Objective. To evaluate the efficiency of anterior cervical foraminotomy in patients with degenerative disease of cervical spine presented with monoradicular syndrome. Material and methods. The anterior cervical foraminotomy was performed in 51 patients in the «Federal Center of Neurosurgery» of the Russian Federation, Novosibirsk in the period from December 2012 to December 2015. Clinical and neurological status was evaluated by «visual analogue scale of pain estimation» (VAS) in hand and neck, life quality control - «Neck Disability Index» (NDI). Results of surgical treatment were estimated according to «Macnab» scale. Results. The study included 50 patients with degenerative changes of cervical spine with clinical and neurological development of monoradicular syndrome. The cause for the nerve root compression in 27 patients (54%) was a disk fragment, in 4 patients (8%) - osteophyte, combination of disk fragment with osteophyte - 19 patients (38%). The follow-up period was 12 months. There were no symptoms of radicular pain according to VAS in 12 months after operation. NDI was 10.2/11 (8; 12). The results of «Macnab» in 12 months were the follows: 52% - «excellent», 48% - «good». Conclusion. Anterior cervical foraminotomy provides possibility to achieve direct effective anatomical decompression of the nerve root and preserve the functioning motion segment. Therefore, this surgery is an effective option for the treatment of patients with degenerative disease of the cervical spine and clinical-neurological manifestations of monoradicular syndrome.

Objective: To validate the critical approach to the results of early computed tomography in patients with focal traumatic brain injury in the acute period of TBI. Material and methods: Data of 109 patients in acute period of TBI with total number of 209 focal brain lesions were analyzed. The volume dynamics of the lesions was monitored in primary and follow-up CT-scans. The common estimation of CT images was conducted using the Marshall and Rotterdam classifications in comparison with dynamics of clinical signs. Results: It was revealed that the lesion volume increased due to hemorrhagic component of the traumatic lesions, which was the smaller as shorter was the time period from trauma to their detection on a primary brain CT scan. There was not found any correlation between the lesions progression and the clinical status, that may be due to different brain reactions on the injured zone enlargement. Conclusion: “Early” (15 minutes - 2 hours) computed tomography studies in acute period of TBI do not reflect the real severity of brain damage, the evolution of which is still going on and ends later. The usage of the special CT-scales in dynamics allows selecting “important” progression of traumatic lesions with mass-effect increasing and “unimportant” without it.

Objective: to evaluate the outcomes of endovascular treatment of intracranial aneurysms in acute period of subarachnoid hemorrhage (SAH) with the aim to enlarge the usage of endovascular treatment in routine practice for ruptured aneurysms in acute period of SAH. Material and methods: 28 patients suffered from ruptured aneurysms were operated using endovascular method in acute period of SAH from 2012 to 2015 in Federal Medical Biophysical Center n.a. A.I. Burnazyan of FMBA of Russian Federation. Results: Total occlusion of aneurysms was seen in 75% of cases, one patient (3,6%) suffered from intraoperative ischemic stroke. Favorable outcomes were seen in all patients (Hunt-Hess I-III) as well as in 4 among 7 patients with Hunt-Hess IV. Common lethality was 14%, excluding patients with Hunt-Hess 1-IV severity of state. Conclusions: endovascular treatment of ruptured aneurysms in acute period of SAH is effective and safe method among patients with Hunt-Hess I-IV.

Objective: to verify the variability of shapes and sizes of bony structures of occipitovertebral region. Material and methods. The shapes and sizes of occipital condyles and upper articular facets of atlas were determined using 70 complexes of skull and upper cervical region of adults using craniometry and osteometry. Results. The following shapes of occipital condyles and articular facets of atlas were determined: oval, beanshaped, eight-shaped, triangular, divided and irregular. Their extensiveness was demonstrated. The statistically significant predominance of occipital condyles sizes (length, width and square area) above the sizes of upper articular facets of atlas. The correlations between examined parameters were demonstrated. Conclusion. The articular surfaces of atlanto-occipital joint have variable shapes and sizes. The fluctuant dissymmetry is indicative for the sizes of articular surfaces of atlantooccipital joint. There are various variables and malformations of bony structures in occipitovertebral region. The assimilation of atlas and the presence of third occipital condyle are also described in the group of examined patients.

Objective. The literature review concerning surgical treatment of cervical spinal stenosis with myelopathy using laminoplasty. Material and methods. The analysis of 46 papers from Pubmed and Russian publications was conducted. The following key words were used: spinal stenosis, myelopathy, laminoplasty. All papers were published from 1963 to 2015. Results. Multiple studies indicate the efficacy of laminoplasty for treatment of multilevel cervical spinal stenosis with myelopathy. The favorable outcomes according to various authors were achieved in 50-70% of cases. Conclusion. The correct selection of patients for laminoplasty allows achieving good clinical outcomes in the treatment of multilevel cervical spinal stenosis with myelopathy.

Objective. To describe the clinical pathobiomechanics, existing classifications, diagnostics, and treatment conceptions of atlas injuries. Material and methods. Literature review. Results. Atlas injuries make up to 25% of craniocervical injuries, and from 1,3% to 2% of all spinal injuries. Their most frequent cause is motor vehicle accidents going with axial loading. In majority of cases the atlas fractures are combined with the fractures of other cervical vertebras, mostly with the axis fractures. The treatment approaches are based on the isolated or combined type of atlas injuries and also on transverse ligament integrity. The treatment options in combined atlas injuries depend on the type of axis fracture, and include halo fixation, atlantoaxial or transodontoid surgical stabilization. The main way for treatment of the isolated atlas fractures is halo-fixation. Surgical stabilization is recommended in cases of late instability. The evolution of methods of atlantoaxial stabilization as the main way of the surgical treatment of this type of injuries is also represented. Conclusion. The halo-fixation is effective way to treat atlas fractures. The necessity and probable advantages of surgical stabilization of atlas fractures requires further study for refinement.

The analysis of literature data concerning cell and tissue technologies in bone plastics and prospects of their usage in stabilizing interventions on vertebral column was conducted. Authors analyzed 119 articles from PUBMED and Google Scholar database in international peer-reviewed periodicals from 1989 to 2015. The growth factors enhancing bone regeneration and bone block formation, optimal properties of material for bone replacement as well as the influence of stem cells and inflammatory mediators for the processes of osteoreparation and osseointegration were discussed.

The first clinical experience of non-invasive motor cortex brain mapping in patients who underwent stereotactic gamma knife radiosurgery for malignant brain tumors is presented. MRI Functional brain mapping (fMRI) and navigated transcranial magnetic stimulation (TMS) were performed to achieve lower doses of eloquent cortex irradiation. Motor mapping allowed achieving the optimal beam collimation even in conditions of changed brain anatomy. Integration of fMRI and navigated TMS into treatment planning may lead to reduction of motor complications after stereotactic radiosurgery.

The clinical case of successful microsurgical treatment of 52 year-old man with proximal fusiform aneurysm of the right posterior-inferior cerebellar artery (PICA) is presented. This patient underwent microsurgical trapping of the right PICA aneurysm after the performance of intra-intracranial side-to-side bypass between the right and left PICA in delayed period of subarachoid hemorrhage. The side-to-side PICA-PICA bypass is the optimal revascularization surgery for fusiform aneurysms of proximal PICA region and can be applied as a first step before the deconstructive microsurgical or endovascular intervention.

Authors present the clinical case of patient with cavernous venous malformation which leaded to ischemic stroke of right cerebellar hemisphere with hemorrhagic transformation. The pathogenesis, features of clinical signs, methods of diagnostics and surgical treatment are discussed. Authors present their own clinical case because of extremely rarity of such pathology.

Functional magnetic resonance imaging (fMRI) is a modern, non-invasive method of the neurovisualisation allowed measuring and localizing specific areas of the human brain, responsible for some functions, without application of radiation. Physiological principles of fMRI are based on detecting of small changes in blood flow in the brain areas in response to increasing demands during metabolic activation. This technique has grown rapidly in popularity over the past decade and is being used increasingly in neurosurgery for both preoperative planning and intraoperative neurosurgical decision making in patients with brain tumors and other neurosurgical pathologies such as intractable epilepsy. If the patient needs tumor resection or removing a portion of the brain responsible for initiating epileptic seizures, the preservation of functions during operation is an essential goal of neurosurgery and fMRI allows planning surgical approach that will spare as much of these areas as possible. The combined registration of high resolution anatomic and physiological data from multiple complementary sources such like electroencephalogram (EEG) and fMRI, which provide insights into the networks underlying seizure generation will be used to investigate many pathological processes and plan more neurosurgical procedures in the future.

Objective: to discuss the modern aspects of interventional surgical care organization for patients with acute ischemic stroke. Material and methods: the current literature data concerning usage of interventional techniques in patients with acute ischemic stroke were analyzed. The main principles of interventional surgical care organization for such patients were determined. Results: the key moments for organization of interventional surgery are the follows: specialists training, development of working protocols and algorithms for usage of interventional techniques in patients with acute stroke as well as to provide the techniques and consumable materials for vascular medical centers, where this type of medical care is possible. Conclusion: The national recommendation protocols determined the training of specialists, operation algorithm for «stroke» teams and estimation of medical care efficiency are necessary to be created for effective introduction of such technologies in clinical practice.

Objective. To define the tasks of simulation training as well as the criteria and mechanisms for practical skills certification of neurosurgeons. Methods. The search in the database PubMed data revealed 19 foreign publications devoted to issues of education and training of a simulation curve in neurosurgery. The analysis of the Russian legislation concerning issues of practical accreditation of doctors was performed. Results. The suggestions for dividing the neurosurgical interventions on the terms of complexity and practitioners on the levels of competence were made based on the literature data analysis. The concept of the practical organization of accreditation neurosurgeons within continuing medical education was initiated Conclusions. It is necessary to organize the system of practical training and accreditation of neurosurgeons at the base of simulation-accreditation centers.