INTRODUCTION. Radial nerve injuries are often accompanied by a primary or secondary separation between the central and peripheral ends, significantly complicating the process of bridging the diastasis using a classic end-to-end suture. Based on numerous publications reviewed, effective techniques for diastasis repair have been identified, but a perfect algorithm has not yet been described. Therefore, resolving the problem of radial nerve diastasis repair is an important task, particularly relevant for extended and multiple defects of the nerve trunk.

AIM. Optimization of the results of reconstructive interventions on the radial nerve depending on the location of its damage.

MATERIALS AND METHODS. An analysis of surgical treatment outcomes was conducted for 37 patients with complete disruption of the anatomical integrity of the radial nerve. Within the study group, patients were ranked according to a number of criteria. Surgical outcomes were assessed based on the topographic and anatomical location of the radial nerve injury and the severity of the diastasis between the ends of the nerve trunk.

RESULTS. It has been established that each of the anatomical and topographic zones of the radial nerve has its own characteristics, which significantly influence the choice of method for overcoming diastasis.

INTRODUCTION. In the last decade, a new direction in minimally invasive neurosurgery has emerged – transorbital neuroendoscopic surgery (TONES).

AIM. Study of the anatomical and surgical parameters of the lateral transtialial transorbital approach and the results of its use.

MATERIALS AND METHODS. Modeling of the lateral transciliary transorbital approach was performed on 9 frozen specimens of the human head on both sides, with an assessment of its anatomic-surgical characteristics at various stages. Three patients were operated on using this approach.

RESULTS. According to the study, the angle of attack at the intracranial stage, compared to the intraorbital stage, is significantly reduced from 16–25°, comfortable for surgical manipulations, to the minimum possible for work, 5–10°. The area of surgical exposure is also reduced by more than 2 times.

CONCLUSION. The lateral transorbital approach provides conditions adequate in terms of anatomical and surgical parameters for performing surgical manipulations within the orbit, its superior and lateral walls and adjacent parts of the dura mater.

INTRODUCTION. Cerebral arteriovenous malformations (AVMs) are a relatively rare vascular pathology that has an extremely negative impact not only on patients’ quality of life but also carries a high risk of severe disability and death in the event of rupture. In recent years, the treatment of these malformations has increasingly focused on intravascular approaches, including as a sole method of therapy for total embolization of the pathological vascular tangle forming the malformation using non-adhesive composites. However, the clinical outcomes and effectiveness of this method are not always satisfactory and remain a subject of debate. Further study is required to identify risk factors and methods for reducing the incidence of intraand postoperative complications.

AIM. To evaluate the incidence and pattern of focal neurological deficits in the immediate postoperative period, as well as functional outcomes (mRS) in patients following total embolization of cerebral AVMs using non-adhesive composites.

MATERIALS AND METHODS. A retrospective analysis of treatment outcomes in 48 patients who underwent total AVM embolization with non-adhesive composites (2023–2025). Preand postoperative neurological status, postoperative neuroimaging data (CT, MRI), and functional status (mRS) before surgery and at hospital discharge were assessed.

RESULTS. In the early postoperative period, worsening focal neurological symptoms was observed in 45.8 % of patients, with neuroimaging data revealing foci of acute cerebral ischemia in 72.7 % of these cases. A functionally favorable outcome (mRS≤2) was achieved in 79.2 % of patients, demonstrating the potential of this method when the intervention technique is optimized.

CONCLUSION. Ischemic brain damage is one of the main causes of neurological deficit after total AVM embolization with non-adhesive composites. Despite the high incidence of focal symptom worsening, a functionally favorable outcome is achievable in most patients with optimized embolization technique and postoperative management.

INTRODUCTION. The proportion of patients with glioblastoma who reach the three-year survival threshold is estimated to be 7–8 %. The factors that influence the prognosis of this disease remain a subject of research.

MATERIALS AND METHODS. We studied the data of 91 patients with glioblastoma aged between 32 and 75 who underwent surgery between 2009 and 2020. The diagnosis was made according to the 2021 WHO Classification of Tumors of the Central Nervous System. The analysis included the volume of surgical intervention performed, the patient’s functional status according to the Karnovsky scale, the location of the tumor, the use of RT and/or CT, and their effectiveness, as well as data from a molecular genetic study.

RESULTS. According to the study, 23.1 % of patients with glioblastoma (n=21) lived for more than three years. Significant factors that improve survival include: young age (p=0.000010), the number of neurosurgical interventions (p=0.0001), combination therapy with LT+TMZ in the first line (p=0.04), more than 6 cycles of TMZ (p=0.00106), positive response to treatment in the first (p=0.00010) and the second line (p=0.0089), as well as the use of the second LT line (p=0.0000). It has been separately confirmed that low β-tubulin expression increases overall survival when used in the first line of the LT+ TMZ regimen (p=0.001).

CONCLUSION. Thus, in our study, long-term survival of patients was primarily associated with young age, adjuvant treatment, low β-tubulin expression from the first surgery, and the number of surgical interventions performed.

INTRODUCTION. This article addresses the treatment of aneurysms of the cavernous segment of the internal carotid artery (ICA) using flow-diverting stents. Among all methods of excluding such aneurysms from circulation, implantation of flow-diverting stents represents the most adequate approach in terms of efficacy and patient safety.

AIM. To evaluate the efficacy and safety of endovascular treatment of ICA cavernous segment aneurysms via flow-diverting stent implantation.

MATERIALS AND METHODS. Efficacy of stent implantation was assessed through a single-center retrospective cohort study and analysis of domestic and international literature on this topic. A retrospective analysis was conducted of 40 cases treated between 2018 and 2025 in adult patients (mean age: (58.2±11.3) years). The completeness of aneurysm occlusion was evaluated using the Cekirge-Saatci and O’Kelly – Marotta radiological outcome scales, recurrence rates, complication frequency, and changes in patients’ neurological status.

RESULTS. Complete exclusion of the aneurysm from circulation was achieved in 95% of cases during early postoperative assessment (n=38), in 92.3 % of cases at 6–12 months postoperatively (n=24), and in 100% of cases at 12–48 months (n=17). A positive neurological outcome was observed in 70 % of patients. Reactive vascular wall proliferation was detected in 12 % of patients.

CONCLUSION. Implantation of flow-diverting stents demonstrates high efficacy in treating aneurysms of the cavernous segment of the ICA. The method is highly safe, enables rapid return to normal activity in the early postoperative period, and is associated with a low rate of complications. The findings confirm the efficacy and safety of flow-diverting stent implantation for the treatment of aneurysms of the cavernous segment of the ICA.

INTRODUCTION. Decompressive craniectomy is widely used as a tool for controlling intracranial hypertension. According to the literature, DC is accompanied by some complications that may require surgical treatment. There is different opinions of the etiology and frequency of complications among authors. It is important to define the complications of the early postoperative course and clarify the possibilities of their control.

AIM. To identify the frequency of complications in the early postoperative period and risk factors for their development in children with severe TBI after DC.

MATERIALS AND METHODS. The study included 83 children with severe TBI who underwent decompressive craniectomy. The ICP sensor was installed in 69 (75 %) patients. The analysis of the study included: gender, age, GSC at the time of injury and upon admission, ICP value at the time of surgery, pupil condition, combined injury severity scale (ISS), neuroimaging data. The following complications were considered: Intracranial hemorrhages, infectious of central nervous system, failure of postoperative sutures, wound CSF.

RESULTS. Secondary hemorrhages in 35 % (n=29) patients, infectious complications in 9 % (n=7), failure of postoperative sutures in 8 % (n=6), wound CSF in 5 % (n=4) patients.

CONCLUSION. The incidence of early postoperative complications in children after DC is 39.8 %, the evolution of hemorrhagic contusion dominates. The development of infectious complications is highly correlated with wound CSF. The risk of early postoperative complications in children is primarily associated with high ICP values and its duration.

INTRODUCTION. The classification of mechanical brain injury (MBI) includes a division by type of injury (closed/open, penetrating/non-penetrating), by the nature of brain damage (concussion, contusion, diffuse axonal injury, compression), by severity (mild, moderate, severe), and by biomechanics (impact-counterimpact, acceleration-deceleration, combined), as well as by the periods of the course (acute, intermediate, remote). The classification emphasizes the sequence of development and interaction of pathological processes that unfold after brain injury.

MATERIALS AND METHODS. Verification of the pathological process allows for the selection of a treatment protocol in the shortest possible time, which undoubtedly increases the survival rate of patients. Diagnostic methods that accurately perform this function are of particular importance. These methods include CT (computed tomography), MRI (magnetic resonance imaging), and fine-needle biopsy of the pathological lesion through a single drill hole in the cranial vault, which allows for a reliable morphological conclusion. Cytological and histological methods were used in the study of 47 biopsies obtained during diagnostic operations on the brain. 19 preparations obtained from stereotactic biopsies and 28 preparations obtained from open brain surgeries were studied. The preparations were examined using histological and cytological methods. Standard preparation techniques were used for histological examination.

RESULTS. In patients with severe brain concussions (commotions), circulatory disorders are the main feature of the pathoanatomical picture. Five stereotactic biopsies (performed on the first day) revealed vascular spasms, moderate venous congestion, and pericellular and perivascular edema of the brain and meninges. Twelve hours after the injury (seven cases), diapedetic hemorrhages resembling petechiae were observed in the brain biopsy samples. Petechial hemorrhages resulting from the rupture of small vessels. The petechiae were located in the white matter. In two cases, they were located in the subependymal layer of the walls of the Sylvian aqueduct and the bottom of the fourth ventricle. On the second day (3 cases), as a result of the clinical manifestations of increasing brain edema (CT and MRI did not reveal significant changes), changes in the nerve cells of a dystrophic nature were observed. In one case, there was vacuolization and fragmentation, accompanied by tyroglyosis and a retrograde pattern. When drawing parallels between the clinical course of concussion and diagnostic methods, the most accurate results were obtained from the performed biopsy study. In 11 cases, the patients’ condition was considered to be of moderate severity (CT and MRI were performed), however, after the biopsy study, in 7 cases, the severity was changed to severe, which accounted for 64.7 %. Contusion foci on macroscopic examination were foci of hemorrhagic softening or spots of hemorrhagic imbibition. In fresh cases (up to 5 cases per day), they were dark red in color. In two cases, there was a rupture of the meninges with the bulging of brain detritus. Two patients died 2 weeks after the injury. On section, the contusion foci had a cup-shaped appearance. There was a zone of necrosis (direct destruction) and a border zone (zone of secondary disintegration). The compression syndrome occurred on the third day. There was a complex morphological pattern.

CONCLUSION. Morphological diagnosis of brain injury is an important step in verifying the severity of the process. Clinical symptoms of brain damage do not always correspond to the severity of the injury and the results of CT and MRI scans, which can lead to underestimation of the patient’s condition and unpredictable complications. More than half of the errors are related to the diagnosis of the severity of concussion, which is often based solely on clinical symptoms. In complex clinical cases, we recommend performing a stereotactic biopsy as the most accurate diagnostic method.

Stabilizing procedures in lumbar spine surgery have a long history of development. Since the first application of interbody fusion in 1911 by Hibbs, various approaches to stabilizing a motion segment have been developed, including posterior (PLIF), anterior (ALIF), lateral (LLIF), transforaminal (TLIF), and oblique lateral (OLIF) interbody fusion. Although no studies to date have unequivocally demonstrated the superiority of any single technique, the choice of surgical strategy often depends on the surgeon’s preferences and patient-specific factors. TLIF has traditionally been performed with bilateral pedicle screw fixation, but unilateral pedicle fixation is increasingly considered to minimize soft-tissue trauma and reduce costs. Despite data suggesting comparable effectiveness of these two methods, their respective advantages remain a matter of debate.

Aim – to evaluate the outcomes of transforaminal interbody fusion with unilateral pedicle screw instrumentation (UL-TLIF) and to compare it with bilateral pedicle screw fixation (BL-TLIF) based on the published literature.

The purpose of this work was to summarize and systematize data on the diagnosis and treatment of dissecting aneurysms of the vertebrobasilar basin. A brief review of both modern and fundamental works on this problem was conducted using the keywords “dissecting aneurysm”, “dissection” and “vertebrobasilar basin”. The analysis of the obtained data indicates that there are still unresolved issues related to the complexity of diagnosing and selecting a treatment method for this pathology. Studying and understanding the anatomical and pathophysiological features of this disease can improve the treatment outcomes for this patient cohort.

Cerebral arteriovenous malformations (AVMs) are rare developmental anomalies of the intracranial vasculature that are prone to rupture and whose pathophysiology remains poorly understood. MicroRNAs (miRNAs) are noncoding RNA chains consisting of approximately 20 nucleotides that can modulate the expression of target genes by fully or partially binding to their corresponding complementary sequences. Numerous recent advances have been made in elucidating their contribution to the occurrence, growth, and evolution of cerebral AVMs; however, numerous gaps remain in our understanding of the mechanisms involved.

We searched Medline (PubMed;) for relevant articles on miRNAs and their putative role in AVMs. Seven microRNAs were identified that play a role in the existence of AVMs, three of which were downregulated (miR-18a, miR-137, and miR-195*) and four were upregulated (miR-7-5p, miR-199a-5p, miR-200b-3p, and let-7b-3p).

The conducted search and analysis of publications devoted to the role of microRNAs in the occurrence, functioning, and variability of cerebral AVMs is intended to highlight potential directions for future research and possible biological treatments.