The study objective is analysis of surgical treatment results of adult patients with tumors of the fourth ventricle and determination of predictors of unsuccessful outcomes.

Materials and methods. In the present study we review results of treatment of 33 adult patients with tumors of the fourth ventricle, which were operated via telovelar approach in Federal Neurosurgical Center (Novosibirsk). The most common symptoms included hydrocephalus (54.5 %), cerebellar dysfunction (33.3 %), cranial nerve deficits (30.3 %). The tumor size was more than 40 mm in 22 cases (66.7 %). The brain stem invasion was occurred in 21 cases (63.6 %).

Results. 23 tumors were removed totally (69.7 %). Hydrocephalus was regressed in 17 cases (94.5 %). Cerebellar mutism did not occur in any patient.

 Conclusion. Predictors of poor result may be brain stem invasion, non-radical resection of tumor and preoperative hydrocephalus. We suggest, that the preoperative hydrocephalus should not been operated in the most cases of the fourth ventricular tumors.

The study objective is to assess short-term outcomes of surgical treatment in patients with ruptured pericallosal artery aneurysms (PCAA) and to identify factors affecting treatment outcomes.

Materials and methods. Patients with ruptured PCAA (n = 61) were admitted to the Department of Emergency Neurosurgery at the N. V. Sklifosovsky Research Institute for Emergency Medicine for examination and surgical treatment between 01.01.1992 and 31.12.2015.

Results. At the moment of discharge, 33 (54.1 %) patients demonstrated good recovery (Glasgow Outcome Scale (GOS) of 5), 9 (14.7 %) patients had moderate disability (GOS 4), 6 (9.9 %) patients had severe disability (GOS 3), and 13 (21.3 %) patients died (GOS of 1). An outcome was rated as favorable if the GOS was 4 or 5 and unfavorable if the GOS was 1–3. The following risk factors were found to be significant for unfavorable surgical outcome: Hunt and Hess grade 4 and 5, presence of intracerebral hematoma and its volume over 20 cm3, recurrent aneurysm rupture, pronounced angiospasm and intraventricular hemorrhage, early surgery (within 1–3 days). The patient»s age and the volume of intraventricular hemorrhage had no impact on the surgical outcome.

Conclusion. The choice of an optimal surgery time should be based on the assessment of hemorrhage severity upon admission. Early surgery is recommended for all patients with Hunt and Hess grade I–II, whereas in patients with Hunt and Hess grade V, the intervention should be postponed until the condition is stabilized, unless the severity is associated with a dislocation syndrome due to intracerebral hematoma or occlusive hydrocephalus. In patients with Hunt and Hess grade III–IV, the decision on surgery time should be made for each individual patient according to existing risk factors.

The study objective is to evaluate the effectiveness of surgical treatment of intracranial aneurysms with the use of flow diverting stents (FDS).

Materials and methods. In 2016, in the Federal Neurosurgical Center (Novosibirsk) 64 patients (11 men, 53 women, mean age – 50.1 ± 11.4 years) with intracranial aneurysms were operated on; 69 FDS were implanted. Total number of occluded aneurysms 64.

Results. The digital subtraction angiography control after 6 months demonstrated, that the total occlusion rate with was in 71 % cases, subtotal – in 29 %. An excellent and good functional outcome (modified Rankin scale 0–2) was obtained in 60 (93.7 %) patients, poor (modified Rankin scale 3–5) – in 4 (6.3 %). Complications rate were 4.7 %, death rate – 0 %.

Conclusion. The implantation of FDSs is an effective method for the treating of cerebral aneurysms, including cases, when using alternative endovascular techniques has a high risk of recanalization, and the microsurgical treatment has an increased operating risk.

The study objective is to summarize the existing literature and own experience related to damage to vessels, retroperitoneal organs, and abdominal organs during lumbar spine surgery through the posterior approach, as well as to identify risk factors associated with this damage and to describe measures for their elimination and prevention.

Materials and methods. In addition to analyzing the research literature, we also described 9 cases (3 males and 6 females; mean age 52 ± 9 years) of intraoperative damage to vessels and adjacent organs during lumbar spine surgery for some degenerative disease, including herniated disc (n = 7), anterolisthesis (n = 1), and vertebral-motor segment instability (n = 1). The surgery was performed at the L4–L5 level (n = 7) and L5–S1 level (n = 2).

 Results. The damages observed in the cohort analyzed were caused by a conchotome (n = 6), transpedicular screw (n = 1), Volkmann spoon (n = 1), and a tip of the SpineJet Hydrodiscectomy System (n = 1). The following structures were damaged; left common iliac vein (n = 2), left common iliac artery (n = 2), left common iliac vein and root of the small-bowel mesentery (n = 1), sigmoid colon (n = 1), aorta (n = 1), inferior vena cava (n = 1), and aortocaval anastomosis (n = 1). Five patients had intraoperative hemorrhagic complications. Four patients were found to have damage to vessels or abdominal organs later (1 h, 2 h, 3 days, and 4 months postoperatively). Four patients were discharged without consequences; 2 patients became disabled; 3 patients died.

Conclusion. Damage to vessels, retroperitoneal organs, and abdominal organs during lumbar spine surgery through the posterior approach is a rare, but mortally dangerous complication. Spine surgery should be performed in multi-unit hospitals that have a surgery unit, a vascular surgery unit, an intensive care unit, and a sufficient supply of blood for transfusion.

The study objective is to demonstrate our experience of the spinal cord stimulation in the treatment of drug-resistant pain in patients with the failed back surgery syndrome (FBSS) and to evaluate its effectiveness and complications.

Materials and methods. Systems for chronic spinal cord stimulation were implanted in 78 patients suffering from FBSS in Federal Neurosurgical Center (Novosibirsk) during 2013–2015. All patients had a drug-resistant neurogenic pain syndrome character and were undergone surgical intervention on the spine. Evaluating of the treatment effectiveness was carried out by visual analogue scale (VAS) and a scale Douleur Neuropathique en 4 Questions (DN4). Catamnesis ranged from 6 to 18 months.

Results. The median preoperative VAS score evaluation was 6.7, at hospital discharge – 3.1, after 6 months – 3.2, after 12 months – 3.5, after 18 months – 3.4. Evaluation on a scale DN4 before surgery was 5.3, at hospital discharge – 2.1, after 6 months – 2.4, after 12 months – 2.5, after 18 months – 2.4. Complications in the form of migration, fracture of the electrodes and development of hemorrhage or inflammation at the site of implantation of the system were observed in 12 (15.3 %) cases and required revision surgery.

Conclusion. Spinal stimulation is an effective and safe method of treatment of pain in FBSS, but it has specific complications associated with implantable systems.

The objective is to compare the effectiveness of surgical treatment of the patients with hypertensive intracerebral hematomas (ICH) using endoscopic aspiration and craniotomy removal.

Materials and methods. Analysis of the results of surgical treatment of 132 patients with ICH. Patients of group I (n = 72) underwent craniotomy removal of ICH, group II (n = 60) underwent endoscopic intervention. Endoscopic ICH aspiration was performed using surgical navigation system and ventriculoscope (outer diameter – 6.5 mm, operating length – 13 cm, luminal area of the working channel – 20 mm2), with a high light-transmitting capacity.

Results. Death rate in the patients over the age of 71 after endoscopic intervention was significantly lower than after craniotomy removal (45.4 and 86 %, respectively). In patients with soporose condition, death rate after open removal was 86.4 %, and after endoscopic aspiration – 44 %; in patients with wakefulness reduced to coma this indicator was 100 and 75 %, respectively. Death rate in the patients with thalamic ICH was 20 % after endoscopic intervention and 83.3 % after open surgery, with putaminal ICH – 39.5 and 50 %, respectively, with subcortical ICH – 22.7 and 0 %. Among patients with a hematoma with volume of up to 40 ml, death rate was 17.2 and 4.7 % in the groups I and II, respectively, with volume from 61 to 100 ml – 81.8 and 66.7 %.

Conclusion. After endoscopy-guided removal of ICH the number of patients with good recovery increased 3-fold, and the post-operative mortality decreased by 19 %. The use of endoscopic technique in the treatment of hypertensive ICH under the control of neuronavigation (in comparison with open craniotomy removal and microsurgical ICH evacuation) improved the results of treatment due to decreasing of mortality rate and improvement of functional outcomes of the disease.

The study objective is to analyze the existing research literature devoted to this problem and to assess clinical characteristics and specific features of the diagnosis and rational neurosurgical treatment for ganglion cyst of Guyon’s canal (GCGC) that caused compression neuropathy of the ulnar nerve.

Materials and methods. Since 1955, researchers reported only 19 cases of ganglion cysts located in the wrist area and associated with tunnel neuropathy of the ulnar nerve. Since this condition is extremely rare, we present our own clinical observations.

Results. Using the literature data, we described various types of ulnar nerve compression according to individual nerve characteristics determining clinical manifestations of GCGC. We analyzed the prevalence of GCGC among patients of various age and gender, disease pathogenesis, and main diagnostic methods. A patient with GCGC-associated compression ischemic neuropathy of the ulnar nerve was treated in the neurological clinic of the I. M. Sechenov First Moscow State Medical University in 2016. Using visualization tools, we found a ganglion cyst located on the palmar surface at the level of the hook-shaped bone. The cyst caused medial displacement of the ulnar nerve and ulnar artery. We performed microsurgical decompression of the right ulnar nerve at the level of Guyon’s canal and removed the articular ganglion cyst using a standard procedure. In the postoperative period, we observed partial regression of neurological disorders.

Conclusion. To identify the cause of ulnar nerve neuropathy in Guyon’s canal, a physician should consider both clinical and electrophysiological data and the results of ultrasound examination and/or magnetic resonance imaging. A detailed examination of these patients allows clarifying morphological characteristics of the lesion and identifying such a rare lesion as ganglion cyst.

The study objective is to determine the feasibility and effectiveness evaluation of full-endoscopic surgery in gunshot wound of the lumbar spine.

Materials and methods. A clinical case of a 24-year-old male who received a gunshot wound to the lumbar spine is described. The patient underwent a full-endoscopic intervention aimed at extracting a bullet from the spinal canal.

Results. Minimal-invasive approach to spinal canal with the possibility to extract a bullet, decompression of nerve roots, defect closure of the dura mater is demonstrated.

Conclusion. Good clinical outcome allows to recommend the full-endoscopic surgery with similar gunshot wounds of the lumbar spine at the stage of specialized care.

The article describes the life path of V. N. Shamov – the largest scientist and talented surgeon, doctor of medicine, professor, honored scientist of the USSR and the RSFSR, a full member of the USSR AMS, winner of the Lenin prize, lieutenant general of the medical service.

The article describes the main stages of development of radiological diagnostic methods in neurosurgery from the discovery of x-rays by V. Roentgen and till the invention of modern tomographs. The role of russian and foreign scientists in this succession process is especially noted.

Article is devoted to memory of prof. Vera Leonidovna Lesnitskaya, the famous scientist neurosurgery, which founded first neurosurgery department in the country. The publication is dated for the 120th anniversary of birth.

The study objective is to discuss the issues concerning to pathogenesis, diagnostics and treatment of dura mater tear in spinal injuries. The issues regarding to the risk factors for dura mater tears and complications of surgical treatment in spinal injuries were considered.

Results. It is established that the frequency of dural tears in spinal trauma varies from 7.7 to 65.0 %. The most informative and safe method of diagnosis is magnetic resonance myelography, but its specificity does not reach 100 %. To prevent the development of early and late complications in the postoperative period is mainly used dura mater sealing, preferably expanding plastic.

Conclusion. The absence of the “gold standard” of dura mater defect closure in spinal trauma is associated with a variety of forms of dura mater damages and the difficulties of its plasticity and sealing.