When conducting statistical studies in the Republic of Belarus, it was noted that congenital malformations of the spine account for 2.5–7% of all identified cases. At the same time, in half of the cases there is a progressive development of the vertebral curvature, where active corrective treatment is necessary.  However, the emphasis on radiation diagnostics, as the only method for diagnosing the aggressiveness of the course of the disease, often lags behind the intensity of clinical manifestations.

AIM  OF THE STUDY:  development of criteria for early surgical intervention in the presence of severe congenital spinal deformities in children.

MATERIALS AND  METHODS. The studies were carried out in 52 patients with congenital spinal deformities. The radiation method of research was carried out in 52 patients, the microelement composition of blood (Zn, P, Ca, Cu), and the content of Se, Ag, Pb, Cd were also studied. As part of a genetic study, polymorphisms of the detoxification genes GSTT1, GSTM, GSTP1 (lle105Val), GSTP1 (Ala114Val), as well as mutations of the genes responsible for the growth rate and structure of the vertebrae and intervertebral discs — the  HOXA11, HOXD 13, RUNX2  genes were determined in the same 52 patients, CHST3, DLL3, MESP2, LFNG, HES 7.

RESULTS. It was found that, along with radiation methods of research, when deciding on the need for surgical intervention in congenital malformations of the spine, polymorphisms of detoxification genes, as well as their relationship with biochemical parameters of blood, and heavy metals in biological substrates, can be used.

CONCLUSION. The question of the need for surgical treatment for congenital malformations of the spine can be resolved using radiation diagnostic methods, which requires a long observation time. Combining the radiation method and the method for determining the aggressiveness of the course of the disease using the relationship of detoxification gene mutations with biochemical parameters will significantly reduce the decision-making time, taking into account clinical data.

BACKGROUND.   despite the difference in the natural course of the disease for primary and secondary glioblastomas (as well as for IDH-mutant and IDH-wild type tumors) is well known, little attention has been given to study differences in progression-free (PFS) and overall survival (OS) for primary and secondary anaplastic astrocytomas (AA) and anaplastic oligodendrogliomas (AO).

MATERIALS AND METHODS .  This  study  was  based  on  79  patients  with  primary AA  or AO  and  secondary aforementioned tumors, developing as a result of malignant progression of diffuse astrocytoma or oligodendroglioma, respectively. Patients from both groups were treated identically — surgery followed by adjuvant treatment.

RESULTS . Analysis of PFS and OS in these groups revealed that AAs largely followed the pattern well established for glioblastomas, meanwhile AOs demonstrated less vivid difference between primary and secondary tumors.

CONCLUSION. This is a pioneering work aiming to study differences between primary and secondary anaplastic tumors. Primary  and  secondary AAs demonstrated  similar  natural  course  of  the  disease  with gliolastomas, meanwhile AOs followed it less vividly — most probably, due to the less malignant tumor behavior.

Variome analysis is an assessment of variome (all genomic variations detected in an individual or in a specific disease) by genome scan. Here, we describe an analysis of genomic variations manifesting as copy number variants (CNV) in 139 children suffering from intellectual disability and epilepsy. Chromosomal abnormalities were detected in 24 (17.3 %) children; chromosomal instability was detected in 18 (12.9 %) children; genome instability (chromohelkosis) was detected in 7 (5 %) children; partial uniparental disomy in imprinted chromosomal loci was detected in 15 (10.8 %) children. Five children (3.6 %) were born to consanguineous parents. CNV, which might be associated with functional outcomes, were detected in all the children. Analyzing the genes affected by the genomic variations, we unraveled candidate processes of epilepsy, among which were pathways implicated in cell cycle regulation and genome stability maintenance.

Improving upper limb function is an important part of rehabilitation to reduce disability. About 20 % of patients after a stroke do not use their hand, despite the ability of movements. Functional recovery after shoulder fracture is slow and results are also disappointing. One of the reasons for the lack of restoration of hand function is the syndrome of learned non-use. This review presents the advantages and limitations of the two most modern and common technologies for both the rehabilitation of the proximal upper limb (robotics and virtual reality) and the rehabilitation of the hand with learned non-use syndrome using a sensory glove with computer programs based on the biofeedback.

Epilepsies are a heterogeneous group of conditions characterized by recurrent seizures. Currently, more than 700 epilepsy-associated genes have been identified, some of them encoding sodium channel subunits. In connection with the trends in the development of personalized medicine and the high availability of genome sequencing, the study of the contribution of sodium channel mutations to the pathogenesis of epilepsy is relevant. The task of the study was analysis of epileptogenic mutations in sodium channel genes according to the OMIM database.

METHODS. Analysis of the OMIM database and current publications on the genetics of sodium channels, and their relationship with epileptogenesis.

RESULTS. Epileptogenic and non-epileptogenic mutations in sodium channel genes were characterized from the perspective of systemic genomics.

DISCUSSION. The association of mutations in sodium channel genes with a number of hereditary epilepsies, including early infantile epileptic encephalopathy (developmental and epileptic encephalopathy), has been shown. It is shown that these studies using the methods of systemic genomics can be important for neurological, cardiological and neurosurgical practice.

Spinal epidural abscess is a neurosurgical pathology accompanied by compression of the spinal cord and requiring urgent surgical intervention. The most commonly performed classic extended laminectomy with removal of the abscess of the epidural space. In some cases, post-laminectomy syndrome may develop in the late postoperative period.

THE PURPOSE of the study is to analyze the immediate and long-term outcomes of various methods of surgical treatment of isolated spinal epidural abscesses and to develop a method to reduce the incidence of postlaminectomy syndrome.

MATERIALS AND METHODS. The study was conducted on the basis of the Sverdlovsk Regional Clinical Hospital No 1. 34 patients with primary, isolated spinal epidural abscesses, who were treated in the neurosurgical department from 2005 to 2019, were divided into two groups. The control group underwent classical laminectomy, and in the main group, the operation was performed using the original method of «fenestrated» interhemilaminectomy. / The dynamics of the severity of vertebral pain syndrome was assessed according to the digital pain rating scale, the Karnovsky scale, the Oswestry disability index (ODI), the incidence of postoperative complications, long-term results, the incidence of postlaminectomy syndrome in two comparison groups.

RESULTS. Reducing the volume of the surgical wound and changing the method of drainage when using the proposed method was accompanied by a decrease in the frequency of local infectious complications (40 % and 10.5 %, respectively), the severity of residual vertebrogenic pain syndrome as in the early (3.6 ± 0.6 and 2.5 ±0.5, respectively), and in the late postoperative periods (2.7±0.9 and 1.4±0.7, respectively), as well as the incidence of postlaminectomy syndrome (23.1 % and 6.25 %, respectively) (p<0.05).

CONCLUSION. The introduction of the original method of «fenestrated» interhemilaminectomy allows to reduce the volume of the surgical wound and perform more effective drainage in the postoperative period, which improves the immediate and long-term outcomes of surgical treatment, as well as reducing the incidence of post-laminectomy syndrome.

The effectiveness of the use of puncture laser decompression of the intervertebral discs and radiofrequency dereception of the facet joints was analyzed in 102 patients with the “adjacent level” syndrome (ASP) for the period from 2017 to 2021, operated on in the neurosurgical department of the Institute of Chemistry and Surgery. There were 48 men and 54 women. The average age of the patients was 50.1±1.0 years. The time interval from the moment of exacerbation to surgical treatment was 4.9±0.9 months. During clinical and neurological examination, lumbalgia was diagnosed in 12 patients (11.8 %); lumbar ischialgia — in 78 (76.4 %) and radiculopathy — in 12 patients (11.8 %). Protrusions and median herniations of the intervertebral discs were found in 86 patients (84.3 %) among the reasons for the development of the “adjacent level” lesion syndrome; spondylarthrosis with clinical manifestations — in 16 patients (15.7 %). The main localization of the pathological process was segments L_III–L_IV — in 42 (41.2 %) and L_IV–L_V — in 39 patients (38.2 %), respectively.

Evaluation of the effectiveness of surgical treatment was carried out on the basis of an analysis of clinical and instrumental diagnostic data using a visual analog pain scale and the MacNab questionnaire.

Postoperative epidural fibrosis develops and progresses over time.

PURPOSE OF THE STUDY: to conduct spatiotemporal analysis of changes in the shape and size of the dural sac during the development of epidural fibrosis in the area of laminectomy.

MATERIALS AND METHODS. The experiment was carried out on male rats of the Wistar breed. Animals underwent laminectomy at the level of L_VI–S_I. On days 3, 7, 14, 21 and 28, the rats were taken out of the experiment and a histological examination was performed in the laminectomy zone with hematoxylin and eosin staining. To assess the dynamics of tissue changes, the anteroposterior and transverse dimensions of the dural sac and the ratio of the transverse to anterior-posterior were measured. The images were evaluated in the Image J program (Wayne Rasband, USA), compared with control data (intact animals), and the sizes were measured in pixels. Statistical analysis was performed using SPSS 21.0 (IBM Corp., USA) and Microsoft Office Excel 2016 (Microsoft Corp., USA).

RESULTS. It has been established that during the formation of epidural fibrosis, the shape and size of the dural sac changes. Multivariate logistic regression analysis showed a significant increase in the transverse dimension (χ² = 0.019 at p < 0.05), while the anterior-posterior or longitudinal dimension suffered less, nevertheless, it decreased by more than 10 % of the control (χ² = 0.023 at p < 0.05).

CONCLUSION. The experiment revealed the dynamics of the transformation of the shape and size of the dural sac in the area of formation of the connective tissue scar after laminectomy. Early involvement in the process of scar formation of the dura mater was noted.

INTRODUCTION. The progression of the tumor process begins with the activation of angiogenesis. The proven fact of the primacy of vascular growth with continued growth of gliomas is important for intraoperative determination of the scope of surgical intervention.

AIM OF THE STUDY: to study the possibilities of intraoperative diagnosis of the peritumoral zone, taking into account the mechanisms of glioma growth.

MATERIALS AND METHODS. Archival biopsies of 748 glioma patients aged 18 to 80 years old, operated at the Republican Scientific and Practical Center of Neurology and Neurosurgery (Minsk). To detect herpes simplex virus (HSV) in tumors, an immunohistochemical (IHC) study was performed with antibodies to the HSV antigen type I and II, the number of vessels was counted under the control of monoclonal antibodies to CD 34, to identify inflammatory infiltration, monoclonal antibodies CD 45 (total leukocyte factor), CD 8 (T-lymphocytes), CD 20 (B-lymphocytes), Р53. We used data from a comprehensive study of 6 deceased with glioblastoma using post-mortem MRI (Russian Research Institute. prof. A. L. Polenova).

RESULTS. Tumor growth was accompanied by the appearance of a large number of vessels and round cell infiltrates not only in the tumor tissue, but also in the peritumoral zone, which can become a diagnostic criterion for determining the extent of surgical intervention when removing high-grade gliomas. At the same time, independent studies conducted with MRI of tumors during autopsy showed that around tumors of different histostructure, both in vivo and postmortem, a zone with histological signs of inflammation and proliferating vessels is determined.

CONCLUSION. When performing surgery for the removal of high-grade gliomas, along with the use of photofluorescence methods, intraoperative morphological diagnostics will improve the rate of radicalness of the operation due to the detailing of processes in the peritumoral zone.

AIM OF THE STUDY: study of the рossibilities of immunotherapy in the future treatment of glial tumors using effect  of the level of apoptosis of tumor cells on the antitumor activity of NDV and its ability to inactivate AMK, which stimulates  tumor growth in the experiment. 

MATERIALS AND RESEARCH METHODS. Used VBN, vaccine strain «H», obtained from the Institute of Virology.  DI. Ivanovsky in 1984. One of the leading causes of death according to the World Health Organization is cancer, which is  named the second cause of death in developed countries. Tumor cells of Ehrlich’s adenocarcinoma were inoculated into  mice subcutaneously in a volume of 0.2 ml (20x106 cells/ml). VBN was administered to animals intraperitoneally in a  volume of 0.5 ml on the fifth day from the subcutaneously grafted tumor, every 3–4 days for 25 days. The antitumor activity  of the virus was assessed by the weight of the tumor in the experimental and control groups, as well as by survival. 

RESULTS AND ITS DISCUSSION. When using the culture virus, the animals died after 17 days, while in the case of the  virus-containing allantoic fluid, the animals lived for 300 days (observation period). Both infectious and hemagglutinating  activity of the used VBN is the same. It can be assumed that in the first group, under the influence of NDV and embryonic  proteolytic proteins, cells in the state of apoptosis appear among the tumor tissue, which stimulates an adequate  immunological response, which determined the survival of the animals.

CONCLUSION. The ability of NDV to increase the level of apoptosis as a factor opposing mitotic activity with an increase  in the proteolytic properties of culture media in vitro suggests the possibility of such an approach in the treatment of  malignant gliomas.

INTRODUCTION. One of the complex problems of surgical treatment of peripheral nerve sheath tumors is their  recurrence, which, according to various authors, ranges from 17.3 % to 26.4 %. The defeat of several anatomical regions,  the prevalence of the tumor, the gross involvement of internal organs and great vessels in the neoplastic process make it  difficult to perform a radical surgical intervention with the removal of affected tissues in a single block. 

MATERIALS AN D METHODS. We analyzed the data of 35 patients with recurrences of peripheral nerve sheath  tumors of various histological structures in the period from 2018 to 2021, who were treated at the Russian Research  Neurosurgical Institute n.a. A. L . P olenov — FSBI “SMRC n.a. V. A. Almazov” of Ministry of Health of Russian Federation.  The histological diagnosis was verified by biopsy examination of the tumor material and was established according to the  2020 WHO classification. Follow-up in postoperative patients was observed from three months to 12 years. The most frequent relapses of neurofibromas were 13 (37.1 %) patients. Patients with recurrence of MRAF were slightly  less common — 12 (34.3 %), recurrence of schwannoma was observed in 10 (28.6 %) patients. There were no patients with  recurrence of perineurioma and hybrid tumor in our observations. 

RESULTS. A statistically significant relationship was found between complete and partial microsurgical removal of  the tumor. With partial removal of a peripheral nerve sheath tumor, the frequency and time of recurrence is much higher.  The use of a differential approach to the choice of the method of surgical treatment and access, based on the characteristics  of tumor growth, the somatic condition of the patient, the appropriate equipment in the medical institution and the practical  skills of the neurosurgical team, allows not only to radically remove the recurrence and continued growth of ARF, but also  to perform reconstructive interventions on the nerves structures. 

DISCUSSION OF THE RESULTS. The desire for the maximum volume of resection is a relative guarantor of  a decrease in the number of relapses, on the other hand, it increases the risk of neurological disorders. With pronounced  neurological deficits, it is necessary to strive for the maximum radicalism of surgical treatment, but in the absence of  a clinical manifestation, it is necessary to remember this during the operation. 

The problems associated with the treatment of severe forms of new coronavirus infection (NCI) encourage doctors and scientists to search for and use new drug regimens. SARS-CoV-2 causes a pronounced inflammatory, metabolic response of the body, endothelial damage, and the development of severe hypoxia. The central nervous system participates in the regulation of the inflammatory response of the body to a pathological agent, the implementation of the processes of sanogenesis. Creating conditions for the implementation of genetically embedded protective mechanisms is one of the main therapeutic tasks. Pharmacological protection of cells is more effective in conditions of stable functional state — neurovegetative stability. Optimal cytoprotective drugs in the conditions of «metabolic chaos» created by the NCI are drugs containing natural energy substrates. One of these drugs is Cytoflavin.ThE 

AIM OF THE  WORK is to provide a theoretical justification and practical confirmation of the feasibility of using a two-component model of neurovegetative and metabolic stabilization in patients with NCI.

METHODS : high doses of Cytoflavin, 50 ml per day, were administered to patients with severe NCI against the background of neurovegetative stabilization.

CONCLUSION: the introduction of high doses of Cytoflavin against the background of the created vegetative stability makes it possible to create an optimal level of metabolic protection of cells.

One  of  the  key  methods  for  assessing  the  state  of  the  pyramidal  system  is  transcranial  electrical stimulation (TES). The voltage level used in TES (from 200 V to 800 V) determines the inevitable inconvenience during operation. An alternative method that can significantly reduce the intensity of stimulation is quadripolar transcranial electrical stimulation (quad-TES).

THE   PURPOSE   OF  THE   STUDY:  to  give  a  comparative  description  of  bipolar  and  quadripolar  TES  in  the intraoperative assessment of the state of the corticospinal tract during the removal of neoplasms in the lower spinal cord.

MATERIALS AND  METHOD S .  The study included 15 patients with intradural extramedullary tumors of the spinal cord at the level of Th11-S  2 vertebrae. The minimum intensity of stimulation was assessed to achieve a stable motor response from target muscles during TES (bipolar TES and four variants of quadro-TES). The power of the  m-wave was compared for different montages. R ESULTS .  The average age of the patients was 59.3 ± 10.0 years. In bipolar TES (C 3-C  4), the stimulus intensity was 99 ± 41.6, V.  With quadro-TES: C 3/C 1-C  4/C 2–64.0 ± 30, V (p  < 0.001);  m3/ m1- m2/ m4–59.3 ± 25.6, V (p  < 0.001); C  3/ m1-C  4/m2–52.7 ± 20.2, V (p  < 0.001);  m3/C 1- m4/C 2–52.0 ± 22.2, V (p  < 0.001). With bipolar TES, the highest power of the m-wave was in 1 patient out of 15 (6.67 %). With quadro-TES, 14 out of 15 patients had the highest m-wave power (93.3  %).

CONCLUSION.  To achieve a stable motor response from target muscles using the quadro-TES technique we need a lower stimulation intensity than with bipolar TES. When using the quadro-TES method, the optimal ratio of the intensity of the stimulus and the power of the  m-wave is provided with diagonal mounting m3/C 1- m4/C 2.

Primary modality for surgical treatment of clinically significant internal carotid artery occlusion (ICA) is considered to be application of extra-intracranial microanastomosis (EC–IC bypass). Cerebral hyperperfusion syndrome (CHS) has been not infrequent complication within early post-operation period.

OBJECTIVE:  description of clinical and investigational phenomena of DWI -positive cerebral MRI findings following application of extra-intracranial microanastomosis in patients with clinical signs of CHS in early post-surgery period.

MATERIAL AND METHODS .  Retrospective evaluation of 37 patients’ records has been performed for the period from 2015 to 2021, of the patients, who had undergone treatment in the  department of Neurosurgery of Interregional Clinical diagnostic Center with EC–IC bypass application associated with clinical signs of CHS in the early post-surgery period.

RESULTS .  Patients  with  CHS  during  early  post-surgery  period  presented  with  the  following  symptoms:  seizures, psychomotor agitation, new focal neurological deficit. Cerebral MRI was performed in 37 patients with clinical signs of CHS following EC–IC bypass. In 34 of 37 patients restricted diffusion lesions were revealed on  DWI-weighted images. All patients in the examined cohort had patent bypass confirmed with multiple diagnostic modalities including transcranial duplex scanning, multidetector CT-angiography and 3d-TOF  MRA. depending on actual DWI-positive lesions location (within concerned artery supply area) focal clinical symptoms were observed however different in the intensity.

CONCLUSION. Patients with clinical signs of CHS following EC–IC bypass application due to chronic ICA occlusion specific, however different from “classical” ischemic lesions, MRI abnormalities were revealed. however precise mechanism of their evolvement is not fully understood. Further investigations concerning CHS pathogenesis are required.

Surgical treatment of pituitary adenomas (PA) with cavernous sinus (CS) invasion with Knosp 3 and 4 grades is a challenging problem.

THE  AIM  of the current study is to present the results and complications rate of surgical treatment of patients with PA with CS invasion with Knosp 3 and 4 grades via transnasal endoscopic rout.

MATERIALS AND METH ODS . The  results  of  surgical  treatment  of  69  patients  were  retrospectively  analyzed. Primary PAs were observed in 47 patients, recurrent PAs — in 22 cases, 1 patient had prior radiosurgical treatment.

RESULTS . Gross total tumor resection was achieved in 23 (33.4 %) patients, subtotal resection — in 28 (40.6 %) patients, and partial resection of the PA in 18 (26  %) patients. The most frequent complications were diabetes insipidus in 10 % (n=7) patients and nasal cerebrospinal fluid leak in 5.7 % (n=4) patients; 2.8 % (n=2) patients developed meningitis; 1.4 % (n=1) had cranial nerve III palsy; 1.4 % (n=1) developed adrenal insufficiency; 1.4 % (n=1) had intracranial hemorrhages. There were no injuries of the internal carotid artery and no mortality in the study group.

CONCLUSION: Transnasal endoscopic resection of PA with CS invasion with Knosp 3 and 4 grades can be radical with good parameters of efficacy and safety for surgeons with sufficient experience.

The actual problem of neurology and neurosurgery remains issues related to neoplasms of the central nervous system. Along with the improvement of diagnosis, treatment and rehabilitation, the number of disabled people with both adults and children with this pathology is increasing in the country.

MATERIALS AND METHODS . It should be noted that the Government of the Russian Federation is trying (taking into account the social significance of this problem) to pay attention not only to medical aspects, but also to solve topical issues of social protection.

RESULTS . In recent years, there have been repeated attempts to create a reasonable and transparent system for establishing disability in brain tumors, understandable to the medical community and the patients themselves.

CONCLUSION. The latest classifications and criteria used in our country in the medical and social examination of citizens take into account the features of oncological pathology, which are set out in this article (on   the example of brain tumors).

A retrospective analysis of the results of treatment of 22 patients with severe traumatic brain injury complicated by delayed parenchymal hemorrhagic brain injuries (a   generalized term that includes progressive foci of contusion and delayed intracerebral hematomas) in the acute period of traumatic brain injury, treated for the period from 2018 to 2020 on the basis of the GBUZ «Clinical hospital of emergency medical care» was carried out. The fatal outcome is directly influenced, first of all, by the volume of the hemorrhagic focus, the presence of intraventricular hemorrhage, the nature of the hemorrhage (meaning delayed parenchymal hemorrhages that developed as a result of a probable acute violation of cerebral circulation by the type of hemorrhagic stroke).

Also, the results of surgical treatment were unsatisfactory, since there are many pros and cons when deciding on the timing of surgery and the scope of surgical intervention, which requires further study of the mechanisms of occurrence and course of this pathology.

Fluorescent navigation in glioma surgery has been increasingly used in recent years. In most studies, 5-aminolevulinic acid derivatives (5ALA) are used as fluorescence inducers. Information in the literature regarding the use of drugs from the E6 chlorin group is rather scarce.

PURPOSE  OF THE   STUDY.  To evaluate the effectiveness and possibility of using fluorescent navigation with chlorin E 6 in glioma surgery.

MATERIALS  AND METHODS .  The study included 30 patients with glial tumors of varying degrees of malignancy according to Grade (II–IV). All patients were operated on at the RN hI named after N.N. prof. A.  L.  Polenov. For visual study of fluorescence, equipment was used in the form of a Leica OHS operating microscope, the d-Light AF System by Karl Storz (Germany), a fluorescent module of our own production (St.  Petersburg LOMO, developed by G. V.  Papayan) and special software RSS Cam — Endo 1.4.313. For the histological study of biopsy specimens, hematoxylin-eosin staining and immunohistochemical studies were taken.

RESULTS .  It was confirmed at the histological level that the fluorescence intensity was weak in all patients with Grade II gliomas and strong in almost all patients with Grade III–IV gliomas. The sensitivity of the method of fluorescent diagnostics with chlorin E6 for Grade  II gliomas was 72.2  %, for Grade III gliomas — 83.8   %, for Grade IV — 87.7  %. The  specificity of the method was 60  % for Grade II gliomas, 66.7  % for Grade III gliomas, and 85.2  % for Grade IV gliomas.

CONCLUSION.  The use of a certain fluorescent imaging system made it possible to resect glial brain tumors using chlorin E6, and the intensity of tumor fluorescence correlated with the grade of glioma malignancy.

The  results  of  treatment  of  patients  with  malignant  gliomas  remain  unsatisfactory,  despite  modern possibilities in the diagnosis and treatment based on molecular genetic data. Photodynamic therapy (PDT) is a method with pathogenetic antitumor mechanisms that differ from radiation therapy and chemotherapy and allows to increase the radicalness of the surgical intervention.

PURPOSE  OF  THE   STUDY.  demonstrate the possibilities of photodynamic therapy of malignant glial tumors using chlorin e6.

MATERIALS AND METHODS .  A total of 161 patients with a glial tumor of supratentorial localization, a high degree of tumor anaplasia according to Grade (III–IV), who were treated at the N.N. prof. A.  L.  Polenov. 80 — study group (with photodynamic therapy), 81 — control group (without photodynamic therapy).

RESULTS .  The use of photodynamic therapy as part of the complex therapy of gliomas of the brain can increase the median survival of patients with Grade III gliomas up to 40.4±7.4 months (control group — 23.4±3.9 months), for patients with Grade  IV gliomas up to 21.3±5.1 months (control group — 13.7±3.7 months) (p=0.0003); and the value of the relapse-free period for patients with Grade  III gliomas up to — 22.5±3.79 months (control group — 16.1±3.22 months) (p=0.0002); for patients with Grade IV gliomas up to — 11.4±2.49 months (control group — 8.2±2.13 months) (p=0.0001).

CONCLUSION.  PDT can be considered a safe and effective method to increase the radicalness of the operation and improve long-term results of treatment in patients with malignant gliomas.

The incidence of sciatic nerve (SN) damage after a total hip replacement (THR) is as high as 10 percent. The diagnosis of SN post-surgery neuropathy in patients after THR is a challenging issue as the damage to this nerve can lead to the significant impairment of the extremity function and persistent disability even if the repair and recovery of the osseous structure surgeries were successful. This research had the evaluation of dynamics in clinical indicants and electrophysiological patterns in patients with primary idiopathic coxarthrosis aimed at early detection of post-surgery SN neuropathy after THR as its objective.

 MATERIAL  AND  METHODS .  The  research  involved  71  patients  aged  45  to  68  y. o.  with  primary  idiopathic coxarthrosis who had undergone THR in the Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery in 2019–2020. We examined all patients (n=71) with clinical methods, studied their neurologic status (VAS, muscle strength and sensitivity), and performed ENMG before their surgeries and 14 days after them to diagnose the syndrome of SN post-surgery damage as early as possible.

RESULTS . Post-surgery SN neuropathy was found in all patients (n=71). 55 individuals had sensitivity disorders only and ENMG findings revealed a slight decrease in the amplitude of peroneal and tibial nerves m-responses as compared to their pre-surgery indicants. In 16 individuals who underwent their extremities’ lengthening in more than 3 cm, we observed movement and sensitivity disorders. EN mG findings featured a significant decrease in the amplitude of peroneal and tibial nerves m-responses as compared to their pre-surgery indicants.

CONCLUSION. THR surgery involves a high risk of traction and entrapment changes in SN leading to the progressing of post-surgery neuropathy most evident in patients who underwent their lower extremities’ lengthening in more than 3 cm.

A clinical case of surgical treatment of intracranial hypertension in a child with trisomy 8 is described. The clinical dynamics and the sequence of operations are presented. A diagnostic algorithm is shown when the clinical picture does not match the primary cytogenetic data. The presented case is important as a precedent for successful neurosurgical treatment of a patient with a mosaic mutation.

Epileptic seizures caused by neoplasms of brain and its meninges play a significant role among other types of structural epilepsy. The algorithms of using different neurophysiological monitoring tools in the patients operated for neoplasms associated with structural epilepsy, are poorly determined so far. The present study is aimed for evaluation of our experience with applications of neurophysiological examination tools in structural epilepsy in the patients with neuro-oncological disorders subjected to surgical treatment at A. L. Polenov Neurosurgical Institute.

PURPOSE: to evaluate experience of neurophysiological support during surgery treatment of structural epilepsy aiming for increased efficiency of surgical treatment of this disorder.

MATERIALS AND METHODS. We have examined 241 patients 18 to 75 years old, subjected to neurosurgical treatment due to malignancies of brain and meninges associated with symptoms of structural epilepsy over 2018–2021.

RESULTS. The study has shown a need for polymodal neurophysiological monitoring in cases of proven epileptogenic foci. Electroencephalography and electrocorticography are used when epileptogenic focus is located beyond functionally significant areas (performed in 38.4 % of intracerebral neoplasias, and in 76.7 % of convexital meningiomas). Meanwhile, motor cortical mapping is required if the focus is located within functionally significant areas (for 61.6 % of the patients with brain neoplasias, and 23.3 %, with convexital meningioma). We have also shown that, in terms of removing epileptogenic focus, intraoperational electrocorticography proved to be as sensitive as 61 %, thus two-fold exceeding diagnostic sensitivity of electroencephalography performed during the surgical invasion.

Aqueductal stenosis is the most common form of obstructive hydrocephalus. About 75 % of cases the cause of occlusion is unknown. Endoscopic third ventriculostomy is a highly effective minimally invasive surgical technique. In practice, the assessment of the effectiveness of the surgery performed often causes difficulties due to the discrepancy between dynamics of the clinical symptoms and radiological picture.

PURPOSE OF THE STUDY: to assess the clinical and radiological results of treatment of patients with idiopathic obstruction of the aqueduct of cerebri and to identify the relationship between the dynamics of neurological symptoms and changes of radiological characteristics in the postoperative period.

MATERIALS AND METHODS. From October 2011 to March 2021 at the Burdenko neurosurgical Institute 290 patients were operated. They met the criteria for adult idiopathic hydrocephalus: the onset of symptoms in adulthood and no indications for the etiology of hydrocephalus, as well as congenital hydrocephalus. In 113 (40 %) cases aqueductal stesosis was identify. The age of patients ranged from 18 to 77 years, averaged 42 + 16.7 years, there were slightly more men (50.5 %). The main symptoms of the disease were headaches (76 %), gait disturbance (64 %), memory loss (56 %), dizziness (33 %), urinary incontinence (33 %) and nausea (22 %). The condition of patients before surgery was evaluated by the Kiefer and Rankin scales and amounted to 6.43 + 3.2 (0–19) points and 2.26 + 0.88 (0–5) points, respectively. Brain MRI of all patients was analyzed for the size of the cerebral ventricles, the condition of the cerebral aqueduct, convexital and basal cerebrospinal fluid spaces, periventricular edema, the size of the sella turcica and the position of the cerebellar tonsils.

RESULTS . The ventral dislocation of the premamillary membrane, compression of the convexital subarachnoid spaces, and hyperintensive periventricular signal are significantly associated with a more severe condition of patients (p < 0.05). In 88.5 % cases endoscopic triventriculostomy was performed, other 11.5 % cases — ventriculoperitoneal shunting. In 70 % of patients after endoscopic surgery the symptoms completely regressed, in 25 % cases a significant improvement in the condition was noted. The average meaning of the Kiefer and Rankin scales after surgery was 0.96 + 1.82 (0–13) and 0.52 + 0.76 (0–4) points, respectively. After shunt-surgery 50 % patients had a complete regression of symptoms and 50 % had a significant improvement in their condition. Approximately 60 % of cases after surgery had a decrease in the size of the ventricles of the brain. The improvement in the condition of patients was significantly associated with a decrease in the size of the ventricles, an increase of the convexital subarachnoid spaces, and normal position of the premamillary membrane (p < 0.05). Reposition of the cerebellar tonsils into the cranial cavity occurred in 62.5% of patients.

CONCLUSION . Decrease of the size of the ventricles after surgery significantly associated with an improvement of the condition of the patients, but is not observed in all cases. The elimination of the pressure gradient and an increase of convexital subarachnoid spaces are the most important factors for the patients. Each of them individually and collectively leads to a regression of the symptoms of hydrocephalus.

Low flow EC–IC bypass is the operation of reserve, which can approve recovery for patients with occlusion of ICA and failure of endovascular revascularization methods in acute phase of ischemic insult.

THE PURPOSE OF THE STUDY was improvement of treatment results of patients with ICA occlusion and acute ischemic insult with help of early EC–IC bypass between external temporal artery and M4 brunches.

MATERIALS AND METHODS. 8 patients (7 man and 1 women) 55–75 years age, were treated with EC–IC bypass in first 5–14 days of acute ischemic insult. Doppler M1 flow assessment, ASPECTS score, penumbra zone changes, NIHSS and mRS scores were compared before and 1 month after surgery.

RESULTS. All anastomoses were parent. In 2 cases 10 % enlargement of ischemic area were seen the next day after surgery without neurological worsening. One patient with wide penumbra zone have shown malignant hemisphere ischemia at the third day after surgery, and required emergent hemisphere decompression. In other case, the new ischemic areas were seen in the basal ganglia and contralateral hemisphere after the acute myocardial infarction onset at the second postoperation day. One acute subdural hematoma emergent evacuation was performed in one case. The M1 flow was normalized at the 14 day after operation in 75 % of patients. Two deaths were registered because of somatic pathology progression. 5 patients were released from the hospital with slight improvement up to 6–7 points in NIHSS score. mRS were 1–2 points in 5 cases, and 4 points in one.

CONCLUSION. Early EC–IC bypass in acute ischemic insult doesn’t lead to quickly neurological recovery of patient. Low-flow EC–IC bypass with M4 brunches is the additional source of collateral blood flow, and gives no meaningful protection of cerebral parenchyma in case of cerebral perfusion pressure drop during acute ischemic insult.

Achievements in medical genomics have allowed to propose conceptually new approaches towards understanding mechanisms for brain diseases. The applications of genome medicine technologies provide new opportunities for identification of genetic causes of epilepsy. Uncovering molecular and cellular processes leading to epileptic disorders has underlain a new biomedical direction, genomic epileptology. Currently, genomic epileptology is an actual and promising area of molecular medicine. Discoveries in this area would be useful for developing science-based therapy and rehabilitation of this devastating disease.

During the last two decades, it has been demonstrated that genomic pathology manifesting as chromosome and gene mutations as well as genomic and chromosomal instability affects directly the brain. These forms of tissular mosaicism (mosaicism confined to the brain) may cause the wide spectrum of central nervous system (CNS) diseases. To use the results of such studies for developing science-based therapy and neurorehabilitation of severe brain diseases, there is a need for acquiring knowledge about causes and consequences of genomic variations in CNS cells. The most promising methods in this context are system analyses of genomic instability. Uncovering candidate processes for brain diseases and tissue-specific susceptibility to genome instability, these methods give opportunity for molecular therapy and science-based neurorehabilitation.

  Arteriovenous malformation is a fairly common malformation of the cerebral vessels — an average of 1 in 100,000. One of the most dangerous complications is hemorrhage, which can be fatal. One of the most important tasks of health care is to improve the provision of medical care, including rehabilitation, to reduce the disability of patients and the associated economic losses. The early start of rehabilitation increases the level of rehabilitation potential and rehabilitation prognosis. The article presents a clinical case of patient A., born in 2011, who receives staged rehabilitation starting from the second day after hemorrhage (december 2019). At each stage, the multidisciplinary team ( MDB) developed rehabilitation goals, in accordance with which a rehabilitation plan was built. The MDB included: resuscitator, neurosurgeon, neurologist, rehabilitation doctors, ophthalmologist, orthopedist, speech therapist, occupational therapist, massage therapist, physical therapy instructor. As a result of teamwork, all the short-term and long-term goals were achieved. To date, the result of the work of the  MDB is that all the lost skills (speech, self-service skills, walking) have returned to the child, and they are preparing to return to school next year.

Intraneural ganglion (IG) is a rare and poorly studied benign mucinous lesion within peripheral nerves in pediatric practice. We described a clinical case of IG of the peroneal nerve in a 16-year-old teenager. The most reliable instrumental method for diagnosing of IG is  MRI. The best treatment result is provided by microsurgical removal of the IG with the identification and excision of the articular branch of the nerve.

RELEVANCE. Mixed neuronal-glial tumors (NGTs) are rare tumors of the central nervous system that consist of both neuronal and glial components. The surgical treatment of NGTs is primarily focused on the epileptic nature of the disease. In routine oncological operations, the degree of tumor resection is determined by minimizing the likelihood of recurrence. The optimal tactics of surgical treatment should take into account not only the epileptogenic nature of the disease, but also the oncological aspect — the likelihood of recurrence and malignant transformation. Nevertheless, at present, the question of the tactics of surgical treatment of NGTs is still open, the basic principles of choosing one or another method of surgical treatment have not been fully formulated. Over the past decade, isolated studies have been published in the literature devoted to a systematic review of the surgical treatment of the brain NGTs. most of these works are devoted to the treatment of such tumors mainly in children. There are no publications in the Russian literature devoted to the surgical treatment of NGTs in adults. This prompted us to write this literature review.

CONCLUSION.  despite the lack of a clear surgical strategy, the first stages of consensus have emerged that defines a differentiated approach to the surgical treatment of cerebral NGTs.