Objective is to present the first experience of creating extracranial-intracranial (EC-IC) bypass using the maxillary artery (MA) as an arterial donor for treatment of giant intracranial aneurysms (GIA), as well as for treatment of internal carotid artery (ICA) occlusion.

Materials and methods. We performed EC-IC bypasses using MA at 4 patients: at 3 patients with GIA of the anterior part of the Willis circle (giant fusiform aneurysm of the М1 segment of middle cerebral artery (MCA), giant fusiform aneurysm of the supraclinoid part of ICA, giant ICA bifurcation aneurysm) and at patient with ICA occlusion. All patients with aneurysms had tumor-like clinical manifestation. Patient with ICA occlusion had crescendo ipsilateral MCA transient ischemic attacks. Creation of the traditional EC-IC bypass was impossible because of superficial temporal artery injury as result of prior surgery in other hospital.

Results. We used transzygomatic pterional craniotomy, MA as a donor artery, M2 segment of MCA as a recipient artery and radial artery as an interposition graft in all cases. At patient with ICA occlusion surgical treatment included bypass creation, at all patients with GIA after bypass creation we performed aneurysm trapping (distal clipping of М1 segment at patient with MCA aneurysm, cervical ICA ligation at patient with supraclinoid ICA GIA, temporary trapping, thrombectomy and aneurysm clipping at patient with bifurcation ICA GIA). We confirmed bypass patency by intraoperative Doppler sonography and flowmetry and computed tomography or magnetic resonance imaging in postoperative period. In all cases bypasses were patent with flow 33–57 ml per min. Patient with ICA bifurcation GIA suffered from contralateral hemiparesis due to ischemia in anterior choroid artery territory in early postoperative period, which partially regressed at discharge. In other cases there were not any complications.

Conclusion. EC-IC bypasses with using MA as a donor and radial artery as an interposition graft can provide sufficient replacement blood flow in the MCA territory in cases of giant cerebral aneurysms and in patients with occlusion of the ICA. This type of bypasses is less traumatic compared with high-flow bypasses. Given the shorter length and less tortuosity of the graft, its more secure localization, we can assume a lower risk of bypass thrombosis in the early and late postoperative periods and higher patency of the graft.

Introduction. Pituicytomas and spindle cell oncocytomas (SCO) are very rare benign tumors of sellar and suprasellar region (grade I). In case of these tumors, the clinical symptoms and the results of neuroimaging are not specific, so it is almost impossible to diagnose the pituicytoma or SCO preoperatively. The feature of these tumors is ample blood supply which results in intense intraoperative bleeding. Such events on background of high density and infiltrative growth of the tumors make a radical resection difficult.

Objective is to present our own experience in surgical treatment and perioperative management of 8 SCO and 5 pituicytomas and compare it with the data of the scientific literature.

Materials and methods. The retrospective study included 8 patients with SCO and 5 patients with pituicytomas that underwent endoscopic endonasal transsphenoidal removal in 2012–2017. Also, the literature data on pituicytoma and SCO were analyzed.

Results. Total resection of SCO was successful in 4 cases, subtotal resection was done in 2 cases, and partial resection was done in 2 cases. All pituicytomas were resected extensively. Relapse of SCO was found in 4 patients. Postoperative complications (visual disorders and hemorrhagic complications) occurred in 2 SCO patients and in 1 pituicytoma patient. Postoperative improvement was seen in 3 patients.

Conclusion. Optimal treatment method for pituicytoma and SCO of sellar and suprasellar region is a total resection using endoscopic endonasal access. The prognosis is favorable if the resection was total, however, if the resection was not extensive a relapse of the tumor can occur, and repeated operation or radiation therapy can be required. In case of slow asymptomatic progression of the tumor, an observation can be continued.

Introduction. Different types of facial pain (FP) are the chronic, intractable diseases of the nervous system. To improve the effectiveness of surgery in patients with FP, to reduce the number of unnecessary invasive procedures and to increase the number of favorable outcomes, it is needed to use algorithms for choosing the most preferable interventions.

Objective is to evaluate the effectiveness of the proposed algorithm in the treatment of the FP in the practice of a neurosurgical hospital on a large number of patients, the development of algorithms for differentiated treatment of patients with the different etiologies of FP syndrome and to review the literature in light of the effectiveness of different types of interventions.

Materials and methods. The proposed algorithm was tested in 382 patients (128 men and 254 women) with different types of FP. Patients were treated in 4 hospitals from 2000 to 2016.

Results. The pain relief more than 25 % of the initial intensity of pain was detected in 78.2 % of patients in the follow-up period in all types of surgical interventions when using the algorithm.

Conclusion. The choice of the type of surgical intervention is based primarily on clarifying the etiopathogenetic mechanisms of the development of pain syndrome. This requires a comprehensive examination of patients using methods such as magnetic resonance imaging, the use of the T2 3D-CISS, the tractography of the trigeminal nerve root, the use of a contrast to diagnose the cause of FP. To select the optimal type of treatment, it is proposed to use algorithms, which reflect the most preferred methods.

Introduction. Improvement of the endovascular equipment expands the possibilities in the treatment of complex aneurysms of the brain. The use of low-profile stents allowed performing operations on complex distal aneurysms. This publication assesses the effectiveness and safety of such operations.

Materials and methods. In the department of vascular neurosurgery for the period from June 2014 to December 2016 using low-profile stent, 44 patients with 45 aneurysms of cerebral vessels were operated.

Results. 44 patients with 45 cerebral aneurysms performed 46 endovascular interventions. Most stents were implanted in the posterior circulation – 30 (65.2 %), in the anterior circulation – 16 (34.8 %) patients. Total occlusion (Raymond–Roy I) immediately after surgery was achieved in 35 (83.3 %), subtotal (Raymond–Roy II) – 7 (17.7 %). A favorable outcome of treatment was obtained in 44 (97.7 %). An unfavorable result was obtained in 1 (2.3 %) patient. There was no mortality.

The concept Philosophy of Neurosurgery, including genesis, meaning and purpose of this clinical discipline and neuroscience, basic principles, patterns of development and direction of research and treatment of neuropathology, interdisciplinary connections, comprehension of means and methods for the emergence of scientific, clinical, technological and humanitarian knowledge in relation to the tasks of neurosurgery, as well as the worldview of neurosurgeons, is revealed.

It is shown how the philosophy of neurosurgery is practically realized through clinical thinking and conceptual approaches to the surgical interventions on the brain and spinal cord.

Justified the importance of philosophical positions in the development of a new direction is preventive neurosurgery.

It is revealed how philosophical approaches allow successfully resist the hipoxillia and syndrome of the patient-physician separation. The development of neurosurgery philosophy allows to preserve both the integrity of the perception of this clinical discipline with its increasing technologization and differentiation, as well as the systematic approach to the patient.

Objective is to discuss the indications, technical details, risks, complications, results and prognosis of hemispherectomy in the treatment of seizures based on critical literature review and the authors experience.

Materials and methods. It was performed bibliographical consultation from 1920 to 2016, using as keywords “seizures”, “epilepsy”, “hemispherectomy”, in the databases MEDLINE, LILACS, SciELO, PubMed, utilizing language as selection criteria, choosing preferably recent articles in Portuguese, Spanish or English and only articles based in humans studies.

Results. The functional hemispherectomy showed improvent in the quality of life of patients that has the indication to perform this procedure because it allows reducing the frequency of seizures, whether tonic or atonic, tonic-clonic. Furthermore, it has been associated to a low rates of postoperative complications, like superficial hemosiderosis, ependymitis and obstructive hydrocephalus that often it has been showed in anatomical hemispherectomy.

Conclusion. The functional hemispherectomy has been showed a significant impovement in the outcome for those with seizures arising when indicated to selected cases. However, we concluded that there is no important study comparing the functional hemispherectomy approaches with results adjusted for different causative pathologies, what would be for future necessary for an important source of data about this topic.

Objective is to analysis of literature data, which analyzed the treatment data for patients with single and multiple spinal trauma at the thoracic and lumbar levels.

Materials and methods. The article analyzes 98 sources of domestic and foreign sewers published from 1971 to 2015, which reflect the issues of epidemiology, classification, clinical course, tactics of surgical treatment of patients with single and multiple vertebral-spinal trauma at thoracic and lumbar levels. In the sources, the results of treatment of long-term observations were performed.

Results. In the structure of spine and spinal cord trauma, its weighting is noted: an increase in the proportion of combined and complicated injury. Also in recent years there has been an increase in the number of multiple (5–20 %) and multilevel (3–50 %) spinal injuries. Despite the widespread use of modern diagnostic methods, such as computer and magnetic resonance imaging, the widespread distribution of X-ray diagnostics, multiple spinal injuries are not diagnosed in all cases or not in full. A huge number of both russian and foreign works is devoted to the diagnosis and treatment of vertebral-spinal trauma in general. The works highlight some aspects of diagnosis, tactics of management, scope and timing of surgical treatment for trauma to the spinal cord and spinal cord with lesions at various levels. However, there is a small number of publications, both in foreign and russian literature, devoted specifically to the diagnostic search features and tactics of surgical treatment of patients with multiple vertebral-spinal trauma. None of the work fully covers the tactics, sequence and features of treatment with multiple spine and spinal trauma.

Conclusion. Improvement of the diagnostic algorithm and development of optimal tactics for surgical treatment, prevention of complications and reduction of mortality in the group of these patients require more detailed specification and study, which will be of great practical interest.

The article considers epidemiology, features of diagnosis and treatment of patients affected by catatrauma, clinical picture of various types of catatrauma, possible complications and their causes.

Objective is to clarify the algorithm for diagnosis and prevention of treatment of purulent-inflammatory complications in patients after surgical treatment of diseases and injuries of the thoracic and lumbosacral spine.

Materials and methods. For iterature analysis 55 sources were used, they were chosen in eLIBRARY.ru and PubMed. Search terms: thoracic and lumbosacral spine, purulent-inflammatory complications, spondylitis, spondylodiscitis, obesity, surgery stenosis of the spine. The article describes the risk factors, treatment and prevention of inflammatory complications in patients operated on for spinal injuries and diseases of the thoracic and lumbosacral spine.

Objective is to analyze the results of introduction of simulation training in skills of surgical revascularization of the brain in the practice of rendering neurosurgical care to patients with carotid stenosis.

Materials and methods. Simulation training in skills of surgical revascularization of the brain was performed by the original method in the framework of the 5-day course. Regions have been identified, of which the largest number of doctors were trained, and calculated target surgical activity indicators with carotid stenosis, depending on the population of these regions. Comparison of target and achieved by 2016 indi cators of surgical activity allowed to judge the effectiveness of the implementation of a simulation training results in health care practice.

Results. In the period from 01.01.2014 to 31.12.2016 were trained 52 doctors from 20 subjects of the Russian Federation. Across the country, there was an increase the number of operated patients from 302 in 2002 to 4305 in 2015, and 5377 in 2016 which however does not exceed 4 % of the required number of surgical interventions. By 2016 78 % of carotid stenosis surgeries were made outside of Moscow and St. Petersburg. The ratio of interventions performed by neurosurgeons and vascular surgeons in the Russian Federation in 2002 was 1:8, and by 2016 – already 1:4.

Conclusion. Organization of simulation training in skills of surgical revascularization of the brain in a master class format is an effective tool for increase surgical activity in carotid stenosis.

Objective is to compare the annual demand for implementing mechanical thrombectomy (MT) in patients with acute ischemic stroke in the carotid pool, calculated in accordance with the current guidelines and criteria, which developed at the Interregional Clinical Diagnostic Center in Kazan (ICDC).

Materials and methods. The analysis of 851 case histories of patients with acute ischemic stroke, hospitalized at the ICDC, was carried out. The calculation of the implementing MT demand in the selection of patients according to current guidelines and criteria developed at the ICDC was performed.

Results. Annual demand for the implementing MT, calculated according to current guidelines is 14 operations per 100 thousand people per year. When applying the selection criteria developed in the ICDC, the annual demand is 9 operations per 100 thousand people.

Conclusion. The estimated demand for MT in acute ischemic stroke in the carotid pool depends on the criteria for selection of patients.