapy, psychotherapy methods of treatment, the effectiveness of treatment of patients suffering from various types of pain syndromes remains very low. This leads to frequent and unjustified use of strong and narcotic drugs, to the occurrence of serious side effects and complications of pharmacotherapy. In recent decades, minimally invasive methods of treating chronic pain associated with electrical and drug stimulation of various parts of the nervous system have been increasingly used worldwide. This article discusses modern methods of treatment of chronic pain syndrome used in neurosurgery. The article analyzes such modern methods of neuromodulation as epidural spinal cord stimulation and intrathecal opioid therapy. The mechanism of action of the above methods is described, indications and contraindications to them are presented. The author focuses on the criteria for selecting patients for these interventions. The data of modern scientific literature on their effectiveness are presented.

Degenerative diseases of the spine are one of the most pressing problems in neurosurgery. Taking into account the increase in surgical activity in relation to this pathology and the wide choice of possible technologies, it is important to select the correct patients for surgical intervention. In our opinion, one of the most important criteria for grouping factors is the possibility of their correction. Thus, all predictors can be divided into two large groups, modifiable and non-modifiable. From this 2 it follows that when planning surgical treatment, patients will be divided into several cohorts: patients who are already ready for surgical treatment; patients who have modifiable factors in an unfavorable condition and require their correction; patients with unfavorable unmodified factors. The last cohort of patients will have the worst prognosis for surgical outcome. Thus, further prospective studies are required, taking into account clinical, social and psychological factors when determining the scope of surgical treatment of patients with degenerative-dystrophic diseases of the spine.

The article presents modern literature data on the consequences and complications of spinal cord injury (SCI) in patients at all stages of recovery. The authors discuss definitions of the terms «SCI consequences» and «complications during SCI course». They underline the need to have a clear distinction between these terms. The authors also background the necessity to revise the current classification of SCI complications which was proposed in 1994.

OBJECTIVE: to present a modern approach to the diagnosis and treatment of paraarticular cysts of the facet joints.
MATERIALS AND METH ODS. The analysis of the specialized literature on the clinical results of treatment of patients with paraarticular cysts of the facet joints was carried out.
CONCLUSION. Currently, the choice of the optimal treatment for paraarticular cysts remains debatable. Conservative treatment is only a symptomatic temporary measure for the provision of specialized neurosurgical care. Surgical treatment of paraarticular cysts of the facet joints is an effective method of surgical treatment.

A neurogenic dysfunction of the pelvic organs is one of the signs that may be in a patient with lesions of the brainstem at the entry of the superior cerebellar peduncle, and the upper parts of the pons Varolii. However, these disorders as one of the first symptoms of the disease are extremely rare, and their nature is determined localization of the neoplasm. In case of damage of the brainstem, in particular the pons Varolii, obstructive dysfunctions of the pelvic organs can be noted, and very rarely – irritative. The article presents a rare clinical case of primary multiple subtentorial glioblastomas in a patient with severe obstructive dysfunction of the pelvic organs.

OBJECTIVE: to present the result of successful surgical treatment of a cranio-orbital benign tumor in a patient with juvenile glaucoma with a history of multiple recurrence of a mass lesion. Analyze the results of the chosen tactics of surgical treatment and evaluate the follow-up history of this patient.
MATERIALS AND METH ODS. A retrospective analysis of the surgical treatment of a 20-year-old patient in the OA «Neftyanik» medical unit in Tyumen was carried out. The operation consisted in radical removal of recurrent lipofibroma of the cranio-orbital region on the right with simultaneous reconstruction (osteosynthesis) of the facial skeleton with dynamic titanium plates, which allowed the patient to have a relapse-free course of the disease and a good functional result. After discharge, follow-up examinations of the patient were carried out at intervals of 6 months.
RESULTS. The duration of relapse-free follow-up was 5 years, according to the examination, the correctness of the chosen surgical tactics and a good functional result of the reconstruction of the facial skeleton were proved.
CONCLUSION. Clinical observation demonstrates a rather rare combination of two nosologies of juvenile glaucoma and lipofibroma. The combined (multidisciplinary) surgical approach using modern reconstructive technologies demonstrates the radical nature of surgical treatment, which ensured a relapse-free course of the disease and a good functional result in the postoperative period.

Distal aneurysms of the anterior cerebral arteries are a rather rare pathology, even more rare is the option of a “kissing” aneurysm, in which two aneurysms interact intimately with each other, often in contact with their walls. This message is devoted to the study of this pathology by turning them off from the bloodstream in one form.

The use of bone cement in spinal surgery in most cases does not lead to clinically significant complications and remains asymptomatic, but sometimes it can lead to serious clinical consequences of cement embolism. The consequences of vertebroplasty for hemangiomas, trauma, osteoporosis are most widely covered in the literature. At the same time, the complications associated with cement strengthening of screws during pedicle fixation are poorly covered. The article presents two clinical cases of symptomatic cement embolism of the branches of the pulmonary artery after pedicle screws fixation. Clinical manifestations, differential diagnosis of the causes of hemodynamic and respiratory disorders are described. There is a brief review of the literature on complications, prevention and treatment of complications from the use of bone cement. Differential diagnosis of the causes of the clinical manifestations is difficult. Revealed cement pulmonary embolism are usually of no clinical significance.

Multisystem injuries of nerves and vessels in upper extremities refer to major traumas, and their prognosis is often unfavorable. The recovery of the nerve function directly depends on the blood flow recovery rate in major vessels. The outcome of the surgery may be enhanced with reconstructive and remedial interventions performed by multidisciplinary teams, and the employment of electroneuromodulation to activate regeneration processes in neural tissue

Development of objective markers for visualization of the efficacy of surgical treatment is an urgent problem and is important for the choice of further treatment tactics in patients with Dandy-Walker anomaly combined with hydrocephalus.
The aim was to demonstrate the effective use of endoscopic treatment techniques in patients with subcompensated hydrocephalus and Dandy-Walker anomaly and to evaluate the possibility of using morphometric indicators and signal characteristics of the brain MR imaging in determining their effectiveness.
Materials and Methods. We present a rare clinical observation of a 37-year-old female patient suffering from Dandy-Walker anomaly with hypertension-hydrocephalus syndrome in the subcompensation stage; endoscopic triventriculocysternostomy was performed. Examination was performed: head MRI, phase-contrast magnetic resonance imaging (PCMRI) with cardiosynchronization before and after surgery 6 months later on “Ingenia” 3 Tesla magnetic resonance imager (Philips). Measurements of ventriculometry and morphometric indicators of bone-brain structures of the brain were performed before and after surgical treatment.
Results. Clinical improvement of the patient’s condition was observed after the performed minimally invasive intervention. FKMRI with cardiosynchronization in dynamics after 6 months confirmed the functioning of the third ventricular floor stoma and a slight decrease in the width of the third ventricle. Of the morphometric indices, an increase in the pontomezencephalic angle from 56.7° to 79.7° and in the mammillopontine distance from 9.32 mm to 10.3 mm were noted.
Conclusion . When Dendy-Walker anomaly is combined with hypertension-hydrocephalic syndrome in the subcompensation stage, a triventriculocysternostomy is performed as the first stage. The use of morphometric indicators of the bone-brain structures in combination with ventriculometry and signal characteristics of MRI examination is an accessible method in the work of a multidisciplinary city hospital, which does not require special software. The observation demonstrates the efficacy of triventriculocysternostomy in the treatment of patients with ADS combined with subcompensated hydrocephalus syndrome and the possibility of using radiological diagnostic methods to assess the dynamics of MRI picture before and after surgery.

Pilocytic astrocytomas are highly differentiated tumors of neuroectodermal origin, low grade (WHO Grade I), which are localized in any part of the brain and spinal cord, but the most common area of occurrence is cerebellar hemispheres and temporal lobes. Pilocytic astrocytomas of spinal localization account for 2–5,2 % of all tumors of this type, which makes the study of each clinical observation urgent. Despite their rarity, spinal astrocytomas attract great attention due to pronounced neurological deficits, which is associated with their intramedullary location, and also due to the need for a thorough differential diagnosis with clinically similar conditions. Complete surgical resection is possible in 50–81 % of cases, postoperative survival is high, and the prognosis is assessed as favorable. Considering the urgency of the problem, epidemiology and certain difficulties of primary clinical diagnosis, we present a description of a clinical case of a middleaged patient with pilocytic astrocytoma.

On 17–18 May 2021 Bekhterev National medical research centre for psychiatry and neurology hosted the conference «Biopsychosocial Approach to Treatment and Rehabilitation of Patients with Epilepsy. There was held the conference «Biopsychosocial approach to the problem of treatment and rehabilitation of patients with epilepsy» dedicated to the 110th anniversary of the Russian Anti-Epileptic League, whose first chairman was the founder of the Institute (Centre) Academician V. M . B ekhterev. The conference was organized within the framework of the 27th Congress of Russian Psychiatrists, which united experts in various fields. The scientific programme of the conference presented the main aspects of epileptology. Modern scientific and practical achievements were highlighted in reports and lectures by leading Russian experts. Specialists of Polenov Russian Scientific Research Institute of Neurosurgery took an active part in the conference programme: 6 reports were presented, 8 abstracts were published. The opportunity to present the results of scientific work at the most important Russian conference highlights the relevance and modernity of the research conducted at the Institute in the field of applied and fundamental epileptology.