Objective. To determine the frequency and timing of cerebral vasospasm (CV) at patients with different clinical forms of severe TBI and assessment of its impact on patient outcomes. Materials and methods. The study included 43 patients with isolated and combined sTBI and depression level of consciousness to 8 or less points on the Glasgow Coma Scale (GCS) at admission. The average age of the patients was 32,4 ± 10,8 years, 36 of them were men,7 - women. The duplex scanning with the measurement of blood flow velocity, Lindegaard index, pulsatility index, ratio overshoot was performed at all patients daily for 11 days starting with the 2d day after admission. Results. The CV was not developed at 10 patients (23%) and was observed at 33 (77%) patients. The moderate spasm was seen at 16 patients (48%, 17 (52%) - pronounced vasospasm. The development of moderate CV observed mainly at the 4-5th day from the date of injury. Four patients (25%) had unilateral spasm, 12 (75%) - two-sided vasospasm. The more expressed CV occurred at most affected persons within the first 3 days after injury, two patients(12%) had unilateral spasm, 15 (88%) patients - two-sided vasospasm. The duration of the CV in all affected persons exceeded 11 days. Conclusions. The incidence of cerebral vasospasm at patients with severe traumatic brain injury is 77%. The moderate CV occurs mainly in 4-5 days and reaches its peak on the 6th day after the injury. The expressed CV develops in the first 3 days, and reaches its peak at 5-8 days after injury. Dynamics of indicators in Dopplerograms is asymmetrical in nature, a more pronounced CV prevails on the side of significant damage of intracranial structures.

The rigid fusion of vertebral column leads to pathological redistribution of loads on the spine and to development of adjacent level syndrome. The dynamic implants, which allow saving the mobility in operated spinal motion segment, are placed to prevent the development of such complication. Objective: to estimate the surgical treatment outcomes at patients with degenerative-dystrophic diseases of cervical and lumbar spine who underwent the placement of dynamic implants. Materials and methods: We operated 70 patients suffered from degenerative-dystrophic spinal diseases, who underwent the placement of various dynamic implants («DCI», «Endocarbon” and “M6” in the cervical level; «Coflex», «DIAM», «Interspinal U», «Cosmic-mia» and «Legacy» at the lumbar level) from 2008 till 2013 in Scientific Research Institute of Emergency Care n.a. N.V. Sklifosovskiy. Results: all implants in lumbar spine remained dynamic in delayed postoperative period, but not all implants at the cervical level continued to play their dynamic role partly because of developing of spondylodesis in case of new bone tissue formation in dynamic cages.

Objective: to estimate the effectiveness of rehabilitation in early postoperative period and to reveal the predictors for favorable outcome using integral assessment at patients underwent surgical removal of cervical intramedullar tumors (IMT). Material and methods: We examined and operated 20 patients suffered from cervical IMT with the following rehabilitation course. The integral examination included the neurological assessment, cervical MRI with contrast before and in 6 months after operation, somatosensory evoked potentials (SSEP) as well as transcranial magnetic stimulation (TMS) before operation, after surgical treatment and after rehabilitation course. All operations were conducted under neurophysiological monitoring. All patients were divided into 2 groups to reveal the predictors of favorable outcome: 14 patients with improving of functional status, 6 patients - with no changes or worsening of functional status. The rehabilitation course was prescribed individually taking into account the degree of neurological deficit and estimation by McCormick (MC) functional scale. Results. The differentiated rehabilitation algorithm which effectiveness is based on estimation of neurophysiological measurements was developed. The neurophysiological predictors of favorable clinical outcome based data of neurophysiological monitoring are the follows: the presence of М - answer at the end of operation, the improvement of latency criteria of N20 cortical response according to the data of SSEP which correlates with the improvement of deep sensibility, while the decrease of threshold of evoked motor response according to TMS data reflects the regress of movement deficit. Conclusion. The favorable surgical outcome was observed at patients with functional status I-III according to MC functional scale (mild and moderate neurological deficit). The rehabilitation in early postoperative period leads to maximally rapid adaptation of patients as well as to maximal improvement of motor and sensitive functions to the moment of patients’ discharge.

Objective: to examine the dynamics of spectral and coherent parameters of EEG at patients with brain edema in acute period of ischemic stroke. Material and methods. The analysis of EEG with calculation of interhemispheric coherence parameters in suffered and intact hemispheres at patients with acute ischemic stroke complicated by brain edema was conducted. The 2 groups of patients were determined: patients with favorable and unfavorable course of disease (the dynamics more than 2 scores by NIHS scale). Results. The unfavorable prognostic sign of ischemic strike course is the decrease of interhemispheric coherence parameters in intact cerebral hemisphere in peracute period of disease. The significant compensative increase of interhemispheric correlations in the most regions of intact hemisphere in acute period of ischemic stroke was indicative for patients with unfavorable course of disease (by NIHS scale). The increase of interhemispheric coherence parameters in fronto-temporal and central frontal areas of clinically intact hemisphere during all time of acute period of ischemic stroke in our opinion has the favorable prognostic value for recovery of impaired functions first of all movement disturbances at patients of this group. Conclusion. The estimation of interhemispheric coherence parameters in suffered and intact hemispheres at patients in acute period of ischemic stroke allows predicting the disease outcome.

Objective. To analyze the efficacy of routine puncture aspiration in surgical treatment of putamenal hemorrhages Material and methods. The retrospective analysis of surgical treatment outcomes at 27 patients with putamenal hemorrhages was conducted. All patients underwent routine aspiration of intracerebral hematoma using universal technique. The operations were conducted under local anesthesia. The mean age of patients was 55 (37-70) years old, 22 were men, women - 5. The mean value of preoperative level of consciousness was 13 (10-15) scores according to GCS. The mean preoperative value of hemiparesis was 1,4 (0-2) scores. The preoperative volume of hematoma was 47 (25-80) ml, the average value of brain shift was 6,1 (3-12) mm. All patients were divided into 3 groups according to time of operation: 1st group (n=6) - operation was performed during first 2 days of disease, 2d group (n=16) - 3-7th days of disease, 3d group (n=5) - 8th day of disease and more. The estimation of treatment outcomes in relation to side of hematoma was conducted as well as the estimation of functional outcome. Results. Lethality was 44% (12 patients died). Lethality was 67% among patients with hematoma in left hemisphere and 17% - at patients with hematoma in right hemisphere. The mean value of hemiparesis at survived patients was 2,1 (0-3) scores at discharge. The mean percentage of evacuated hematoma during operation at patients of various groups was the follow: 1st group - 64% of initial volume of hematoma, 2d group - 53%, 3d group - 77%. The accuracy of reaching the center of hematoma was 74%. The development of severe perifocal edema without hematoma relapse but with repeated development of expressed brain shift was observed at 3 patients in spite of regress of brain shift in early postoperative period and small residual volume of hematoma on 3-4th days after operation. One patient suffered from relapse of hematoma on the 2d day after operation. Conclusion. The routine aspiration was the effective method for removal of putamenal hematoma in conducted study. The usage of such technique allowed achieving the rapid regress of brain shift and partial regress of neurological deficit at majority of patients.

Objective. To create a model of cerebral angiospasm (CA) due to non-traumatic subarachnoid hemorrhage (SAH) at laboratory white rat using human blood and to study the effects of forteplase (recombinant staphylokinase fibrinolytic) Materials and methods. The study was performed on 13 laboratory white rat weighing 180-220 g. Autologous venous and human venous blood was injected in cistern magna twice. The neurological assessment of the animals was performed daily. The rat brain for morphological study was taken at 5th day. The microscopy assessment was done at the level of the upper third of the basilar artery using special histochemical stains (by Gram-Weigert, by Lie). The slide description was performed using light microscope Leica DM 1000 with an increase of 400-1000 times, the photomicrography was performed using digital camera Leica EC 3. The intravenous injection of forteplase was used for studying effects on rat fibrinolytic system Results. The direct qualitative features of cerebral vasospasm (smooth muscle cells (SMC) proliferation, SMC cytoplasm vacuolization, internal elastic membrane wrinkling, hypercontractive changes of smooth muscle cells, capillary blood flow violations in the level of the slides) were identified in all animals without any difference between autologous venous and human venous blood groups. There was no evidence of forteplase effect on rat fibrinolytic system. Conclusion. The proposed model of human venous blood injection in cisterna magna of the rat demonstrates CF due to non-traumatic SAH. Rat fibrinolytic system is insusceptible to forteplase.

Some number of cerebral aneurysms (CA) (up to 19,6%) are supposed to be «complex» aneurysms because of such key features as anatomy of CA (wide neck, large or giant size, calcinated walls, arising of arteries from aneurismal dome, thrombosis of aneurysm), difficult accessibility of CA for microsurgical treatment, severity of patient’s state (Hunt & Hess > 3, presence of cerebral angiospasm). Complex CA could not be treated using only one method (routine neurosurgical approaches for CA clipping or endovascular treatment). The analysis of 87 literature resources dedicating to this topic was conducted. The usage of endovascular method alone for complex CA treatment results in high level of incomplete aneurysm occlusion (25-62%), recanalisation (8-60%) and repeated treatment (5-38%). The usage of routine neurosurgical approaches for complex CA clipping is accompanied by patients’ invalidization and lethality. The one of current strategies for complex CA surgery includes combined treatment - the combination of endovascular and microsurgical occlusion of CA. The skull base approaches are used for microsurgical treatment of complex CA (clipping, step-by-step modeling of aneurismal neck during combined treatment, revascularization surgery) providing the satisfactory visibility of aneurismal neck for its clipping.

This article discuses the Russian classification of traumatic injuries in the context of terminology unity. The literature review was conducted which enlights the key definitions according to authors of various medical schools. The aim of our review is to arrange the terms and definitions of trauma classifications, that is important both in scientific researches for conducting statistic and epidemiological studies and in routine practice for diagnosis statement. The reasonability of preservation of Russian (Soviet) classification of mechanical traumas, suggested by Kaplan A.B. and approved by III All-Soviet Union conference of traumatologists and orthopaedists in 1975, is substantiated.

The knowing of skull base triangles topography is necessary for performing of transcavernous approaches to difficult accessible segments of internal carotid artery (ICA) and to apex of basilar artery (BA) as well as for removal of cavernous sinus tumors or skull base tumors with spreading into cavernous sinus and also for proximal control and performing the intra-intracranial bypasses between loops and segments of ICA during revascularization surgery. The topography and anatomy of triangles of cavernous sinus roof (oculomotor triangle, carotid Umansky triangle, medial Hakuba triangle, clinoid Dolenc triangle) as well as the triangles of lateral cavernous sinus wall (Parkinson triangle and superior Fukushima triangle) are presented. The knowing of these triangles is necessary for performing the modern transcavernous approaches for clipping of basilar apex aneurysms and for transcavernous approaches to meningohypophyseal trunk for treatment of carotid-cavernous fistula.

This article presents the clinical case of surgical treatment of patient with thoracic capillary hemagioma, which was localized only in epidural space without affecting of bone structures. The compression of spinal cord was predominately presented with signs of posterior columns damage. This clinical case is the first one in Russian literature and appeals for extreme rarity of such localization of hemangioma.

The endoscopic endonasal approaches are applied for various pathological processes across the entire anterior skull base. The olfactory groove meningiomas are the tumors of the anterior skull base which result in significant challenges occurrence during their removal.

This lecture presents the comparison between the dislocation syndrome stages and scores of Coma Glasgow Scale at patients with supratentorial brain compression in the case of severe head injury (HI). The significantly more high probability of dislocation signs increase in dynamics at patients with more expressed stages of dislocation syndrome observed at the moment of initial examination was detected. Some features of treatment strategy at patients with supratentorial brain compression are discussed.

This article presents the historical information dedicated to one of the founders of Russian neurosurgery Vasilii Ivanovich Razumovskii as well as brief reviews about chevaliers of Labor Hero medals among neurosurgeons.

This article presents the analysis of head injury (HI) at mountain skiers as well as the epidemiology, risk factors for HI and methods of traumatism frequency calculation at mountain skiers. The comparison of traumatism at mountain skiers and snowboarders is conducted as well as the methods for security upgrade of sportspeople are discussed.