Objective: to optimize the surgical treatment strategy as well as to estimate the results of surgical treatment at patients with spinal hemangioblastomas. Material and methods: we operated 20 patients with solitary or multiple (von Hippel-Lindau syndrome) spinal hemangioblastomas - 12 men and 8 women from 2000 year till 2010 year. Multiple tumors because of von Hippel-Lindau syndrome were at 4 patients, idiopathic tumors - at 16 patients. Results: The temporary rising of neurological deficit after tumor removal was seen at 12 among 20 patients. There were no patients with small tumors (max size not more than 5 mm) who showed clinically significant deterioration of neurological status in postoperative period. The partial regress of neurological symptoms compared to preoperative status was seen at 6 patients, absence of neurological status dynamics - at 4 patients and deterioration of neurological signs - at 2 persons among all patients with larger tumors in postoperative periods. All patients remained within their functional class in spite of various dynamics of neurological status in postoperative period. Conclusion: the surgery is definitive mandatory for treatment of patients with solitary small hemangioblastomas located dorsally. The symptomatic spinal hemangioblastomas because of von Hippel-Lindau syndrome as well as solitary tumors are subjects to surgical removal. The open surgical treatment or radiosurgery may be proposed for solitary asymptomatic spinal hemangioblastoma. Multiple asymptomatic spinal hemangioblastomas are the indications for radiosurgery treatment.

Objective: to clarify the indications for osteoplastic craniotomy (OPC) and decompressive trepanation (DT) at children with tumors of posterior cranial fossa (PCF). Material and methods. We present the analysis of suboccipital craniotomy methods at 53 children at the age from 3 months till 17 years with PCF tumors, operated on in Russian Scientific Research Neurosurgical Institute n.a. A.L. Polenov during period from 2007 till 2009. We conducted the comparative examination of postoperative period features including estimation of biomechanical characteristics of craniospinal system (CSS) in two groups of patients: I group - DT, II group - OPC. Results. The both studied group were comparable according to radicality of tumor removal. Pseudomeningocele were seen at 7 (29,2%) patients and liquorrhea - at 4 (16,6%) patients in I group; there were no such complications at patients in II group. Infectious complications were seen at 3 (12,5%) patients in I group and at 2 (6,8%) patients in II group. The liquorshunt operations for correction of postoperative hydrocephalus were performed at 6 (25%) patients in I group and at 4 (13,8%) patients in II group. The monitoring of liquor pressure as well as measurement of pressure-volume interrelation (PVI CSS) revealed no significant difference between groups (р>0,3) after total resection of tumor. Conclusion. OPC should be the method of choice for surgical treatment of children with PCF tumors. DT of PCF in children is significantly more often accompanied by postoperative complications associated with the presence of trepanation window that is why the usage of DT at such patients requires the presence of additional indications. The algorithm for choice of trepanation method at children with PCF tumors was offered.

The movement disorders present the serious clinical problem in treatment of patients with infantile cerebral paralysis (ICP). These movement disorders are the cause of orthopedic contractures and deformities as well as failure of the rehabilitation treatment. The low effectiveness of conservative treatment is often occurred in such patients and requires neurosurgical treatment in some cases. Nowadays there are two group of neurosurgical operations used for treatment of movement disorders at patients with ICP: destructive operations and neuromodulation surgery. The destructive surgery is based on the destruction of certain structures of nervous system taking part in maintaining of movement disorders and includes the following operations: selective dorsal rhizotomy at lumbar and cervical level of spinal cord, selective neurotomy, stereotactic destruction of deep brain structures. The neuromodulation surgery is based on depression of abnormal neuronal activity by using of high frequency electrical stimulation or drug infusion and includes such operations as chronic stimulation of spinal cord and stimulation of deep brain structures, chronic intrathecal baclofen therapy. Each operation has a specified indication according to severity and type of movement disorders.

Objective: to estimate the possibility of liquorrhea diagnostics by identification of β-trace protein (ß-ТР) concentrations in nasal discharges. Material and methods: The study was conducted in 3 stages. First stage included examination of β-ТР concentration in blood, CSF and nasal discharges at patients underwent transnasal operations or suffered from head injury or from idiopathic nasorrhea. Second stage included the identification of β-ТР in CSF at 8 patients with purulent meningitis and at 7 patients with subarachnoid hemorrhages (SAH) as well as blood concentration of β-ТР at 7 patients with acute renal failure (ARF). Third stage included the estimation of β-ТР concentration in nasal discharges at 17 patients suspected on basal liquorrhea. The identification of β-TP was conducted using automatic nephelometer BN ProSpec by nephelometric test with reagent N Latex betaTP. Results: We determined that blood concentration of β-TP was 0,5±0,1 mg/l (from 0,4 till 0,7 mg/l), CSF concentration of β-TP - 17,2±8,2 mg/l (from 9,7 till 37,7 mg/l) analyzing samples of blood, CSF and nasal discharged at 13 patients. The CSF concentration of β-TP unchanged at patients with SAH and was 16,2±7,0 mg/l, but this CSF concentration of β-TP decreased in 2,2 times at average (mean - 7,9±4,2 mg/l, min - 4,3 mg/l, max - 15,1 mg/l) at patients with meningitis. Blood concentration of β-TP increased slightly (up to 1,5±0,9 mg/l at average) at patients with ARF. The nephelometric test allowed identifying CSF in nasal discharges in 8 (36,4%) from 22 samples during examination of patients with suspect for basal liquorrhea that influence on treatment strategy. Laboratory method was ineffective for microliquorrhea diagnostics. Conclusion: nephelometric test for β-TP identification is effective for diagnostics of basal macroliquorrhea however purulent meningitis and acute renal failure must be taking into account during reading the results of analyzes.

Objective. To study the dynamics of arterial blood gas at patients in critical state with intracranial hemorrhages during conduction of hyperbaric oxygenation (HBO) under conditions of artificial lung ventilation (ALV). Material and methods. We conducted the analysis of arterial blood gas and ratio of arterial pressure of oxygen (РаО) to fraction of inspired oxygen (FiO₂) (Р/F ratio) during 113 sessions of HBO under the conditions of ALV at 43 patients with intracranial hemorrhages. HBO was conducted in intensive care altitude chamber «Sechrist 2800» (USA), equipped with ALV apparatus «Sеchrist-500» (USA). Results. The conduction of HBO was accompanied by increase of РаО₂ from 178±44 till 195±55 mmHg - on 19,2 (9,2;30,8)% (р<0,05), РаСО₂ с 34±6,6 до 35,3±7 mmHg - on 3,8 (-1,2;6,9)% (р<0,05) and P/F ratio from 297±74 till 325±90 - on 9,8 (2,1;16,4)% (р<0,05). The best dynamics of РаО₂ and P/F ratio was revealed at patients with depression of consciousness level till 7-8 scores according to Glasgow Coma Scale. The significant dynamics of arterial blood gas during HBO conduction was not revealed at patients with initially normal pulmonary gas exchange. The increase of РаО₂ from 143±26 mmHg till 170±43,4 mmHg - on 21,2(9,8;31,4)% (р<0,05) and P/F ratio from 239±44 till 283±72 - on 19,8(3,3;30)% (р<0,05) at patients with acute lung injury. Conclusion. The received data testify that HBO conduction under the conditions of ALV at patients with intracranial hemorrhages is accompanied with evident increase of arterial pressure of oxygen and P/F ratio. The positive influence of HBO therapy on arterial blood oxygenation is the most expressed at patients with depression of consciousness level till 7-8 scores according to Glasgow Coma Scale and in case of acute lung injury.

Introduction. The non-syndrome craniosynostoses are wide spread among children and present by multiple combined functional and cosmetic defects [3]. Objective. To estimate the possibilities of endoscopic treatment for surgical correction of non-syndrome craniosynostoses at children. Material and method. We conducted the analysis of surgical treatment data as well as data received from medical cards of patients with non-syndrome craniosynostosis underwent endoscopic surgery. Results and their discussion. There were no intraoperative complications in all examined clinical cases. The postoperative period proceeded uneventfully without any infectious and surgical complications. There was no negative dynamics in neurological status. Conclusion. The minimally invasive endoscopic method is safe and esthetically acceptable alternative to open surgery for treatment of children with such pathology

Introduction. We presented the first experience in Russia of the usage of mobile operational X-ray unit O-Arm combined with navigation station Stealth Station Treon Plus (Medtronic Navigation) during transcutaneous transpedicular osteosynthesis of lumbar spine. Objective - to estimate the possibility for the usage of mobile operational X-ray unit O-Arm combined with navigation station during transcutaneous transpedicular osteosynthesis of lumbar spine and comparison of this method with routine intraoperative roentgenoscopy. Material and methods. We analyzed the surgical treatment outcomes at 168 patients (72 men and 96 women) operated on in spinal neurosurgical department of FFSI «Federal; Neurosurgical Center» (Tyumen, RF) from April 2011 till August 2012. Results. The accurate positioning of transpedicular screws was achieved in 99,4% of patients during usage of X-ray unit O-Arm combined with navigation station (2d group, 114 patients, 530 screws), that was much more better comparing with the usage of routine methods of roentgenoscopy with the help of C-arch (1st group, 54 patients, 258 screws) where the accuracy of positioning was only 86,8%. The mean duration of operation was 195,4±36,5 min and 269,8±41,3 min in 2d and 1st groups respectively (P<0,05). The decreasing of operation duration in 2d group with О-Arm was related to cutting time of screws positioning from 9,2±2,7 min (during usage of C-arch) till 5,3±1,7 min (P<0,05) and decrease of the number of provisional procedures for repeated roentgenoscopic control examinations comparing with the 1st group. Conclusion. The percutaneous transpedicular osteosynthesis with the usage of mobile operational X-ray unit O-Arm combined with navigation station is the safe and effective method of surgical treatment which allows providing the high accuracy of transpedicular screws positioning as well as decreasing the duration of surgical intervention comparing with routine methods of roentgenoscopy.

The cortical dysplasias are a kind of malformation due to abnormal cortical development which is a common cause of medically intractable epilepsy. Dysplasia is the frequent pathologic substrate of the MRI-negative localization-related epilepsy. In the review a specification on formation mechanisms of dysplasia, various classifications of the lesions and epileptogenicity of the different types of dysplasia are resulted. Value of multimodal diagnostics and invasive neurophysiological investigations in presurgical evaluation of the patients, and also actual questions of planning of surgical interventions at different variants of the epileptogenic caused by the cortical dysplasia are discussed. Various methods of the resective and deafferentation surgical procedures are presented. Questions of a choice of the surgical strategy, being a subject of discussions are considered.

There are considered the history and modern possibilities of the usage of ultralow temperature in Russian and World neuro-oncology and neurosurgery (especially for brain tumor removal), the phases of cryosurgery development. The cryotherapy control and its perspective methods are showed. Also there are reviewed main mechanisms of freezing influence on cells, tissues and vasculature, different parameters of cryo-destruction. This article reports about technical factors and possibilities of their influence on the result of cryo-destruction. Cryo-immunology mechanisms are included.

This article presents the surgical technique of endoscopy usage for treatment of fractures of frontal sinus anterior wall and orbital walls.

The fractures of vertebrae associated with osteoporosis represent the significant medical as well as social and economic problems. The effective method for treatment of such vertebral fractures as well as for pain syndrome management is puncture vertebroplasty. The appropriate conservative treatment of osteoporosis in postoperative period delays the progression of this disease and decreases the probability of new vertebral fractures appearance in case of multimodality therapy of this disease.

Objective: to study the hemodynamic features in intracranial aneurysms. Material and methods: we performed 4D CT-angiography at 3 patients with unruptured aneurysms of various localization and size. Results: The aneurysm contrast was observed in arterial, venous and delayed phases after contrast injection. We noted the repeated contrast of aneurismal sac in venous phase (on 27-29 sec from contrast injection) in each of three presented clinical cases. Conclusion: The noted feature of aneurysm contrast (repeated contrast in venous phase) is much more likely related to so-called “theory of slow blood flow” which is one of the modern theories for explanation of aneurysm occurrence and their growth. However the further investigation is necessary to confirm this suggestion.

This clinical case describes the symptomatic idiopathic lumbar spine epidural lipomatosis at a man of 50 years old suffered from neurogenic intermittent claudication associated with obesirty. The patient underwent two-sided microsurgical decompression via unilateral approach at the level of L4-L5, L5-S1 vertebrae with removal of hypertrophic adipose tissue at the mentioned levels.

This article describes the method and usage aspects of frameless navigation for surgical treatment of patients with posttraumatic cranial deformations and cranioorbital defects. The problems and application algorithm as well as indications and methods for estimation of frameless navigation system usage results in reconstructive surgery are presented.