Objective: to popularization the knowledge about hemostasis in patients with chiasmosellar tumors during conduction of endoscopic transnasal transsphenoid neurosurgical operations.

Material and methods. The analysis of literature data dedicated to mechanism of action and area of application of modern hemostatic materials to solve the problem of hemostasis on endonasal surgery; our own material including more than 2000 patients operated during 10 years.

Results: nowadays the principles of surgery in patients with chiasmosellar tumors had been totally changed thanks to endoscopic technologies. The appearance of new hemostatic materials and new methods of their application allow recommending them in various clinical situations.

Conclusion: the usage of modern hemostatic materials allows conducting endoscopic transnasal interventions with minimal blood loss as well as decreasing the numbers of complications and expenses involved in blood transfusion.

Objective — to analyze the dynamics of status of neurosurgical care for patients with cerebrovascular diseases in Russian Federation in framework of implementation of Program aiming on reduction of mortality from cerebrovascular diseases.

Material and methods. The working data from departments of vascular neurosurgery of regional and federal centers along whole Russian Federation in 2007, 2014 and 2016 years were analyzed to study the surgical activity for treatment of the most widespread cerebral vascular pathology (aneurysms, arteriovenous malformations, cavernous malformation, hypertensive hemorrhages) based on previously determined number of operations which are needed to be performed per year in each region and in whole country per population. The postoperative lethality indicators were also examined in 15 regional vascular centers (RVC) of various federal regions and in 5 federal centers with the most active development of vascular neurosurgery and well-adjusted statistical process control system.

Results. The number of neurosurgical operations for treatment of cerebral aneurysms increased in 5,2 times from 2007 to 2016, arteriovenous malformation — in 5,8 times, hypertensive hematomas — in 5,3 times. Microsurgical treatment exceeds endovascular methods for treatment of aneurysms and AVMs in regional vascular centers however these methods are used equally as often in Federal centers. The numbers of operations for cavernous malformations are still insufficient in RVC. Surgery for hypertensive hemorrhages is carried out in RVC with some minor exceptions, moreover most of patients operated in EVC were in more severity state that is why the postoperative lethality was higher in RVC.

Conclusion. The surgical activity for cerebrovascular pathology increased in 9 times within 9 years of implementation of Program aiming on reduction of mortality from cerebrovascular diseases. The priority of neurosurgical care was moved from federal to regional centers where 75% of operation are performed nowadays. 

Objective: to demonstrate the efficacy of intraoperative videoangiography usage during microsurgery of intramedullary spinal haemangioblastomas.

Material and methods: 683 patients with intramedullary spinal tumors were operated on from 2002 till 2017, among them 93 (8%) patients had intramedullary haemangioblastomas. Authors operated 2 patients from June to August 2017 with the usage of videoangiography (microscope Haag-Streit Surgical©).

Results: The feeding arteries and drainage veins of tumor solid component were identified due to intraoperative videoangiography in 22 patients which allowed removing tumor without bleeding and increase of neurological deficit. The remnant of tumor was revealed in one patient during videoangiography and was totally removed.

Conclusion: The intraoperative videoangiography is available method of visualization of feeding arteries, drainage veins and borders of solid component of spinal intramedullary haemangioblastoma with the possibilities for multiple repeated usage during surgery. The application of this method in routine work allows increasing the safety of intramedullary haemangioblastomas surgery and decreasing the numbers of subtotal removal of tumor. 

Abstract. Background and Purpose. Associations between clinical presentation of brain arteriovenous malformations (AVMs) and their angioarchitecture have been described. This study aims to identify significant factors related to the initial hemorrhagic event through multivariate statistical methodology.

Methods. The authors studied the initial clinical presentation of 257 consecutive patients with brain AVMs. Angiographic features present at that time, such as location, size, and blood supply, were recorded following a standard protocol and associated, through multivariate analysis techniques, with type of presentation. Conclusions. For initial hemorrhagic presentation, deep location, а small size AVM, a small number of afferents, deep venous drainage and presence of intranidal aneurysms were significant associated factors. 

Objective: to study the influence of surgery timing on results of rehabilitation in treatment of atherosclerotic stenosis of carotid arteries in acute period of ischemic stroke.

Material and methods: the neurological outcome of treatment of 154 patients with symptomatic stenosis of internal carotid artery (ICA) in patients suffered from acute ischemic stroke were analyzed: 70 patients underwent conservative treatment, 84 patients — reconstructive operations on brachiocephalic arteries. Al patients were divided into 2 groups according to timing of surgical treatment: 1 st group — patients operated within 2 weeks after stroke (61 patients), 2d group — patients operated on 3d and 4th week after stroke (23 patients).

Results: оthe correlation between NIHSS scores and duration of hospitalization was discovered. The clearer dynamics of neurological restoration was seen among patients with early surgical treatment (first 14 days after stroke) with shorter hospitalization time comparing with patients operated on in delayed period after stroke. Conclusion: early reconstructive operations on carotid arteries in acute period of ischemic stroke leading to the better restoration of neurological functions and shortening of the rehabilitation.

Objective. The clarification of craniocerebral correlation, biomechanical characteristics of craniospinal system (CSS) and cerebrospinal fluid (CSF) dynamics has the significant importance for diagnostics and treatment of some pathology of central nervous system accompanied by development of hydrocephalic, hypertensive and dislocation syndromes. The widely used method for estimation of biomechanical characteristics and CSF dynamics reduces to performance of infusive-liquor test (partial infusion of physiological saline into CSF system and measurement of CSF pressure dynamics). This method is traumatic that is why it has limited application.

Material and methods. The biomechanical characteristics of CSS (compliance, PVI-index, resistance to CSF absorption, curves of infusive-liquor test) were studied using widespread method of A. Marmarou. The analysis of 126 infusive-liquor examinations of intracranial pressure (ICP) in 116 patients with hypertensive hydrocephaly of various etiology was conducted.

Results. The correlation which could be formalized was determined between ICP, CSS compliance and range of ICP pulse waves. The pulse wave going into brain during systole can be considered as model of infusive test.

Conclusion. The formula based on correlation which allows using physiological liquor dynamics tests with infusion of 2-5 ml of physiological saline for obtaining the accurate data about CSS biomechanical characteristics was created. 

Objective: to demonstrate the outcomes of open reconstructive surgical interventions for treatment of various types of non-syndromic craniosynostosis in children.

Material and methods: authors performed 57 open reconstructive operations to treat the various types of craniosynostosis from January 2014 till June 2016. Age of children varied from 6 months till 11 years old. The wide decompression of parietal lobes was performed in case of sagittal craniosynostosis. The bilateral frontoparietal reconstruction with reposition of frontoorbital complex is required for treatment of one- and two-sided coronal craniosynostosis. Frontoorbitoparietal reconstruction was performed in case of metopic craniosynostosis, parietooccipital reconstruction was used in case of one-sided posterior plagiocephaly. Algorithms for ordinary craniosynostoses surgery were applied for treatment of combined disease of cranial sutures. Preoperatively all patients underwent multispiral computer tomoghraphy with 3D-reconstruction for estimation of synostosis type, craniometrics values and intracranial volume. Treatment outcomes were estimated in 1 year using L.A. Whitacker scale.

Results. Postoperatively intracranial volume was increased in varied ranges in depends on patients’ age and types of craniosynostosis according to CT-volumetry data. Values of cephalic index in case of scaphocephaly were increased up to 6% in average, changes of frontal angle in case of trigonocephaly — about 12%, asymmetry coefficient of cranial vault in case of plagiocephaly changed to 47%. The good treatment outcome was observed in 89,5% of cases, satisfactiry — in 10,5% according to L.A. Whitacker scale.

Conclusions. Surgical treatment outcomes in patients underwent open reconstructive operations demonstrate the prevention of development or reversal of intracranial hypertension and deformation of child’s head. The achievement of esthetic effect was observed after operation at once. 

Objective. To estimate of efficacy of hyperbaric oxygenation in early postoperative period in patients with lumbar degenerative stenosis.

Material and methods. The analysis of treatment outcomes of 20 patients with degenerative lumbar stenosis was conducted. All patients had only neurogenic intermittent claudication in one or both legs as clinical signs of disease. The presence of radicular symptoms at rest and in prone position was the exclusion criteria as well as diabetes mellitus, any concomitant pathology of nervous system and previous spinal operations. The electroneuromyography (ENMG) of lower extremities was performed before operation for all patients. Surgical treatment included decompression of vertebral canal at the level of stenosis with the following stabilization in most of cases. All patients were divided in 2 groups after operation and repeated ENMG was performed in 8 days after operation: I group — 10 patients with routine postoperative conservative treatment (antibiotic and analgesic therapy, medical gymnastics, physiotherapy); II group — 10 patients who underwent routine treatment with combination of 8 sessions of hyperbaric oxygenation (HBO) starting from 1st postoperative day. Patients of both groups were compared according to intensity of neurogenic intermittent claudication before operation and in 8 days after operation estimating the walking distance and pain intensity in leg using Visual Analog Scale (VAS). ENMG data before and in 8 days after operation were also compared. The following nerves were estimated during ENMG: mixed common peroneal nerves, motor tibial nerves and sensory sural nerves. The parameters of M- or S — response (latent time, amplitude), nerve conduction velocity (NCV) and parameters of F-waves (recruitment, amplitude range, latency diapason, F/M correlation) were estimated.

Results. The mean value of pain intensity before operation was 5,2±1,7 scores according to VAS in patients of I group and 5,4±1,9 scores — in patients of II group. The mean walking distance before operation was 370±330 m in I group and 340±310m — in II group. Postoperatively the mean value of pain intensity was 1,8±0,7 scores according to VAS in I group and 1,3±1,4 scores in II group, walking distance — 620±310 m and 610±340 m correspondingly. There were no significant difference in parameters of ENMG in both groups.

Conclusion. The HBO conduction in patients with degenerative lumber stenosis in early postoperative period improves the clinical signs and fastening the rehabilitation however it does not improve the ENMG parameters. 

Objective: to examine the results of surgical treatment of patients who had previous operations with the usage of implants because of degenerative disease of lumbar spine.

Material and methods. The results of repeated surgical treatment of 96 patients who had previous operations with the usage of implants because of degenerative disease of lumbar spine are analyzed, among them 36 (37,5%) male and 60 female (62,5%) patients with the average age 53,813,3 years old. 5 (5,2%) patients underwent first operation in authors’ department. Preoperative examination included MRI, CT and X-ray examination of lumbar spine with the evaluation of segments stability and vertebral balance. Functional activity and life quality were assessed using Oswestry disability index and SF36 before operation as well as in 6 and 12 months postoperatively. Treatment outcomes were estimated using MаcNab scale [11].

Results. Patients were divided into 2 groups — with insufficient primary surgical intervention (43 patients) and with disease progression on adjacent level (53 patients). The main surgical techniques are described. Follow-up period was for 1 year/ The analysis of the treatment outcomes and causes for repeated surgery was conducted as well as the occurred complications were examined. The favorable outcomes of differentiated treatment were achieved in 74,2% patients.

Conclusion. The syndrome of adjacent vertebra level is the main cause for repeated surgery (55,2% patients). The most often cause for repeated surgery on operated vertebral segment is pseudarthrosis which was revealed in 30 (69,8%) patients. The surgical treatment outcomes are significantly worse (p=0,03) after interventions on previously operated segment comparing with the adjacent segments.

Objective. To estimate the life quality level, neuropsychological status and cognitive functions in patients with cerebral aneurysms in early and delayed period after surgical treatment.

Material and methods. 140 patients with cerebral aneurysms operated in Military State Academy were examined in early and delayed postoperative periods. The SF-36 questionary, was used for estimation of life quality, anxiety level — Hamilton Rating Scale, cognitive functions - Mini Mental State Examination, Montreal Cognitive Assessment and battery of tests for estimation of frontal dysfunction.

Results. The decrease of life quality was revealed according to all subscales of SF-36 questionary in patients suffered from hemorrhage as well as deterioration of emotional aspect of life quality in patients with unruptured cerebral aneurysms. The cognitive dysfunctions are observed in half of patients with ruptured aneurysms in delayed postoperative period. The postoperative cognitive dysfunctions in patients with unruptured aneurysms were fragility and were not seen in delayed postoperative period.

Conclusion. The decrease of life quality and development of neuropsychological deficit are the often consequences of aneurysmal subarachnoid hemorrhage and surgical treatment of cerebral aneurysms in patients with good neurological outcomes with more expressed negative effect on these aspects after open surgery comparing with endovascular treatment.

Objective: to present the rare clinical case — cyst of pellucid septum with aggressive clinical course.

Material and methods. Female patient, 24 years old had transient and gradually growing within 6 months occlusive and hypertensive symptoms after minimal head injury. Brain MRI revealed cyst of pellucid septum with the volume of 16 cm3, compressed the frontal horns of lateral ventricles and occlusion of Monro foramen from both sides.

Results. The endoscopic fenestration of pellucid septum cyst was performed under the control of frameless neuronavigation. The good clinical outcome was achieved with the total release of symptoms of intracranial hypertension and occlusion of liquor pathways.

Conclusions: endoscopic fenestration of pellucid septum cyst is effective treatment method. 

Objective. Literature review dedicated to clinical usage of ultrasound navigation in surgical treatment of spinal cord and nerve roots.

Material and methods. Authors analyzed 79 papers from 1984 to 2017 of Pubmed database dedicating to ultrasound navigation in patients with extramedullary and intramedullary tumors, syringomyelia, arachnoid cysts, Arnold—Chiari malformation.

Results. Intraoperative ultrasound examination (IOUE) allows conducting navigation in real-time mode, providing images of those structures not available for direct visualization in high quality, that is allows optimizing the surgical manipulations.

Conclusions: IOUE in surgery of spinal cord and nerve roots is perspective method, which is simple in teaching and effective for intraoperative visualization not requiring high economical costs.