Objective: to demonstrate the possibilities and application area of lateral approach in the surgery of craniovertebral mass lesions. Material and methods: within 2013-2014 11 patients suffered from craniovertebral ventral mass lesions were operated on using lateral approach. The clinical cases of surgical treatment of ventral craniovertebral mass lesions are described as well as the features of the usage of lateral approach are discussed and the surgical treatment outcomes are presented. Results: lateral approach to craniovertebral region in specified cases allowed performing the total removing of mass lesions located ventral in relation to spinal cord. Conclusion: lateral approach may be recommended for removal of ventral craniovertebral mass lesions as safe and efficacy approach.

Objective: to estimate the efficacy of covered stents usage for treatment of various pathology of extra -and intracranial arteries based on our own data. Material and methods: the experience of covered stents usage at 39 patients is presented: 24 cases – cerebral aneurysms of various localization, 13 — carotid-cavernous fistulas (CCFs) of type «А», 2 — arteriovenous (AV) fistulas of V2 segment of vertebral artery. There were 19 women and 20 men. The average age was 36 years old. The follow-up angiographic studies were performed firstly in 6 months after operation. The follow-up varied from 6 till 60 months. Results. The technical success during usage of covered stents was achieved in 84,2% (n=32) cases. The radical elimination of aneurysm from blood flow was seen in 87,5% (n=21) cases. The usage of covered stents for treatment of basilar aneurysms didn’t result in augmentation or appearance of neurological deficit. The treatment outcomes was assessed as 1-2 scores by mRs in 22 patients, lethality was 8,3%. The usage of only covered stent allowed achieving the occlusion of CCF in 69,2% (n=9)cases while in 3 patients the additional usage of coils using venous or combined approach was necessary. The disjunction of CCF with reconstruction of injured ICA was achieved in 12 (92,3%) patients. There was no lethality or postoperative augmentation of neurological deficit in this group. The good clinical and angiographic result was achieved in patients with disjunction of vertebral artery fistulas. Conclusion. The high clinical and economical efficacy of covered stents usage defines the reasonability of their more active appliance for treatment of pathological shunting and aneurismal damages of brain in case of favorable anatomy.

Objective: To present the results of intraarterial methods applying for blood flow restoration (recanalization) in case of thrombosis of internal carotid artery (ICA) in patients with acute ischemic stroke (ACI) Materials and Methods: During period from December 2006 till February 2014, 11 patients (8 men, 3 women), average aged 62, with ACI symptoms and occlusion of ICA were treated within 6-hour therapeutic window using various methods of intraarterial recanalization. The average severity of neurological deficit at admission was 18 scores by NIHSS. Two patients were treated with selective infusion of the rt-PA (Actilyse «Boehringer Ingelheim») thrombolytic agent and aspiration of thrombotic masses, while ICA stenting was performed in 7 patients. Stent-assisting devices with the Solitaire stent (EV3) were used in 4 patients. Results: The successful recanalization of (TICI 2b-3) ICA was achieved in 45,7%. The frequency of symptomatic hemorrhagic transformations in patients with ICA occlusion was 18,3% while the fatal brain edema was observed in one case. The good clinical (neurological impairment — 0-2 scores by mRs) outcome was observed in 2 patients, mortality was 27,2% (3 patient died). Conclusions: The accurate selection of patients with evaluation of the volume of brain ischemic damage is necessary for safe and effective intraarterial reperfusion in case of acute ICA thrombosis. The mechanical devices of revascularization should only be used in case of acute ICA thrombosis. The type of ICA occlusion and degree of collateral blood flow must be taking into account during selection of surgical intervention type

Objective: to search the criteria for early diagnosis of secondary trigeminal neuralgia (TN) as the primary sign of mass lesions of lateral cistern of the pons. Material and methods. The clinical features of TN as the first symptom of mass lesions of lateral cistern of the pons were studied in 21 persons among 253 patients operated on because of TN. Results: the staging of clinical signs development of secondary TN was established: 1st stage — syndrome of classical TN; 2d stage — syndrome of trigeminal neuropathy; 3d stage — combination of clinical signs of TN or trigeminal neuropathy with symptoms of mass lesion. Conclusions: The clinical signs of classical TN in case of mass lesions of lateral cistern of the pons are resulting from development of neurovascular conflict in patients with premorbid contact or close relationships between root of trigeminal nerve and superior cerebellar artery. The brain MRI is prescribed in case of clinical signs of classical TN in patients younger than 40-50 years old for exclusion of secondary nature of disease. One should not use the destructive operation before exclusion of secondary nature of TN using intrascopic examination. The brain MRI is also justified for for exclusion of secondary nature of disease in any deviance from clinical manifestation of classical TN.

The methodology of current diagnosis in neurosurgery taking into account the interinfluence of clinical signs and high technologies is discussed. The forming of full diagnosis of brain pathology based on pooled analysis of principle of syndromes, topography, nosology, visualization, age-related approach, phase approach, data sufficiency and data integration as well as on principle of individual attention to patient is justified.

This article presents the rare clinical case of surgical treatment of patient 38 years old with combination of meningoradiculocele and extravertebral lipoma. This patient was not operated during his childhood because of objective and internal reasons. The causes for visit to a neurosurgeons in adulthood were the following: 1) recurrent hernial liquorrhea started 3-4 years before admission; 2) local back pain and pains in legs; 3) sexual dysfunction, started 14 years before admission and increasing during last 2 years; 4) occasional acts of involuntary defaecation. The set of objective reasons went before the disease onset (growth of lipoma caudal to hernia, the change of work character from mental to physical activity with long-time working, frequent leaning and heaviness pickup). The indication for surgical treatment were posed at the base of complex examination including invasive methods. The reconstruction of vertebromedullar anomaly was performed during many-hours-long operation. The condition and quality of life were significantly improved after surgery with following effects: 1) the seal of spinal subarachnoid space was patent; 2) back pain and pains in legs were regressed; 3) the night and morning erection were restored; 4) act of defaecation became violent; 5) the relatively acceptable cosmetic result was achieved.

This article presents the rare clinical case of abscess of sella turcica (AST) after transnasal endoscopic removal of pituitary adenoma. This female patient underwent the transnasal endoscopic removal of abscess with the following conservative treatment with achievement of good clinical outcome. The features of clinical sings of AST and variants of treatment strategy are analyzed in this article.

The case report of aggressive adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma with metastases into posterior cranial fossa after two surgical operations (transcranial and endoscopic endonasal interventions) and radiotherapy is presented. This article enlights the clinical, neuroradiological, histological and immunohistochemical data of the presented patient.

This article discusses the feartures of surgical treatment of patients with high-level atherosclerotic damages of extracranial part of internal carotid artery (ICA): high bifurcation of common carotid artery (CCA), ICA stenosis by prolonged atherosclerotic plaque, high tortuosity of ICA. The temporary mandible subluxation is one of the method for approach to distal parts of cervical ICA. The anatomical features and surgical tricks of approach to distal parts of cervical ICA are presented. The one—sided temporary mandible subluxation provides the additional space for approach to distal part of cervical ICA and allows performing the necessary volume of reconstructive operation.

The specific variant of neurovascular conflict is the combination of trigeminal and facial nerves compression in patients suffered from «tic douloureux». This article presents the case report of left-sided progressive drug-resistant trigeminal neuralgia combined with hemifacial spasm. The MR-signs of neurovascular conflict between megadolichobasilar artery and roots of trigeminal and facial nerves were observed during examination of female patient. The microvascular decompression of trigeminal and facial nerves was performed. The close contact between roots of trigeminal and facial nerves and dolichobasilar loop dislocated to the left was revealed during operation. The full regress of symptoms of trigeminal neuralgia and hemifacial spasm was achieved in postoperative period. This clinical case demonstrates the efficacy of microvascular decompression for treatment of complex combined drug-resistant pathology because of one etiologic factor.

Objective: to optimize the surgical approaches to the tumors of posterior cranial fossa (PCF). Material and methods. The analysis of 93 CT scans and 48 MRI scans as well as 72 CT- and MR-angiograms with sinuses visualizations of patients with PCF tumors using system of bone landmarks and projection lines was conducted. Results. The variants of PCF configuration as well as features of dislocation of cerebral and neurovascular structures according to localization of tumors and type of bone-meningeal frame were determined. The algorithm of preoperative planning and calculation of surgical approaches parameters was developed at the base of individual features of topography and histological structure of PCF mass lesion in various types of bone-meningeal frame. Conclusion. The usage of individual planning of surgical approach in 67 patients with PCF tumors allowed increasing the accuracy and decreasing the injury rate of surgical approach as well as decreasing the operation time, number and severity of postoperative complications.

Objective: the description of experience of introduction of interactive system for training of spine surgeons for percutaneous endoscopic transforaminal lumbar discectomy within the course of graduate education. Material and methods: the interactive program of surgical training for percutaneous endoscopic transforaminal lumbar discectomy is created using the resources of the Russian Medical Academy of Postdegree Education (RMAPE). It represents the high-quality three-dimensional video animation of each stage of surgical intervention considering natural anatomic relationship and proportions, reproducing appearance and operation of real surgical instruments. It gives the trainee opportunity to repeat and reproduce it as many times as may be necessary. The program consists of video animation, text description, pre-test and final examination test. The program hosts on the special Internet site therefore after receiving the individual access the student is capable to be trained on-line. Results: the interactive program of surgical training for percutaneous endoscopic transforaminal lumbar discectomy was introduced as a part of program of professional education at the base of department of neurosurgery of the Russian Medical Academy of Postdegree Education (RMAPE). Conclusion: Introduction of the interactive program of surgical training for percutaneous endoscopic transforaminal lumbar discectomy at the base of department of neurosurgery of RMAPE demonstrates the effective way of training of surgeons and has wide prospects of further development.

The literature review is presented dedicated to the problem of degenerative lateral stenosis of lumbar vertebral canal. The data of pathological anatomy, types and clinical signs of lateral stenosis are presented. The possibilities of current instrumental diagnostics of this pathology described as well as treatment options are discussed. The indications for surgical treatment and various types of surgical interventions are enumerated.

This literature review enlights the current data concerning frequency and character of neurotrauma among snowboarders as well as presents the comparative analysis of trauma characteristics in downhill skiing and other sport activities.

This article considers the contemporary issues of microsurgical treatment of distal cerebral aneurysms as well as the classification and anatomical features of mentioned aneurysms and describes the used microsurgical approaches and outcomes of surgical treatment.