Objective. To clarify the causes, enlight the features of damage and optimize the treatment strategy in patients with penetrating wounds of esophagus after anterior cervical fusion or with its combination. Material and methods: Authors operated on 13 patients suffered from the injury of esophagus after anterior cervical fusion performance via anterior approach from 01.01.2003 till 31.12.2014. Two patients were admitted into our hospital in acute period of spinal trauma (1-3d day). They underwent emergent surgery (decompression and stabilization of cervical spine), 11 patients were transported from other hospitals with instrumentally confirmed injury of esophagus. The instrumental diagnostics of esophagus injury included roentgenologic (plain radiography of neck and thorax, radiographic contrast study of esophagus with liquid barium meal, fistulography, CT of the neck and mediastinum) and endoscopic (esophagoscopy) methods as well as neck MRI. The defect of esophagus wall was revealed in all patients during period from 1st till 330 days after operation on cervical

There are several different approaches for the surgical treatment of cranial base pathology in the region of anterior cranial fossa (ACF). Objective: to examine the features of lateral supraorbital approach (LSOA) and treatment outcomes while using such approach in patients with tumors and bone defects of ACF base. Material and methods: LSOA was used in 126 patients among them 102 patients had olfactory groove meningiomas, 16 persons - pituitary adenomas and craniopharyngiomas and 8 patients suffered from ACF bone defects with nasal liquorrhea. Results: The radical removal of tumors was achieved in 95% of patients with meningiomas and in 62,5% of patients with pituitary adenomas and craniopharyngiomas. The hemorrhagic complications requiring repeated surgery was observed in 2 (1,5%) patients. The plasty of ACF bone defects was performed in 23 (18%) patients. There were no signs of postoperative liquorrhea in any case. Conclusion: LSOA has several advantages in the surgery of ACF base pathology comparing with the other surgical approaches. The good outcomes concerning radicality of tumors removal as well as efficacy of ACF bone defects reconstruction were achieved with the low risk of postoperative complications.

Introduction: Microvascular decompression (MVD) is the method of choice for treatment of trigeminal neuralgia (TN) in cases of revealed neurovascular conflict. It is traditionally considered that this surgical technique is contraindicated for elderly patients. These patients are often offered the various destructive methods. Objective: To evaluate the efficacy and safety of MVD of the trigeminal nerve root in patients with TN older than 75 years (elderly patients). Materials and Methods: authors performed MVD in 17 elderly patients (13 women, 4 men) suffered from TN from 2012 to 2015. VAS, BNI Pain Scale and BPI-Facial were used before and after MVD to estimate the pain intensity. The surgery results were assessed using scales by Miller (2009) and by Kondo A. et al. (2012). The efficacy and the safety of surgical intervention were evaluated between the two main groups (up to 74 years and older than 75 years). Results: The conducted analysis did not reveal any statistically significant differences between the patients of two groups as well as while analyzing the efficacy and safety of MVD. The relapse of pain after MVD within follow-up period was comparable in two groups (in 17.6% in elderly patients and 18.4% in younger patients). Conclusion: MVD in patients older than 75 years was found to be a safe and effective surgery given that precise preoperative planning which includes the evaluation of physical status of patients.

Objective: the method of individual planning of retrosigmoid approach to the pontocerebellar meningiomas taking into account the localization of tumor matrix, growth direction of tumor and configuration of posterior cranial fossa (PCF) was developed aiming the optimization of the parameters of mentioned approach. Material and methods: 8 forms of bone basis configuration of PCF as well as structure features and spatial relationship of petrosal bone were revealed after X-ray data examination of 160 CT scans of patients without neurosurgical pathology Results. The projection analysis of 38 CT scans and angiograms of patients suffered from pontocerebellar meningiomas revealed the features of dislocation of various brain stem structures as well as vascular and neural structures in relation to growth direction of tumor and bone and dura mater configuration of PCF. Conclusion. The method of planning and parameters optimization of retrosigmoid approach based on individual anatomical model of PCF and features of tumor topography was developed. This method allowed increasing the accuracy of surgical approach and lowering the operative trauma and risk of complications.

Introduction. The Blood and its degradation products are considered to be the main cause of cerebral angiospasm (CA) due to non-traumatic subarachnoid haemorrhage (SAH). Intrathecal fibrinolytic therapy is one of the most effective methods for clearing the basal cisterns from the blood. Objective. To study the effectiveness and safety of intrathecal fibrinolytic therapy (recombinant staphylokinase, recombinant human plasminogen activator) for CA prevention using double haemorrhage model. Materials and methods. The study was performed on 81 laboratory white rat. The double haemorrhage model was used for reproduction of CA. All animals were divided into 4 groups: 25 were treated with recombinant staphylokinase (fortepase) - group 1, 15 were treated with recombinant tissue plasminogen activator (alteplase) - group 2, 30 animals were included in control group (cerebrospinal fluid drainage only) - group 3, cisternal microcatheter was introduced to 11 animals (group was excluded from further analysis because of CSF drainage inefficiency). Rat brain for morphological study was taken at 5th day. Microscopy assessment was done at the level of the upper third of the basilar artery using special histochemical stains. Results. The morphological scale of CA severity was performed and the specific microcirculatory changes of brain tissues were identified. We included 25 animals (nine from group 1, four from group 2, twelve from group 3) in the main morphological analysis. Mild CA was observed in 4 cases (33,3%), moderate - in six cases (50%), severe - in 4 cases (33,3%) among animals of control group. Severe CA was absent in fibrinolytic groups. Moderate CA was observed in 6 cases (66,7%), mild - in 3 cases (33,3%) in forteplase group. Both mild and moderate CA was observed in 50% of cases in alteplase group. Intracranial haemorrhage was not observed in any group. Conclusion. The proposed intrathecal fibrinolytic therapy is effective and safe method to reduce the severity of CA in rat double haemorrhage model.

The combination of stenotic changes of cervical part of internal carotid artery (ICA) and intracranial aneurysm (IA) is the rare and insufficiently examined pathology. The frequency of such pathological combination counts to 2,1-4,1% among all patients suffered from hemodynamically significant ICA stenosis and to 8,3-21,4% - among patients with subarachnoid hemorrhage because of IA rupture. The selection of treatment strategy for such patients with combination of ICA stenotic-occlusive damage and IAs currently presents the challenge in response to the features of disease pathogenesis. The undiagnosed IA may cause the life-threatening intracranial hemorrhage after performance of reconstructive operation on extracranial ICA. Meanwhile patients with undiagnosed hemodynamically significant ICA stenosis are in the group of high risk of cerebral ischemia development because of temporary clipping of intracranial arteries during operation on IA. This article presents the literature review concerning treatment strategy with combination of ICA stenotic-occlusive damage and IAs. Nowadays there are no accurate algorithms for treatment of such patients and definite criteria for selection either microsurgical or endovascular operation as well as the order of operations on cervical part of ICA and IA is not clearly defined.

Objective: to examine the influence of Mozart’s compositions on human. Material and methods: the analysis of 95 literature sources was performed. Results: it was observed that the listening of sonata k448 leads to the activation of medial and neocortex parts of temporal lobe as well as structures of limbic system and deep parts of brain. Conclusion: the everyday listening of sonata k448 in combination with anticonvulsant drugs taking allows decreasing the frequency of pathological patterns of electrobiological cerebral activity.

This article presents the features of ventriculoatrial shunt performing with the usage of intraoperative sonography for hydrocephalus treatment. The technique of ventricular and atrial catheters placement using ultrasound navigation is described. This technique allows reducing the duration of operation as well as decreasing the intraoperative risks and improving the quality of surgical treatment.

The aneurysms of ophthalmic artery present the extremely rare variant of distal aneurysms without definitive treatment strategy. Objective. To conduct the review of literature data and to analyze the treatment strategy in pathient with ophthalmic artery aneurysm. Material and methods. The literature review has done and the treatment of the patient with ophthalmic artery aneurysm (analysis of medical records with prospective follow-up) was performed. Results. The cerebral angiography had revealed the aneurysm of intraorbital part of ophthalmic artery with the following twice increase of aneurysm during 6-years follow-up. The embolization of aneurysm with coils allowed excluding the aneurysm from blood flow with the preservation of patent ophthalmic artery without increase of neurological deficit. Conclusion. The treatment strategy concerning the presented clinical case was based on necessity for preventing the development of visual disturbances because of optic nerve compression by growing aneurysm or hematoma in case of aneurysm’s rupture. The selected treatment option allowed achieving the optimal outcome without additional trauma.

The autosomal dominant polycistosis kidney disease (ADPK) is the severe hereditary disorder, which often combined with the formation of intracranial aneurysms (IA). Objective: to estimate the aneurysms frequency among the patients suffered from ADPK as well as the treatment strategy development for such patients. Material and methods: the prospective trial for revealing of IA among patients with ADPK using various neurovisualization methods is conducted. All patients with acute subarachnoid hemorrhage (SAH) suffered from ADPK who was admitted to our hospital were included in this study. The selection of treatment method was based on the evaluation of anatomical parameters of aneurysm and parent arteries. Results. We examined 47 patients with ADPK, IAs were revealed among 14 of them, 9 patients were operated on, among them 7 had history of SAH and 3 persons were operated on in acute period of SAH. Conclusion. The screening CT or MR-angiography is obligatory for patients with ADPK especially in the case of family history concerning SAH for revealing unruptured IAs for their future surgical treatment. The intraoperative monitoring in patient with chronic renal failure has to include the control of volemic status with uninterrupted registration of central venous pressure and usage of PiCCO method. It is preferred to conduct the surgical treatment of such patients under condition of multi-field hospital where the possibility for substitutive renal therapy is existed. The surgical treatment of patients suffered from IAs combined with ADPK does not lead to increase of lethality and bad treatment outcomes.

Objective: to present the clinical case of acute manifestation of transverse spinal cord damage syndrome in patient 25 years old suffered from Chiari malformation type I and syringomyelia. Material and methods: we present the clinical case of acute transverse spinal cord damage syndrome in patient 25 years old who was follow up examined during 2 years with stable course of Chiari malformation type I and syringomyelia. The emergent operation including craniovertebral decompression with dura mater plasty using fascia lata was performed. Results: the increase of muscle strength in extremities (with full recovery in upper limbs) as well as regress of coordination disturbances in upper limbs and bowel and bladder functions recovery was observed in neurologi cal status after craniovertebral decompression. The control MRI of craniovertebral region and cervical spine performed in 3 months after operation confirmed the formation of adequate cisterna magna and regress of syringomyelia. Conclusion: the acute development of symptoms because of Chiari malformation type I is very rare and occurs approximately in 1% among patients with such pathology according to literature data. The pathogenesis of acute manifestation of symptoms is still not clearly defined. That is why it is necessary to remember about possibility of such acute diseases manifestation while the observation and follow up is prescribed as treatment strategy for patients with Chiari malformation type I and syringomyelia.

Introduction: nontraumatic subarachnoid hemorrhage (SH) because of cerebral aneurysm rupture during pregnancy is a very rare pathology that is why there are insufficient literature data, which may be the possible base for treatment guidelines development. The modern technologies in neurosurgery allow conducting the surgical treatment with minimal theoretical risk for pregnancy course. Clinical case: female patient, 26 years old , 16-17th gestation week , was admitted into our hospital in 14 days after repeated SAH because of rupture aneurysm of right posterior communicating artery. The emergent balloon-assisted coil embolization was selected as the most justified method in this case. The surgical intervention was performed completely without complications. The regress of neurological signs was observed in postoperative period against the therapy of cerebral angiospasm. The patient was discharged after acute period of disease for observation and delivery in time. Conclusion: The aneurysmal SAH is not the indication for interruption of pregnancy and vice versa the pregnancy is not the contraindication for surgical treatment of cerebral aneurysm. The patients with such pathology ought to receive urgent medical high-technological care under the conditions of special hospitals.

Objective - to popularize the knowledge concerning features of diagnostics and surgery strategy selection for treatment of tumors in chiasmo-sellar region. Material and methods: this lecture presents the generalized experience of more than 5000 patients with the tumors of chiasmo-sellar region treated at the base of Scientific Research Institute of Neurosurgery n.a. acad. N.N. Burdenko. Results: nowadays the development of modern transnasal endoscopy changed radically the preexisting perceptions concerning the selection of surgical approach for removal various tumors of chiasmatic region. The gathered experience allows recommending the transnasal approach in some cases as worked out technique with predictable outcome and relatively low numbers of postoperative complications. Conclusions. The lessons learned and modern possibilities of face-to-face and distal learning create opportunities for increasing the numbers of neurosurgical departments throughout the Russian Federation, which are possible to provide the surgical treatment of tumors in chiasmo-sellar region on current competitive and capable level.

Introduction. There are 20 neurosurgical departments for medical care administering for patients with trauma and diseases of central nervous system in Moscow Public Health Department. Material and methods. This article presents the analysis of Moscow neurosurgical departments’ activity during 2014 and 2015 years. The analyzed materials were annual reports of heads of neurosurgical departments as well as results of annual personal visit to all departments. Results. The number of neurosurgical departments will decrease from 22 till 20 within 2 analyzed years and the decrease of neurosurgical beds also was detected from 981 till 689 (on 30%). The number of patients receiving neurosurgical treatment was increased from 25 563 to 28 468 as well as the number of neurosurgical operations was increased on 18%. The total and postoperative mortality was decline. Total number of died patients in 2014 counted to 1279 and in 2015 -1408 (total mortality - 5,1% and 4,9% consequently). Total number of patients who died after operation was 941 in 2014 and 962 - in 2015 (postoperative mortality - 12 and 10,5% consequently). The head injury has the predominant position (51-52%) among all neurosurgical pathology in Moscow with the following trauma and spinal diseases (27-29%). The analysis of neurosurgical departments’ equipment, patients’ forwarding and working conditions of physicians and nursing stuff as well as conformance of departments’ and hospitals’ activity to valid warrants of Ministry of Health of the Russian Federation and Moscow public health department was conducted. Conclusion. The significant changes due to reorganizations in health care occurred during 2014-2015 in Moscow service. The revealed weaknesses in organization of every day work in neurosurgical departments will allow optimizing the activity of departments as well as improving the quality of health care received by population.