Objective. To analyze the variation of clinical features and computer-tomographic dynamics of focal traumatic parenchymal brain lesions (TPBL) in the acute period of mild traumatic brain injury (TBI). Material and method. We observed 78 patients suffered from initially clinically mild TBI (GCS 13-15) and focal parenchymal brain lesions identified by CT at admission. We analyzed the clinical course of the TBI within the first 72 hours after injury in relation to the dynamics of the lesion by CT data. The examination included the repeated brain CTs at admission and within the next 3 days. Results. The worsening of patients’ condition with initially, clinically mild TBI occurred in 21 observations (27%), which was associated with the various manifestations of the TPBL progression. The deepest (up to 7 points on GCS) and fastest, within 8-12 hours after admission, fall in the level of consciousness had observed in six patients who suffered from development of delayed intracerebral hematomas. The dissociation between volumetric changes and clinical features of parenchymal lesions was observed in 24 cases (30,8%),. Conclusion. The critical assessment of “early” CTs at brain injuries with a repeated CT control is required. The small traumatic lesions or even invisible damages on primary CTs can progress and achieve the “surgical” level in a few hours with the sharp clinical deterioration.

Objective: to improve the treatment outcomes in patients with complex aneurysms of internal carotid artery (ICA) and middle cerebral artery (MCA). Material and methods: 18 patients suffered from ICA (n=13) and MCA (n=5) complex aneurysms were operated on with the usage of high-flow extracranial-to-intracranial (EC-IC) high-flow bypass in our Federal Center of Neurosurgery in Novosibirsk during 2013-2014 years. Results: all aneurysms were totally occluded while patency of EC-IC high-flow bypass was confirmed in 17 patients, 1 bypass thrombosed in postoperative period/ No ischemic stroke because of MCA temporary occlusion during anastomosis performance was seen. Conclusion: the usage of high-flow EC-IC bypass allows performing the successfully occlusion of ICA and MCA aneurysms with prevention of blood flow in their blood supplies territories.

Objective: to estimate the influence of surgical intervention on the frequency of postoperative complications occurrence in patients with supratentorial recurrent gliomas . Materials and methods. The retrospective analysis of frequency of postoperative complications in 97 patients with supratentorial gliomas operated initially and repeatedly at the base of the Clinic of Neurosurgery of the Military Medical Academy (1998 - May 2014) was performed. The features of early postoperative period in such patients were studied. The studied group included patients with recurrent gliomas, the control group - patients with primary gliomas. Results. There were no statistically significant differences for complications occurrence in early postoperative period (26,5% in studied group compared with 20,8% in control group (r=0,47)). The general surgical complications were diagnosed in 13,5% of patient after primary surgery and in 22,9% of cases after reoperation, increase of focal neurologic deficit was seen in 25,0% and in 27,7% (r=0,81) consequently. The significant difference concerning the rate of lethality was not detected. The increase of local complications rates and system complications significantly does not differ in both groups, though the tendency to the higher occurrence of extracranial inflammatory complications was observed in group of patients with recurrent gliomas. Conclusions. The occurrence of early postoperative focal neurologic complications in patients with recurrent gliomas is comparable to this parameter for primary gliomas, however there is the tendency for higher frequency of extracranial inflammatory complications in patients with recurrent gliomas. The obtained data can be the base for making the decision for surgical treatment possibility of recurrent gliomas.

Multiple cerebral metastases, causing the neurological and mental disorders, quickly lead to disability and lethality. The aim of this investigation was to develop optimal surgical approach for patients with multiple brain metastases as well as to evaluate the outcomes and to determine the prognostic factors. Material and methods. 54 patients with multiple brain metastases were operated on, 138 metastatic foci were removed. The simultaneous removal of metastases without changing the patient’s position was performed in 52 cases. Total removal of all metastases was performed in 39 persons, whole brain radiation therapy was applied for 35 patients. Results. The method of simultaneous removal of multiple brain metastases without changing the patient’s position was developed. The median survival time for the whole group was 7.2 months; for patients with complete resection of metastases - 1.8 months. Two-year survival rate was 9.3 %. Adjuvant whole brain radiation therapy after resection prolonged the median survival time up to 12.7 months compared to 4.7 months in patients who received only symptomatic treatment. The median survival time for patients with a preoperative Karnofsky performance score <70 was significantly lower than for patients with Karnofsky performance score >70. Conclusion. The method of simultaneous removal of multiple brain metastases without changing the patient’s position is considered as optimal. The surgical treatment rapidly improves the condition of patients with multiple brain metastases, saving time for postoperative adjuvant treatment. Median survival time for patients with totally removed of all metastases achieves 11.8 months. The favorable prognostic factors for prolonged survival are the following: total resection of all metastatic lesions, preoperative Karnofsky performance score >70 and adjuvant whole brain radiation therapy.

Objective: to estimate the predictive value of corneal thermography for diagnostics of atherosclerotic changes of brachiocephalic arteries. Material and methods. Authors examined 97 patients with stenotic changes of brachiocephalic arteries (48 men and 49 women). The middle age was 62,3±4,6 years old. The examination algorithm in examined group included clinical and neurological assessment, clinical blood analysis, cholesterol and blood lipids level assessment, coagulation profile, triplex scanning of brachiocephalic arteries (estimation of stenosis severity, characteristics of atherosclerotic plaque and condition of its surface). Bran CT or MRI was performed in some patients. Patients with any ophthalmological disease were excluded from this study. All patients were distributed into 3 groups according to data of triplex scanning of brachiocephalic arteries (BCA) and in accordance with NASCET criteria: 1st group - stenosis of BCA is less than 40%, 2d group - 50-60% stenosis and 3d group - stenosis more than >70%. Results. The decrease of corneal temperature is observed at the side of ICA atherosclerotic damage which is correlates with the degree of artery stenosis. The most important is the corneal temperature gradient of both eyeballs which is increases according to increase of stenosis severity. The value of corneal temperature gradient depends on the grade of ICA stenosis. The meaning of this gradient more than 0,4 °С allows supposing the ICA stenosis with the following obligate performance of ultrasound of angiographic examination of BCA. The temperature gradient > 0,4°С is correlates with 30-40% stenosis of ICA, > 0,6°С - 50-60%, > 0,8°С - ICA stenosis more than 70%. Conclusion. The measuring of corneal temperature can be used for early diagnostics of stenotic atherosclerotic changes of BCA.

Objective: to perform the literature review of clinical trials data examined the method of cortico-cortical evoked potentials (CCEP) in neurosurgical practice. Material and methods. The analysis of 38 reports from international database Pubmed, which presented the CCEP method in patients suffered from neurosurgical pathology (publication dates from 1970 till July 2014). Results. CCEP method allows receiving information concerning existence of neuronal connections between functional cortical areas, identifying the direction of interneurinal connections (to determing receiving or generating zones) and evaluating the degree of cortical excitability in the area of epilepric zone and in surrounding tissues as well as getting information about seizure pattern paths along the cortex and subcortical structures. Conclusion: CCEP is a perspective method for investigation of connections between various cortical and subcortical structures in patients with neurosurgical pathology in pre- and postoperative periods as well as intraoperatively. This method can be useful in conditions of local (during awake surgery) and general anaesthesia.

This article presents the successful treatment of complex aneurysm of M1 segment of the left middle cerebral artery (MCA) using the combination of various revascularization techniques - double-barrel extra-intracranial low-flow bypass between superficial temporal artery and cortical branches of MCA (STA-MCA bypass) following by complete resection of the aneurysm with intra-intracranial reanastomosis «end-to-end» of the M1 segment. The treatment outcome was favorable with achievement of radical exclusion of aneurysm from blood flow.

Introduction: The one of the actual pediatric neurosurgery problems remains the optimal strategy selection for treatment of occult tethered cord syndrome (TCS), which presents no neuroimaging signs of spinal cord tethering in spite of clinical manifestation and characteristic of TCS. Objective: to define the specific aspects of the TCS diagnostics and to determine the indications for surgical treatment. Methods: clinical, neurovisualization, neurophysiological, urological examination, intraoperative diagnostics and morphometry in female patient 9 years old with TCS. Results: clinical and electrophysiological improvement after surgical treatment was observed. Conclusions: the presence of clinical manifestations of the TCS resistant to drug therapy is an indication for surgery, even in the absence of neuroimaging signs of the spinal cord tethering.

The distal aneurysms of superior cerebellar artery (SCA) are very rare pathology with no clear recommendations concerning treatment strategy. Objective: to present the clinical case and literature review concerning distal aneurysms of SCA. Material and methods. The review of literature was conducted and clinical observation with follow-up of patient with distal aneurysm of SCA was performed. Results. The distal fusiform aneurysm of SCA was verified according to the data of digital subtraction angiography (DSA) in patient with acute subarachnoid hemorrhage with following aneurysm enlargement in 3 months. This patient once suffered from acute vertigo during MRA procedure. The following MRA and DSA procedures revealed total thrombosis of aneurysm and parent artery. The control DSA in 1 year showed no signs if aneurysm and left SCA refilling. Patient had no neurological deficit. Conclusion. The conservative treatment for distal SCA aneurysms may be as effective as microsurgical and endovascular treatment which can result in ischemic damages in case of surgical trapping of parent artery.

The subarachnoid hemorrhage (SAH) during pregnancy is rare but extremely dangerous pathology because of high mortality and morbidity in both mothers and children. Objective: to present the treatment strategy of pregnant patient in acute period of SAH and literature review data. Material and methods. The literature review was performed as well as clinical observation of pregnant patient (22-23 weeks of dichorial biamniotic pregnancy) with estimation of medical reports and follow-up results. Results. The successful surgical treatment of patient with dichorial biamniotic pregnancy (22-23 weeks of gestation) suffered from rupture of ICA aneurysm in acute period of SAH was performed. The choice of surgical strategy was determined by necessity of aneurysm elimination and cerebral angiospasm treatment as well as the desire for life surviving of both mother and 2 children. Conclusion. The urgent surgical treatment of ruptured aneurysm which allows keeping the pregnancy must be perform in pregnant patients with ruptured aneurysm in acute period of SAH.

Purpose. To demonstrate a rare case of aplasia of both internal carotid arteries (ICA) has not been published in the Russian literature before. Materials and methods. The clinical case of 27-year-old patient with aplasia of both ICA without neurological deficit is presented. Results. The diagnosis of both ICAs dysplasia is carried out by cerebral angiography and CT scan of the carotid canal of the temporal bone, where the canal is absent or reduced. ICA dysplasia in most cases is asymptomatic due to collateral flow through the circle of Willis (most often), through anastomoses with the external carotid artery or through the embryonic vessels. Conclusion. The dysplasia of ICA is characterized by a high incidence of cerebral aneurysms. The follow-up for such patients seems reasonable to prevent aneurysmal hemorrhage or ischemic stroke.

Objective: to summarize the author’s own experience in treatment of patients suffered from spinal dural arteriovenous fistulas (DAVF). Material and methods. The analysis of endovascular treatment outcomes of 160 spinal DAVFs was performed. Men were 83%, women - 17%, average age - 52 years old. The clinical signs of progressive myelopathy were lower paraparesis of various severity degree (10% of cases - lower paraplegia), sensitive and pelvic disturbances. DAVFs were verified by data of MRI and spinal angiography. The glue compositions consisting of hystoacril or N-butil-cyanoacrylate mixed with lipiodol as well as polyvinyl acetate emboli (PVA) sized from 100 till 500 micron were used for occlusion of afferent vessels of DAVFs in the areas of pathological veins. Results. Endovascular treatment of spinal DAVFs allowed stabilizing or decreasing the severity of neurological signs in 90% of clinical cases. The improving of clinical outcomes in case of earlier embolization of DAVFs was detected. The usage of steroids as antiedemic therapy resulted in deterioration of neurological clinical signs (lower paraparesis, pelvic disturbances) and worsened the outcomes. Conclusion: endovascular embolization of spinal DAVFs is effective treatment method.

This review is devoted to historical and biographical aspects of development of microsurgical approaches in neurosurgical treatment of cerebrovascular disorders in the Ural region. It started from the moment of creation of specialized stroke ambulance teams by professor D. G. Shefer, meeting of the author with outstanding Russian neurosurgeons performing such microsurgical operations, appearance of a dream to master this technique and its implementation thanks to unique master of microtechnical miniatures A.M Sisolyatin who helped to make the necessary equipment for such microsurgical operations on cerebral vessels and mainly for extra-intracranial bypass which was first performed in the Urals by author of this review, the following accumulation of experience of these operations and synthesis in researches, dissertations and books, teaching of multiple neurosurgeons and creation of microsurgical neurosurgery in the Ural region, for the first time in Asia part of Russia. This review is sign of deepest gratitude and memory to all people who took part in the development of Russian microsurgical neurosurgery.

The article raises the question of medical ethics in the postmodern era in the aspect of the relations’ between doctor and patient changes which are detected in the substitution of the direct verbal with depersonalization and standardization of the treatment process. Comparison of the main characteristics of social processes has revealed that the changes above are the direct results of the postmodern era. Transforming medicine in the part of the service sector, it introduced the new depersonalized identity into medicine: a service provider who works in accordance with medical economic standards (doctor) and a service consumer (patient). This allows considering the emergence of medical economic standards as natural result, virtually replacing the category of “morality” for medicine. Possible solutions to correct of the situation on a personal and national level were offered: “simulation of modernity”, return to the classical propaedeutic canon and the synthesis of the modern achievements and the traditional approach.