Background. Surgical treatment of petroclival meningiomas (PCM), especially of giant PCM, remains one of the most difficult problems in neurosurgery and is associated with high risks of postoperative morbidity and mortality.

Aim. to determinate frequency and reversibility of post-operative neurological deficit after giant PCMs resection as well as identify risk factors of this surgery and the resection quality of these tumors.

Materials and methods. The results of surgical treatment of 18 patients underwent 22 operations to resect giant PCMs were retrospectively studied. The neurological status and Karnofsky Performance Scale (KPS) of patients were assessed before surgery, immediately after and 6 months later, as well as neuroimaging characteristics of tumors before and after surgery were studied. We analyzed the influence of various factors on neurological outcomes and the resection quality.

Results. The average PCM volume before surgery was 46.3 ± 25.4 cm3, the average resection volume was 81 ± 16.8 %. The incidence of neurological deficit in the early postoperative period was 63.6 %, mortality was 0 %. The most common complication was injury of cranial nerves (63.6 %). The scores according to Karnofsky Performance Scale (KPS) before surgery (median 80 %) improved 6 months after surgery (median 90 %). The PCMIS after 6 months was on average equal to the preoperative level (8.1 ± 6.3 and 7.5 ± 5.3, respectively). Low Karnofsky Performance Scale status before surgery (<70 %) did not affect the occurrence of postoperative deficit (p = 0.465)

Conclusion. Surgery of giant PCMs is a difficult problem. Subcompensated patients with these tumors are often rejected in surgical treatment, however, our results demonstrate that this surgery leads in most cases to an improvement in the patients’ neurological condition in 6 months after surgery, while using the surgical treatment principles described by us.

Background. Radiofrequency thermocoagulation of the epileptogenic zone via depth stereo electrodes may be an alternative to resective surgery in patients with drug-resistant epilepsy.

Aim. To determine the parameters of radiofrequency thermocoagulation that affect the lesion volume.

Materials and methods. A study was conducted using chicken egg whites. With the help of depth electrodes, lesions of different volumes were produced at different parameters. Data of two patients who underwent stereoelectroencephalography at the N.I. Pirogov National Medical Clinical Center (the size of the focus of destruction and its effect on the course of the disease) are presented as examples of the use of the method in clinical practice.

Results. The largest lesion was created at a power of 3 W for 180 seconds between adjacent contacts of one electrode. Using this technology in clinical practice allowed partial destruction of the epileptogenic zone in one case and complete destruction in the second.

Radiofrequency thermocoagulation allows to achieve seizure freedom or a reduction in their frequency and intensity in patients with drug-resistant epilepsy. The relationships we discovered between the parameters of radiofrequency thermocoagulation and the parameters of the formed lesions are similar to those presented in other works.

Conclusion. The largest lesions are formed as a result of radiofrequency thermocoagulation with lower power and longer exposure. The effectiveness of radiofrequency thermocoagulation as a treatment for epilepsy is influenced by the ratio of the lesion size and the size of the epileptogenic zone.

Background. Brain tumors (BT) are one of the most pressing problems in modern neurosurgery. Surgical treatment of BT is the most successful method. In the early postoperative period, patients have neurological and functional deficits. Lack of walking function reduces the quality of life of patients, independence, and increases the risk of falls. Rehabilitation activities of the multidisciplinary team in the postoperative period are aimed at improving the functioning of the patient.

Aim. To study the functional and clinical components of walking function in patients with a brain tumor in the early postoperative period.

Materials and methods. Ten patients with BT underwent postoperative early rehabilitation. Before and after the operation, after rehabilitation treatment, the diagnosis of walking function was performed using a complex of motion analysis and evaluation according to clinical scales.

Results. An improvement has been achieved on the Bartel and Rivermead clinical scales in the form of independence and independence. Tests responsible for walking safety demonstrated an improvement in performance from a high risk of falling after surgery to safe walking after rehabilitation. Objective diagnosis of walking function showed that the main parameters demonstrate a syndrome complex characteristic of slow walking. A functional phenomenon specific to the examined group was found – excessive muscle activity at a significantly lower walking speed.

Conclusion. Assessment of the pre- and postoperative functional state of patients’ walking is important from the point of view of building a patient’s treatment strategy and selecting an individual medical rehabilitation program. The use of clinical scales and objective diagnostics makes it possible to detect hidden motor deficits. Examination and rehabilitation eliminate the high postoperative risk of falls.

Background. The successful surgical management of spinal stenosis depends on a comprehensive preoperative evaluation, including the assessment of paravertebral muscle health. Despite the pivotal role of these muscles in supporting the spine and facilitating post-surgical recovery, their condition is frequently overlooked in standard pre-surgical assessments. This article underscores the importance of utilizing magnetic resonance imaging (MRI) to evaluate the paravertebral muscles’ integrity before surgery. Proposed methods and data could contribute to better surgical prognoses and elevate the quality of life for patients undergoing surgery for spinal stenosis.

Aim. To study the possibilities of using the index of fat replacement developed by us to evaluate condition of the paravertebral muscles and to analyze its objectivity compared to quantitative calculation of fat fraction in the muscles (M. Gloor et al.) per MRI data, to identify the optimal study level to perform the abovementioned evaluation.

Materials and methods. Data were acquired from 16 patients with symptomatic spinal canal stenosis (average age 43 years, an equal number of men and women) who underwent MRI on a Siemens Magnetom Prisma 3T scanner. Special attention was paid to evaluating the area and fatty infiltration of the paravertebral muscles using a three-dimensional axial T1 gradient echo sequence and the Dixon technique for fat suppression. Images assessment was performed using the InobitecPro software, where the muscles signal intensity and area was measured, and the fat fraction index and fat replacement index were calculated. Statistical analysis was performed using Statistica version 8.0 software, allowing for an objective assessment of the degree of fatty infiltration in the paravertebral muscles in patients with spinal canal stenosis.

Results. Qualitative analysis of images showed consistently visible attachment of fascia to the facet joint at the L₄ level, unlike at L₅ and L₃ levels. Additionally, the varying curvature angles of lumbar lordosis affected the complete inclusion of the spinous process on axial plane at L₅ and L₃ levels, complicating standardized data collection. Histograms constructed to determine the optimal measurement level showed the least variation in the fat replacement index at L₄ among patients. Spearman’s correlation analysis revealed a significant positive relationship (ro = 0.74, p <0.05) between proposed fat replacement index and fat fraction values. Linear graphs for these variables clearly demonstrated that with an increase in muscle fat fraction, the accuracy of the fat replacement index improves, being least precise at lower fat fractions.

Conclusion. The obtained data show potential benefit of including axial T1-weighted images parallel to the inferior endplate of the L4 vertebra and calculation of the proposed index of fat replacement into preoperative MRI protocol. However, to determine the possibility of using the index of fat replacement as a prognostic factor, it must be studied dynamically in a large patient sample.

Background. The infiltrative nature of glioblastoma growth, resistance to treatment lead to its recurrent growth after standard treatment. The first-line chemotherapy has a limited effect, and after 4–8 months, most patients experience recurrent glioblastoma growth in the perifocal zone. Optimization of the penetration of existing drugs and the use of new effective drugs that do not penetrate the blood-brain barrier (BBB) is a relevant issue.

Aim. To determine the possibility of overcoming the restrictive function of the BBB when using laser hyperthermia in order to predict the possibility of glioblastoma treatment with drugs that do not penetrate the BBB.

Materials and methods. The strategy and evidence of opening the BBB in the perifocal zone of coagulation necrosis resulting from laser hyperthermia are presented. After trepanation of the skull, the dye indocyanine green (ICG) was intravenously injected into the rat’s tail vein. An optical fiber of 400 μm was inserted into the avascular area of the cortex to a depth of 2 mm, and interstitial irradiation with a wavelength of 1560 nm was performed for 50 seconds. After laser coagulation of the cortex area, the exit of ICG into the perivascular space of the perifocal zone was observed.

Results. The experiment visually demonstrated an example of extravasation of a large dye molecule, which under normal conditions does not leave the vascular bed. The observed exit of ICG into the perivascular space at the periphery of the coagulation necrosis using a fluorescent camera demonstrates the opening of the BBB.

Conclusion. The combination of cytoreductive surgery and opening of the BBB show synergistic possibilities of laser hyperthermia for chemotherapy. The emerging opportunities for using new drugs in the treatment of glioblastoma in the perifocal zone of the operated tumor are potentially able to increase the therapeutic effect and prolong the lives of patients.

Cavernous hemangioma of the orbit (CHO) is the most common benign vascular malformation in adults. Surgical resection is considered the optimal treatment strategy for CHO with the aim to totally remove the malformation with the best functional and cosmetic results. During CHO resection, different types of approaches are used depending on the size and location of the malformation, specialization and preferences of the surgeon.

The article presents 3 clinical cases of patients with CHO who underwent treatment at the Federal Center of Brain Research and Neurotechnologies of the Federal Medical and Biological Agency (FCBRN of FMBA of Russia). In two cases, the CHO was resected using a modified orbitozygomatic approach, in one case a transnasal endoscopic approach was applied. The choice of surgical approach to orbital neoplasms continues to be a topic of discussion between ophthalmologists, neurosurgeons and maxillofacial surgeons. Surgical treatment of CHO requires additional clinical and anatomical research to systematize surgical techniques, taking into consideration the wide range of approaches, specific anatomy of the orbit, localization of CHO, specialization of the surgeon, and individual characteristics of the patient.

The improvement of methods of noninvasive radiation diagnostics, their wide accessibility to the population of developed countries, has made it indisputable that a recurrent course of aneurysmal brain disease is possible, even in cases of radical surgical treatment. The main causes of the progression of aneurysmal disease are considered to be an increase in the size of residual aneurysms, recurrence and formation of de novo aneurysms.

The article describes the case of successful treatment of a 43-year-old female patient with a recurrent aneurysm of the fork of the middle cerebral artery. The issues of dispensary observation of patients with cerebral aneurysms and surgical tactics in cases of progressive course of aneurysmal disease, which remains the subject of scientific discussions to date, are discussed.

Female patient with a ruptured aneurysm of the middle cerebral artery was admitted in serious condition. Reconstructive clipping was performed using 5 clips. Control angiography revealed a recurrence in the cervical part of a small size. After 5 years of stable angiographic picture, an increase in the cervical part was revealed. Repeated surgical treatment was performed – clipping of a recurrent middle cerebral artery aneurysm. In control cerebral angiography, the aneurysm is not contrasted.

The modern concept of treatment of aneurysmal brain disease involves the most radical shutdown of a ruptured aneurysm and all clinically significant intact aneurysms. Surgical tactics in the progressive course of aneurysmal disease remains controversial, is subjective, takes into account the clinical type of the disease, the method of turning off aneurysms and the surgeon’s experience.

Repeated surgical interventions are indicated with the progression of aneurysmal disease accompanied by hemorrhage, in all cases of “true recurrence”, detection of de novo aneurysms.

The optimal method for disabling recurrent and pseudorecidive aneurysms is intravascular embolization of the aneurysm with microspirals, including using assistive technologies or flow-bending devices. Open surgeries should be considered only as an alternative treatment method, due to the high risk of intraoperative complications during the isolation and clipping of aneurysms previously undergoing surgical treatment. The lack of clear data on the timing of recurrence and growth of existing aneurysms requires the development of modality and frequency of control postoperative angiographic examinations.

Traumatic dissection of the internal carotid artery is often the result of motor vehicle accidents. The growth of intramural hematoma leads to stenosis or occlusion of the vessel, the formation of a dissecting aneurysm. Clinical manifestations of dissection vary from local pain to the development of a transient or persistent neurological deficit. When medical therapy is not effective, surgical or endovascular approaches are indicated.

This article presents a case of successful endovascular treatment of a giant post-traumatic aneurysm of the internal carotid artery. The issues of choosing tactics for managing patients, devices for stenting dissecting aneurysms are discussed.

Objective of this paper is to demonstrate the variants of surgical treatment of ethmoidal dural arteriovenous fistulas (eDAVFs), propose a treatment algorithm for ruptured and unruptured eDAVFs taking into account the literature data. This article presents 4 clinical cases of patients with eDAVFs. The arterial supply of eDAVF was performed by the ethmoidal branches of the ophthalmic artery in all cases. There were 3 ruptured eDAVF with formation of intracranial hematoma and one unruptured eDAVF. Three patients underwent open surgical intervention, one – transvenous eDAVF embolization. Complete exclusion of eDAVF without complications in the postoperative period was confirmed in 3 patients, 1 patient died because of consequences of hemorrhage.

Patients with eDAVF rupture required immediate surgical intervention due to extremely high risk of repeat rupture. The main techniques of eDAVF treatment are open surgical intervention and endovascular embolization. Patients with unruptured eDAVF should be referred to Federal neurosurgical centers for endovascular treatment.

The issues of etiology, pathogenesis, diagnosis and surgical treatment of intradural sequestration of herniated intervertebral discs are poorly reviewed in the world literature. This pathology occurs in 0.26–0.30 % of cases of all intervertebral disc herniations. The basis of pathogenesis is scar-adhesive changes in the spinal canal, leading to dense fusion of the dura mater with the posterior longitudinal ligament and collapse of the ventral epidural space. The main clinical manifestations are long-term pain in the lumbar spine with possible radicular symptoms. There was also a high incidence of acute caudal radicular ischemia (29 % of cases). An important factor in the differential diagnosis of intradural sequestration of intervertebral discs and intradural extramedullar neoplasms are neuroimaging phenomena (hawk-beak sign, Y-sign, ring enhancement) observed on magnetic resonance imaging in the native mode and with intravenous contrast enhancement. The correct preoperative diagnosis and, as a result, competent planning of surgical intervention are the keys to a favorable clinical outcome in this group of patients.

The article describes a clinical case of 55-year-old patient treatment who underwent surgery in 2023 to remove an intradural sequestration of a herniated intervertebral disc at the L₃–L₄ level. An overview of the world literature is also presented, and the features of this pathology important for medical practice are discussed.

The issue of systematizing various forms of damage to peripheral nerves remains controversial topic to this day. The lack of a modern unified classification which includes anatomical, morphofunctional and clinical components is accompanied by difficulties in formulating a diagnosis for physicians of related specialties which subsequently leads to difficulties in resolving expert and regulatory issues. The current working clinical classification of peripheral nerve injuries accepted in our country was developed by Soviet scientists A.N. Solomin (1975), K.A. Grigorovich (1981) and supplemented by prof. F.S. Govenko (2010). Like those developed earlier this classification is not exhaustive and has contradictions in the modern interpretation of the proposed terms. The question of the applicability of this classification in patients with combat trauma remains open which becomes especially relevant in the context of current military conflicts. In this article the authors offer their vision of the modern classification of peripheral nerve injuries based on existing ones in the hope that it will help resolve a number of terminological disagreements.

Morton’s neuroma (the disease code according to the International Classification of Diseases of the 10^th revision – G57.6) is an entrapment syndrome of the interdigital plantar nerve, which manifests as a neuropathic pain syndrome in the forefoot and functional disorders. Morton’s neuroma is the second most common among all tunnel neuropathies, which determines the importance of timely diagnosis and treatment of this disease.

The aim of this work – to increase the awareness of medical specialists about this pathology, a review of domestic and foreign scientific literature is presented, including basic information about it: the history of studying, current data on the prevalence, anatomical and histological characteristics and etiopathogenetic theories of the formation of Morton’s neuroma, the main methods of its diagnosis, treatment (conservative and surgical).

Various neoplasms, injuries, as well as congenital and acquired abnormalities of the craniovertebral region can lead to instability of the craniovertebral junction. Currently, depending on the nosology and surgical treatment plan of the patient, various options for anterior and posterior stabilization of the craniovertebral junction, as well as their combinations, are used. The purpose of our work was to highlight modern methods of stabilization of craniovertebral junction, to identify their advantages and disadvantages.

The expediency of conducting conservative therapy for uncomplicated compression fractures of the thoracic and lumbar spine is one of the most controversial in the scientific medical literature. Domestic protocols for the treatment of spinal cord injury do not provide clear recommendations for the conservative treatment of this category of patients. Foreign protocols consider the possibility of in the case of minor degrees of kyphosis and compression of the vertebral body. Thus, to date, a large number of studies have been published on the use of the method of conservative therapy for uncomplicated fractures of the thoracic and lumbar spine. Summing up all the available data, the main indications for its implementation are compression-comminuted fractures of type A according to the AOSpine classification, with compression of the lumen of the spinal canal less than 50 % and kyphotic deformation less than 30–35°.