Objective: analysis of neurological outcomes at patients with severe neurological deficits (8-12 scores according to NIHSS) after reconstructive operation on carotid arteries (СА), performed in acute period of ischemic stroke. Material and methods. We analyzed neurological outcomes at 154 patients with symptomatic pathology of CA, suffered from acute ischemic stroke. Among them 84 patients underwent reconstructive operations of CA and 70 received complex rehabilitation without surgery. We selected 41 patients from the last mentioned group with severe neurological deficit (8-12 scores according to NIHSS), suffering from ischemic stroke, 20 of these patients were operated on and 21 patients received complex conservative treatment. Among 20 patients underwent surgical treatment 14 (70%) were men and 6 (30%) - women, average age - 62,7±11,3 years, mean value of Charlson comorbidity - 2,3±0,9. Average score by NIHHS was 9,9±1,8, index by Rivermead scale - 2,5±2,1 and mean value by Ramkin scale - 3,5±0,7. Control group (21 patients) consisted of 14 (66,7%) men and 7 (33,3%) women. Average age was 67,2±10,4 year, mean value of Charlson comorbidity -3,1±1,4. Average score by NIHHS was 9,6±1,5, index by Rivermead scale - 2,5±1,9 and mean value by Ramkin scale - 3,8±0,7. Patients with severe neurological deficit after surgical treatment and active cerebral reperfusion demonstrate more expressed regress of neurological deficit and increase the level of functional capability comparing with patients received only conservative treatment under low perioperative risk of repeated stroke, acute myocardial infarction and lethal outcome. Results. Low scores according to NIHSS (up to 12 scores) at patients with acute ischemic stroke are not the contraindications for early reconstructive operations on CA. Non-surgical strategy doesn’t allow achieving maximal improving of neurological status at patients with carotid arteries stenoses in acute period of ischemic stroke as well as preventing the repeated complications.

Objective: to demonstrate the first experience of high-flow extra-intracranial (EC-IC) bypasses performance for treatment of patients with giant aneurysms (GA) of internal carotid artery (ICA). Material and methods: we performed high-flow EC-IC bypasses at 4 female patients with GA of ICA: two patients had GA of cavernous ICA with tumor-like (mass effect) signs, 1 patient - complex GA of ICA bifurcation with combined (apoplectiform and tumor-like) clinical manifestation and 1 patient with left ophthalmic GA also with combined clinical manifestation (embolic and apoplectiform). Results: We used radial artery as an autoshunt in all cases. Patient with left ophthalmic GA underwent urgent performance of EC-IC bypass between M2 segment of left middle cerebral artery (MCA) and left external carotid artery (ECA) because if intraoperative thrombosis of supraclinoid ICA after clipping and resection of aneurysm. The other three patients underwent routinely operation with performance of EC-IC high-flow bypass between M2 segment of right MCA and right ECA with following right ICA sacrifice with the usage of moderate hypothermia and barbiturates as well as EEG-monitoring. The bypass patency confirmed by intraoperative Doppler sonography, digital subtraction angiography in postoperative period and by ultrasound examination of subcutaneous bypass region. One patient underwent the bypass thrombosis without any neurological deficit in one week after operation because of collateral blood flow improving but this patient died in 3 week after operation because of pulmonary artery thromboembolia. One patient suffered from bypass thrombosis on next day after operation with following massive ischemia stroke causing death. Two patients were discharged in satisfactory condition with patent bypasses. Conclusion: The performance of high-flow EC-IC bypass is one of the current treatment options for patients with GA of ICA. It is necessary to perform the routine surgery under the conditions of specially equipped operative theatre with the usage of EEG-monitoring, barbiturates and moderate hypothermia. It is possible to perform the urgent high-flow EC-IC bypass in case of intraoperative ICA thrombosis

Objective: to estimate the frequency of systematic connective tissue dysplasia at patients with intracranial aneurysms (IA) and its influence on clinical manifestation of intracranial aneurysms. Material and methods: The conducted examination of 199 patients with confirmed intracranial aneurysms (IA) comparing with 194 patients in control group (healthy donors) revealed 12 following external markers of deficiency (dysplasia) of connective tissue with the frequency of these markers statistically much more in examined group than in control group: visible vessels of face and chest (59,8%), scoliosis (44,7%), varicose veins on legs (39,7%), flatfoot (34,6%), skin hyperextensible in supraclavicular region - more than 4,0 cm (33,6%), spontaneous nasal hemorrhage (25,6%), easy formation of bruises (20,6%), abdominal hernia (13,6%), paradontosis (10,5%), chest distortion (7,5%), abdominal striae (3,5%), joints hypermobility (2,5%). Results: The mean number of markers at patients with IA was 3,07 comparing with 1,17 at patients in control group. The systematic connective tissue disorders at patients with IA were confirmed by morphological examinations of intraoperative biopsy samples of superficial temporal artery (STA) and skin of temporal region, which were conducted at 50 patients with IA comparing with 18 persons in control group (patients with head injury). The signs of mesenchymal dystrophia were revealed at 98,0% patients with IA while investigating the STA biopsy samples and at 82,0% patients - in biopsy samples of temporal region skin. Conclusion: The most expressed changes were seen at patients with presence of 3 and more external markers. The following clinical features were seen at patients with IA with number of external dysplasia markers 3 and more: multiple aneurysms were seen 5 times more among such patients comparing with patients with the number of markers less than 3 (р=0,005) as well as ischemic complications during intracranial hemorrhage (р=0,04).

Objective: to obtain an algorithm to choose the method of minimally invasive treatment of degenerative diseases of the lumbar spine based on modern mathematical methods of data mining. Material and methods: The current minimally invasive surgical treatment of degenerative diseases of the lumbar spine includes microsurgery, endoscopy, puncture technique. Its success depends primarily on the choice of an appropriate method of intervention. An analysis of existing clinical data and the adoption of a decision depends on the personal experience of the surgeon and is a heuristic, intuitive operation. It is difficult for both reproduction and learning, as well as for third-party evaluation. Modern methods of predictive mathematical analysis were applied for reliable and efficient algorithm for selecting the form of surgical treatment. They included an analysis based on the algorithm of neural networks and decision tree algorithm. Choice of treatment was carried out between the laser percutaneous disc reconstruction, percutaneous hydrodiscectomy, transforaminal endoscopic discectomy, interlaminar endoscopic discectomy, lumbar microdiscectomy, lumbar microsurgical decompression, as well as combinations of these methods in the cohort of 80 patients with degenerative lesions of the lumbar spine. Estimated symptoms included clinical signs and morphological data on the basis of MRI. Results: an algorithm for selecting a minimally invasive method of surgery for the treatment of lumbar degenerative disease was obtained on the basis of modern predictive methods of mathematical analysis (Data Mining). Conclusion: the modern methods of mathematical analysis of clinical data (Data Mining) enable us to obtain efficient algorithms for selection of minimally invasive surgical treatment of degenerative disease of the lumbar spine. It is important to improve the effectiveness of treatment, the implementation of teaching and learning tasks, as well as for peer review and development of standards of care.

The spontaneous rupture of hernila sac at patients with myelomeningocele is seen in 17,5% cases not only in the case of isolated myelocele but also with combination with another anomalies of central nervous system. We performed closed external drainage of hernial sac lumen (hernial drainage) at 3 patients for liquorrhea reversal because of spontaneous hernial sac rupture and for development of time reserve for patient preparation for reconstructive surgery (including complex neurosurgical examination). Operation took only 15-20 and didn’t require any specialized and resource-intensive technology. This suggested technique of hernial drainage provided the seal of hernial sac and dosed controlled outflow of liquor. This hernial drainage allowed achieving the stabilization of homeostasis indicants of patients as well as improving the condition of local tissues in parahernial region and normalization of liquor composition. It becomes possible to perform the full complex of examinations during drainage period and produce the conditions for corrective surgical operations under optimal circumstances.

Background. It was shown an opportunity of non-invasive diagnostics of intracranial hypertension (ICH) on the base of pulsatility index (PI) using transcranial Doppler (TCD) in most neurosurgical patients. But in patients with hydrocephalus PI is controversial. This may be due to different degree of cerebral autoregulation (CA) impairment in case of cerebral perfusion pressure decrease. Purpose: to assess the informativity of cerebral hemodynamics indices for assessment of cerebrospinal fluid circulation in patients with hydrocephalus. Materials and methods. Routine diagnostics of cerebral blood flow velocity (BFV) by means of TCD was carried out in 26 patients with hydrocephalus. Cerebral autoregulation was assessed perioperatively with cuff test and cross-spectral analysis of spontaneous oscillations of blood pressure and BVF within the range of Meyer waves. Results. Depending on presence of intracranial hypertension (ICH), all patients have been divided in two groups: with signs of ICH (1^st group) and without ICH (2^nd group). Mean values of PI didn’t differ significantly in both groups. At the same time rate of CA were considerably (p<0.01) higher in patients without signs of ICH. In the 1^st group postoperative clinical improvement was accompanied with considerable (p<0.05) increase of rate of CA. In the 2^nd group of operated patients we didn’t observe any positive changes in neurological state postoperatively. After surgery CA hasn’t been changed significantly. Conclusion. Assessment of cerebral autoregulation being more informative than PI evaluation can increase TCD valuability in noninvasive diagnostics of cerebrospinal liquid dynamics and could be used for clarifying indications for operation in patients with hydrocephalus.

This report presents the data of literature about secondary stroke in brain tumors. The mortality at this pathology remains high. Outcome of various conservative and neurosurgical treatments of patients with secondary stroke in intracranial tumors depending on volume, localization of tumor, patients condition, age and many others. The question about treatment option is still very actual.

The aim of this article was describe the contemporary experience use of mechanical thrombectomy devices for the treatment of acute ischemic stroke and factors which influence on clinical efficient them use.

The treatment of patients with cerebrovascular diseases is one of the most significant current medical and social problems. Two-thirds of ischemic strokes are occurred because of occlusive-stenotic pathology of carotid arteries. The significant part of such patients is in need of revascularization operations, among them the most common is carotid endarterectomy. Cerebral aneurysms are revealed at 0,8-7% patients with stenotic atherosclerotic damage of brachiocephalic arteries. We consider MR-angiography or alternative instrumental examination is justified for all patients with hemodynamic significant stenoses of brachiocephalic arteries. While cerebral aneurysm is revealed it should be reasonably operated on as a first stage of surgical treatment. Revascularization operation may be performed as a second stage in several weeks after first operation. This proposed strategy allows not only decreasing the risk of ischemic stroke development but also preventing the rupture of cerebral aneurysm.

We demonstrate the clinical case of successful surgical treatment of such rare variant of hypertensive hemorrhage as chronic subdural hematoma of posterior cranial fossa. This pathology is difficult for clinical and instrumental diagnostics because of absence of pathognomonic clinical signs and low чувствительности of routine brain CT for such type of hemorrhage. The brain stem compression and occlusive hydrocephalus developed with such localization of hematoma lead to rapid progression of neurological deficit and unfavorable outcome. It is necessary to use modern instrumental methods of neurovisualization (MRI, brain stem evoked potentials) which allows choosing the correct surgical strategy for successful diagnostics and treatment of such rare hematomas.

Intracranial non-traumatic hemorrhage is the rare pathology during pregnancy but dramatically dangerous according to the high mortality and disability rate of pregnant women as well as their children. The main reason for non-traumatic intracranial hemorrhages at pregnant women is rupture o cerebral aneurysm (CA) or arteriovenous malformation (AVM). The most often time for such hemorrhages is the III trimester of pregnancy. The optimal option for treatment of such pathology is surgical operation which can be divided into 2 steps - abdominal delivery as the first step and the second one is surgical treatment of cerebrovascular pathology. Such treatment allows giving the appropriate treatment for the mother as well as decreasing the rate of complications for the child and as a result saving 2 lives.

This case report describes the surgical treatment of female patient in acute period of hemorrhage from ruptured aneurysm of posterior choroid artery (PChA).This 17 years old female patient was admitted into our hospital with clinical signs of subarachnoid-parenchymal hemorrhage. Brain CT with intravenous contrast revealed the hemorrhage into medial parts of left temporal lobe and allowed surmising the vascular malformation. Cerebral angiography showed the cause of hemorrhage - aneurysm of PChA. The usage of frameless neuronavigation system allowed planning and accomplishing the least traumatic approach to aneurysm with removal of intracerebral hematoma and clipping of aneurysm. The full regress of neurological signs was seen in postoperative period.

The objective of this study was to determine the risk factors for unfavorable treatment outcome at surgically treated patients with acute head injury. This study was based on the examination (изучение) of clinical signs and instrumental examination data as well as surgical treatment outcomes of 1098 patient s with acute head injury (time from trauma till operation was not more than 72 hours). We divided all risk factors for unfavorable treatment outcomes into three groups based on data of conducted analysis. First group included high-degree risk factors, second group - moderate-degree risk factors and third group - low-degree risk factors. The high-degree risk factors for unfavorable treatment outcome were clinical signs and CT-signs of acute dislocation syndrome. The moderate-degree risk factors were follows: acute subdural hematoma or multiple brain damages according to CT data, the volume of brain damage focus more than 100 cm³, lateral brain dislocation more than 10 mm, subarachnoid or ventricular hemorrhage, value of VCC-2 8% and less, presence of severe concomitant (сочетанных) extracranial damages (40 and more scores according to ISS) as well as secondary factors for ischemic brain injuries (arterial hypotension and hypoxemia). The low-degree risk factors were age of patients 60 years old and more and «malignant» untreatable intracranial hypertension during operation or in the early postoperative period. We reviewed in details each of determined risk factors with estimation of its statistical significance for influence on treatment outcome taking into account its duration and intensity of its action.

Objective: to study the effectiveness of staphylococcal-proteus-pseudomonas (SPSA) vaccine using experimentalbiological model of intracerebral surgical infection. Material and methods: we used in our study 5912 white outbred mice with body mass appx 14-16 gr. There were two groups of animals: experimental - subcutaneous vaccinated with staphylococcal-proteus-pseudomonas (SPSA) vaccine; control - not vaccinated. The intracerebral contamination of animals from both groups was performed using intracranial injection of following microbial cells cultivations: S. aureus Б-243, strain P. mirabilis № 6, Р. aeruginosa РА. The protective activity was estimated using the test of mice active defense under intracerebral contamination with determination of cultivation LD50 and efficiency indexes. Each experiment was accompanied by set up of virulence control of inoculating strain using not-immunized animals from the same batch. We prepared 2347 microslides of brain, liver, lien and lungs of mice from both groups with previous paraffine preparation and stained with hematoxylin and eosin with following histological examination of prepared microslides. Results: the immunoprotection towards vaccinating strains developed even on first day after contamination according to the data of conducted studies. Immunologic resistance was continuously growing till 5th day and reaching its maximum till the end of 2d week. The Immunity stress on 1st day of contamination was confirmed by high indexes of effectiveness, maximally increasing till 14th day after vaccination. Bacteria isolation rate from internal organs of mice in experimental group terminated at an early date. Histological examination showed the following findings: inflammatory process in vaccinated animals in experimental group had the localized character in the form of leukocytal wall forming with focal accumulation of leukocytes and macrophages comparing to control group. The zone of destructive changes in animals of experimental group had significantly smaller area both in the direct contamination zone and in the extracranial organs. Conclusion: the conducted studies indicate the high protective activity of о SPSA-vaccine towards model of intracerebral surgical infection. Thanks to immunostimulatory factors released after mice vaccination the significant decrease of inflammatory process duration as well as damaged areas of internal organs is seen. The received data concerning the immunomodulatory activity of SPSA-vaccine even on first day give reasons for its usage not only in scheduled but also in urgent neurosurgery when it is necessary to produce the active immunity against the main infectious agents of nosocomial disease in maximum short time.