Introduction: Meningeal tumors present the large group of different mass lesion. This article describes meningiomas, hemangiopericytomas and various non-meningeal  mesenchymal tumors. Preoperative verification of histological  subtype and meningeal tumor density influences of treatment  strategy selection and prognosis of surgical outcomes. Nowadays the analysis of these mass lesions is performed using various MRI methods.

Objective: to analyze the development algorithm of MRI images processing for preoperative verification of histological type and subtype of meningeal tumors .

Material and methods: We analyzed MRI data and histological final conclusion of 47 patients. Preoperative brain MRI performed using  the following devices: GE Signa 1.5 T, Toshiba Excelart Vantage. 1.5  T, Toshiba Atlas — XGV, 1.5 T. Among all examined patients 31  patients had benign meningiomas (Grade I): 13 —  meningotheliomatous subtype, 10 — fibroplastyc subtype and 8 —  intermediate subtype. One patient had intermediate type of  meningioma (atypical meningioma, GR ADE II), 6 patients had  malignant type of meningiomas (GR ADE III), 6 others — hemangiopericytomas and 3 patients suffered from primary intracranial sarcomas.

Results: Sensitivity of algorithm for verification of fibroplastic and meningotheliomatous subtypes of meningiomas, anaplastic and  atypical meningiomas including primary intracranial sarcomas and  hemangiopericytomas consists of 91 — 94,2% for tomographs of various companies.

Conclusion: The developed algorithm with high sensitivity and specify verifies histological type and subtype of meningeal tumors  while analyzing MR tomograms. However, the dislocation of  histogram peaks intervals during processing of MRI images of tomographs of various companies required the following studies.

Abstract. Although temporal lobe epilepsy (TLE) is the most studied form of partial epilepsy, there are still many patients with drug  resistant forms. Temporal lobe surgery takes 50-73% of all epilepsy  surgery and can be an effective treatment for patients whose  seizures do not respond to best medical therapy. However the choice of surgical approach and extent of resection are controversial till nowadays.

Objective: to evaluate the surgical outcomes in patients with TLE using intraoperative and chronic ECoG.

Material and methods: 11 patients with TLE were included to this study. Patients with focal epilepsy caused by tumors (more than  Grade 2) and AVMs were excluded. The area of temporal lobe  resection was determine using intraoperative ECoG in 8 patients (40%), 3 patients (15%) underwent lobectomy determined with the help of MRI and EEG findings and at 9 patients (45%)  preoperative chronic ECoG was used for surgery planning. Follow-up period was 12-36 months.

Results: Surgical outcome was evaluated according to ILAE scale, 10 patients (50%) became seizure-free and got Class 1, one patient  (5%) had only 3 days per year with seizures, which is Class 3. Five  patients (25%) achieved improvement after surgery and got Class 4. Four patients (20%) did not get any significant benefits from surgery and got Class 5.

Conclusion: ECoG-tailored resection provides better surgical outcome.

Objective: to evaluate the influence of volume of arteriovenous malformation (AVM) excluded from cerebral blood flow on course of symptomatic epilepsy.

Material and methods. 137 primary patients with AVM and concomitant symptomatic epilepsy were treated. All patients were  divided into 2 groups: 1st group (n = 67) included patients with total and subtotal elimination of AVM from blood flow, 2d group (n = 70)  – patients with partial elimination of AVM. All patients underwent endovascular embolization of AVM. The dynamics of  symptomatic epilepsy course disease was compared between two  groups according to treatment outcomes. The control for epileptic  seizures after endovascular treatment was estimated using Engel scale.

Results. Follow-up after endovascular treatment was from 1 till 5 years (mean - 3 years). I class by Engel scale in 1st group was  achieved at 44 (66,7%) patients, in 2d group - at 22 (31%) patients that was significantly (р<0,01) verification about advantages of total and subtotal occlusion of AVM comparing with partial elimination of AVM from blood flow.

Conclusion: Thus total occlusion of AVM from blood flow provides the best control over epileptic seizures and significantly improve life  quality. However even partially occlusion of AVM significantly  decrease the frequency of epileptic seizures based on decrease of brain steel phenomena.

Objective: to determine the risk factors, frequency and causes for damage of dura mater (DM), optimize algorithm for prevention and  treatment of postoperative liquorrhea at patients with trauma and  degenerative diseases of subaxial cervical spine.

Material and methods. We analyzed surgical treatment outcomes of 552 patients with trauma and degenerative diseases of cervical  spine which were operated on in neurosurgical department of  Sklifosovsky Research Institute of Emergency Care from 01.01.2001  till 31.12.2013. Among them 438 operations were performed  because of cervical spine trauma, 116 operations — because of  degenerative spinal diseases (79,0 and 21,0% of operations correspondingly). Anterior approach was used at 505  (91,0%) operations, posterior cervical fusion — 28 patients (5,0%  operation), combined interventions on anterior and posterior structures of cervical spine — 21 patients (4,0% operations).  Operation on one spinal motion segment (SMS) was performed at  225 (40,5%) patients, 2 SMS — 269 (48,4%) patients, 3 SMS — 49  (8,8%), 4 SMS — 9 (1,6%) and on 5 SMS — at 2 (0,4%) patients.  Emergency surgical intervention was done at 403 patients (73,0%  operations), scheduled surgery — 151 patients (27,0% operations).

Results: damage of DM after or during surgery occurred at 27 patients (5,0% operations, n=554). Among all patients with cervical  spine trauma liquorrhea was detected at 17 (3,9%, n=438) patients  comparing with 10 (9,0%, n=116) among patients with degenerative spinal disease. The following mechanisms of DM damage were  revealed: 1) DM damage by sharp fragments of fractured vertebra—  9 (33,3%, n=27) patients with spinal trauma; 2) multiple tearings of DM during preganglionic detachment of spinal roots— 2 (7,4%, n=27) patients; 3) damage of DM by Kerrison rongeurs during  decompression of neurovascular structures — 16 (59,2%, n=27) patients. The leakage of cerebrospinal fluid during operation was seen at 24 (88,9%, n=27) patients. This group of patients  demonstrated the high efficacy of wound liquorrhea prevention  during operation and in early postoperative period, DM damage had  not influenced on hospital stay days and treatment outcome. Iquorrhea in eraly postoperative period was revealed at 3  (11,1%, n=27) patients, all of them underwent repeated surgery.

Conclusion: the high risk of DM damage with liquorrhea is seen at patients with ossified оposterior longitudinal ligament (18,0%, p  <0,000001). The most DM damages could be detected  intraoperatively (88,9%) and dangerous complications could be prevented in case of on-time prophylaxis of wound liquorrhea.

Objective: to analyze the surgical treatment outcomes in patients with posttraumatic syringomyelia in «National medical surgical  center n.a. N.I. Pirogov» and to determine the optimal strategy for treatment of such patients.

Material and methods. Authors treated 44 patients with posttraumatic syringomyelia (PTS) from 2010 till 2016 yy., among  them 28 patients were operated on. Follow-up was from 11 months  (minimal) to 54 months (maximal). Age of patients varied from 15  till 58 years old (mean age — 38,7±4,8 years). The estimation of neurological status was done preoperatively, in 4 months after  operation and every 6-12 months postoperatively according to  Karnofsky scale, Japanese Orthopaedic Association (JOA), functional  classification of McCormick, Visual Analogue Scale (VAS) — in the case of pain syndrome. The examination of all patients in pre-and postoperative period includes the following methods: plain  spondylography in two routine projections, spinal CT and spinal MRI. Classification of Klecamp J. was used for evaluation of severity of arachnoid cicatrical tissue.

Results. Patients were divided into two groups for estimation of surgical operation results. The mean score according to Karnofsky  scale was 76,2 preoperatively and in 12 months after operation —  82,7 among patients with uncomplicated spinal trauma. Patients’  condition according to JOA before operation was 10,9 scores, after operation — 14,6; mean value according to McCormic scale  before operation — 2,4 degree, after operation — 1,6 degree. Mean  degree of arachnopathy in this group of patients was 1,5. The  syringomyelic cyst decreased almost twice in 1 year after operation according to MRI (mean Vaquero index decreased from 42,5 till 23,5%). The improvement of condition was seen at 10 (62,5%)  patients, stabilization - at 5 (31,3%) and the progression of disease  was seen at 1 (6,3%)patients. The mean score according to  Karnofsky scale was 62,4 preoperatively and in 12 months after  operation — 76,6 among patients with complicated spinal trauma.  Patients’ condition according to JOA before operation was 8,2 scores, after operation — 11,1; mean value according to McCormic scale before operation — 3,6 degree, after operation — 2,7 degree. Mean degree of arachnopathy in this group of patients was 2. The  syringomyelic cyst also decreased almost twice in 1 year after  operation according to MRI (mean Vaquero index decreased from  53,3 till 26,8%). The improvement of condition was seen at 4  (33,3%) patients, stabilization - at 6 (50%) and the progression of  disease was seen at 2 (16,7%) patients. The postoperative complications developed at 2 patients.

Conclusion. The operation should be directed on elimination of all factors which disturb the spinal fluid circulation. The shunt of  syringomyelic cyst is palliative operation with high risk of PTS  relapse. At the same time arachnolysis in addition to shunting of cyst may improve the surgery outcome due to decrease of spinal cord  volume and rapid clinical effect from operation. The usage of  selected strategy of PTS treatment in our group of patients allowed achieving stabilization of condition or even improvement in 89,2% patients.

Objective. To analyze the efficacy of two types blockade in the treatment of facet syndrome at patients with lumbar osteochondrosis.

Material and methods. The analysis of treatment outcomes at 70 patients with facet syndrome because of lumbar osteochondrosis was performed. Mean age was 61 years old (from 47 till 84 years old),  men were 11, female patients — 59. Exclusion criteria were radicular symptoms, neurogenic intermittent claudication, compression of neural structures according to MRI data, spondylolisthesis,  vertebral instability according to X-ray examination. Diagnosis of  facet syndrome was done based on positive effect of diagnostic  blockade of damaged facet joint. Further we performed the  medicative blockade of relevant facet joint. All patients were divided  into 2 groups accordingly to type of medicative blockade. Patients underwent blockade with Kenalog were included in 1st group (n=40) and patients underwent blockade with alcohol and  lidocaine — 2d group (n=30). The severity of pain syndrome was  estimated in scores using Visual Analogue Scale (VAS). Dynamics of  pain syndrome was evaluated in 2 days after blockade and in 3, 6 and 12 months after procedure.

Results. The mean intensity of pain syndrome before blockade was 7,5 scores in 1st group and 7,2 scores in 2d group. The mean  intensity of pain syndrome in 2 days after medicated blockade was  2,3 in 1st group and 2 scores in 2d group. The mean intensity of  pain syndrome in 3 months after medicated blockade was 2,5 in 1st  group and 2,2 scores in 2d group. The mean intensity of pain  syndrome in 6 months after medicated blockade was 4,8 in 1st  group and 3,3 scores in 2d group. The mean intensity of pain  syndrome in 12 months after medicated blockade was 5,3 in 1st group and 4,6 scores in 2d group. Minima pain syndrome (1-2 scores) in 12 months after blockade was seen at 17,5% (n=7) patients in 1st group and at 20% (n=7) patients of 2d group (n=7).

Conclusion. The usage of facet joints blockade is effective method for pain relief at patients with facet syndrome. The mean duration of  analgesic effect of blockade with usage of alcohol and Kenalog was 3 months and alcohol-lidocaine — 6 months

Objective. To enlight the features of neuroethics and new hallenges  arising in modern neurosurgery because of its intimate connection with technology.

Material and methods. We analyzed the literature concerning neuroethics as well as our long-term experience and some groups of  neurosurgical patients (78 patients with acute traumatic intracranial  hematomas and brain contusions treated conservatively; 490  patients with chronic subdural hematomas) with their  neurovisualization and catamnesis follow-up.

Results. The factors for neurosurgery humanization were ystemized. The new challenges arising because of wide use of neurovisualization methods are discovered: фетишизация of visual data and ignoring  of clinical signs and patient himself; professional duties of physician  and mercantile temptations; holiness of life and quality of life and  some others. It was demonstrated how ethic problems are raised  which may lead to atrophy of clinical thinking, hyposkillia and increase of distance between physician and patient.

Conclusion. The solve of challenges in modern neurosurgery requires taking into account both interests of patient and society  that means combination of high professionalism of neurosurgeon  with priority of ethics and humanity values during all time of his education.

Objective: to estimate the role of functional magnetic resonance imaging (fMRI) in preoperative planning at patients with tumors in eloquent brain areas.

Material and methods: this clinical case describes the patient with the tumor in right precentral gyrus. The mapping of motor cortex  was performed as preoperative examination using fMRI and  navigation transcranial magnetic stimulation (TMS).

Results: it was revealed that tumor is very close to motor cortex of left hand. The removal of tumor was performed using  neurophysiological control taking into account the high risk of moto deficit in postoperative period.

Conclusion: usage of fMRI during pre-and intraoperative planning allows performing the maximal resection with minimal impairment of brain functions.

Objective: to demonstrate the possibilities of modern endovascular surgery for treatment of patient with brain stem arteriovenous malformation (AVM).

Material and methods: patient 46 years old with severe oculomotor deficit suffered from repeated ventricular hemorrhages. Brain MRI revealed AVM in oral parts of brain stem.

Results: the successful transarterial embolization of AVM using non-adhesive composition Onyx-18 (Covidien) was performed.

Conclusion: the usage of endovascular embolization of brain stem AVM is relatively effective method for treatment of patients with such pathology.

Objective: to estimate the technical aspects and safety of surgical treatment of isolated stenosis of common carotid artery (CCA) orifice using endovascular technique from retrograde transcarotid approach.

Material and methods: patient 57 years old was admitted to hospital in scheduled way with diagnosis of atherosclerosis, subtotal stenosis of CCA orifice, chronic cerebrovascular insufficiency.

Results: The stenting of CCA orifice was performed via retrograde transcarotid approach using balloon-expanded stent.

Conclusion: this article made an accent on technical aspects of such surgery which allows successfully using the mentioned method for treatment of proximal stenosis of brachiocephalic arteries.

The rigid fixation of one or more levels of cervical spine in treatment of degenerative vertebral diseases may lead to development of  adjacent level syndrome. The protheses of intravertebral disks  preserving the mobility in spinal motion segment are placed for prevention of this complication.

Objective: to describe the decompression of spinal roots and (or) spinal cord with functional stabilization of spinal motion segments.

Material and methods: we analyzed indications and contraindications for placement of intervertebral disk prothesis «М6-С». Preoperatively the special attention must be paid for patient’s position on the table. The approach is needed to be performed  accurately with the following correct selection of artificial  intervertebral disk and maintaining the surgical technique of its  arrangement. The disk implantation is performed under X-ray control using С-arch.

Conclusion: the wearing of semi-hard head holder is not required for patients after prothesis of artificial intervertebral disks and  patients could restore in shorter postoperative period and return to  their daily activity. The preservation of movements volume in all  projections in operated spinal motion segments promotes the more  physiological distribution of pressure on vertebral column and  prevents the development of adjacent level syndrome.

Objective: to describe the features of 2D and 3D reconstruction modelling based on CT-angiography at patients with intracranial aneurysms in preoperative period.

Material and methods: we analyzed data of CT-angiography of patients with complex cerebral aneurysms performed from 2014 till  2017 to estimate the features of their reconstruction. CT- angiography was performed in routine way and in extended volume including visualization of extracranial parts of brachiocephalic arteries.

Results: anatomical features of skull base and intracranial arteries must be taken into account during reconstructions based on CT-angiography data at patients with unruptured cerebral aneurysms. Obtained results must both provide accurate information about  aneurysm and optimize the planning of surgical intervention  including surgical approach and volume of operation.

Conclusion: 2D- and 3D-reconstructions are the obligatory during CT-angiography of intracranial arteries at patients with unruptured  aneurysms for the preoperative planning taking into account the  possible type of surgical intervention.

Objective: to perform the analysis of literature data dedicated to the problem of postoperative liquorrhea during cervical fusion as well as to treatment strategy and the possibilities for prevention of such complication.

Material and methods: We searched through such databases as PubMed (http://www.ncbi.nlm.nih.gov/pubmed), Еlibrary  (http://elibrary.ru) and archives of journal «Neurokhirurgia. The  Russian journal of neurosurgery» and «Hirurgia Pozvonochnika».

Results: The damages of dura mater (DM) during operations of cervical spine (CS) jccur at 0,4–6,3% patients according to literature data. The negative consequences could be avoided in case of  intraoperative diagnosis of this complication which observed in most  reports that allows performing the adequate manipulations for  primary prevention of wound liquorrhea, otherwise the repeated  operations are required. The most authors mention the following risk factors for DM damage such complicated spinal trauma, rheumatoid  arthritis, elderly age, severe kyphotic deformation of cervical spine  and repeated operations. The DM damages are the most often occurred during usage of high-speed drill, ultrasound bone  knife, rongeurs, scraping curettes as well as during electrocoagulation applying intimately close to DM.

Conclusion: Nowadays predominately retrospective literature reviews with few numbers of cases are dedicated to the problem of  postoperative liquorrhea during cervical fusion. The large prospective multicenter trials are required for development of optimal algorithm  for prevention and treatment of postoperative liquorrhea during cervical fusion.

Objective. To analyze the literature data dedicated to diagnostics of vertebral segment instability at patients with lumbar osteochondrosis.

Material and methods. Search for Russian literature data was performed in central scientific library of First Medical State University n.a. I.M. Sechenov with the usage of internal search system. Search  for English literature data was conducted via Internet using Pubmed  and Medscape. The following key words were used during search:  vertebral osteochondrosis, degenerative disease, lumbar and sacral  spine, instability. Only full-text articles were analyzed.

Results. We found and analyzed 50 literature sources according to our criteria. The biomechanical base for vertebral instability  development are enlighted as well as hypotheses of such condition  development are discussed. The detailed results of modern trials  dedicated to estimation of clinical and instrumental examination of instability are presented.

Conclusion. The problem of lumbar instability because of vertebral osteochondrosis is widely studied. Mostly the term «instability» is  justified as clinical term. Nowadays there are no instrumental  method of examinations correlated in 100% with clinical manifestation of instability.