The study objective is to report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head and to discuss diagnostic methods and neurosurgical treatment. Materials and methods. We report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head in a female patient. The patient was treated in the Neurology Clinic of I.M. Sechenov First Moscow State Medical University. We analyzed clinical manifestations and compared them with the data described in research literature. Results. Upon admission, the patient complained of pain in the anterolateral surface of the right shin and in the dorsum of the foot during walking. At rest, the patient experienced no pain. We observed no motor or sensory disorders typical of nerve root disorders at the level of L₅. Lasegue’s test was negative. The patient had a positive Tinel’s sign in the area of the right fibular head. In order to clarify the diagnosis, we performed a repeated extension test in the right ankle joint and it was positive. The patient underwent surgery that included peroneal nerve decompression and neurolysis at the level of the fibular head. In the postoperative period, the patient had complete pain relief. Conclusion. Due to the difficulties in the diagnostics of dynamic neuropathy of the common peroneal nerve, this disease is often mistaken for radiculopathy at the level of L₅ . Thorough clinical examination, testing for Tinel’s sign in the area of the fibular head, and repeated extension test in the ankle joint ensure the correct diagnosis and reduce the frequency of ineffective surgeries on the lumbar spine. Surgical decompression of the common peroneal nerve at the level of the fibular head with obligatory opening of the entrance to the nerve canal is an effective method of treatment in such patients.

The study objective is to describe the results of surgical treatment of a patient with frontopolar artery aneurysm rupture. Materials and methods. A 22-year-old female patient in grave condition (Hunt and Hess grade 3, Glasgow coma score 14) was admitted to the Department of Neurosurgery on day 5 after hemorrhage. The patient presented with headache, nausea, weakness, and stiff neck. However, no hemodynamic, respiratory, motor, or sensitive disorders were observed. Computed tomography of the brain revealed a 35 cm3 intracerebral hemorrhage in the projection of the interhemispheric fissure and frontal lobes without transverse or axial dislocation. Computed tomography angiography demonstrated a distal aneurysm of the right frontopolar artery. Results. The patient underwent emergency osteoplastic craniotomy in the right pterional region followed by aneurysm excision and removal of intracerebral hemorrhage. The postoperative period was uneventful (Glasgow outcome score 5). The patient was discharged on day 14 postoperatively with no signs of focal neurological deficit. Conclusion. Thorough preoperative examination of patients with lobar hemorrhages prevents severe complications during surgery, such as uncontrolled intraoperative bleeding.

The study objective is to present a clinical case of massive subarachnoid hemorrhage after flow-diverter stent implantation for giant aneurysm and to review the literature on complication rate after use of flow diverter devices. Materials and methods. Forty two patients with large and giant cerebral aneurysms underwent surgical treatment with the use of flow-diverter stents in the department of neurosurgery of the Interregional Clinical Diagnostic Center (Kazan) from 2010 to 2018. In 1 case, massive subarachnoid hemorrhage as a result of aneurysm rupture with fatal outcome developed on the day 4 postoperatively. Results. Causes of aneurysm rupture after the installation of flow-diverter stents are still poorly understood. Possible causes include redirection of blood flow towards the part of the aneurysm, that has not been earlier exposed to high blood pressure; release of a large amount of enzymes from the thrombus formed in the aneurysm, which results in inflammation in the vessel wall; mechanical impact of the forming thrombus on the thinned aneurysm wall; reperfusion syndrome caused by artery stenosis developed before surgery; and administration of antiplatelets. The data on their effectiveness remain controversial. We report a case of aneurysm rupture, which was not prevented by steroid and nonsteroidal anti-inflammatory therapy received by a patients during the postoperative period. Conclusion. Aneurysm rupture after flow diverter implantation remains unpredictable and threatening complication which requires maximum awareness. Further studies and recommendations are needed to prevent this complication.

The study objective is to report 2 cases of endoscopic transsphenoidal removal of hypothalamic hamartomas (HH). This surgical method has not been previously considered in both Russian and foreign publications. Materials and methods. A 16-year-old male patient (R.) was admitted to hospital with complaints of epileptic seizures occurring once every 5–6 days; the disease duration was 9 years. A 23-year-old female patient (M.) was also admitted to hospital with complaints of epileptic seizures occurring once a week; the disease duration was 16 years. Results. Magnetic resonance imaging of the brain of patient R. revealed a HH (1.5 cm × 1.4 cm × 1.4 cm) and focal cortical dysplasia in the right occipital lobe. During a 3-day video electroencephalogram monitoring, we registered 3 secondary generalized complex partial seizures. Patient R. underwent endoscopic transsphenoidal removal of the HH. After surgery, he experienced no epileptic seizures during the next 18 months, even though he continued to receive the same doses of antiepileptic drugs. Magnetic resonance imaging of the brain of patient M. demonstrated a HH (2.44 cm × 2.79 cm × 2.68 cm). During a 4-day video electroencephalogram monitoring, we registered 2 secondary generalized complex partial seizures. The patient underwent transsphenoidal removal of the HH. During the next 8 months, the patient experienced no seizures. Conclusion. Our results suggest that transnasal removal of HH is a highly effective and safe procedure for patients with drug-resistant epilepsy. Surgical removal of HHs ensures effective control of the disease, which was previously resistant to pharmacotherapy.

In this article, we provide the definitions of “sequelae” and “complications” of traumatic brain injury (TBI). We have developed the classification principles for TBI consequences and described their clinical forms and morphological substrates. We also provide a radiological grading for assessing the severity of sequelae of focal and diffuse brain injuries. The article covers conceptual approaches, technologies, and results of their application related to leading surgically significant consequences of TBI, including carotid cavernous fistulas, chronic subdural hematomas, post-traumatic hydrocephalus, long-term basal liquorrhea, and skull defects. We have developed the doctrine of sequelae of TBI.

This article provides a detailed illustrated description of currently available classification and scoring systems for lower cervical spine injuries (including Allen–Fergusson, J. Harris et al., C. Argenson et al., and AOSpine classifications, Subaxial Injury Classification System and Cervical Spine Injury Severity Score). The present review primarily aims to discuss the advantages and disadvantages of each classification system.

The study objective is to evaluate the effectiveness and the safety of different cerebrospinal fluid drainage methods and intrathecal fibrinolytic therapy in the prevention of cerebral vasospasm and improving outcomes in patients with massive subarachnoid hemorrhage. Materials and methods. The study was performed on 86 patients with massive aneurismal subarachnoid hemorrhage (Hijdra score >15) who had clipping surgery within 72 h after symptoms onset. We used lumbal drainage in 12 patients (group 1), combined lumbal and cisternal drainage in 24 patients (group 2), lumbal and cisternal drainage with intrathecal fibrinolytic therapy with recombinant staphylokinase in 25 patients (group 3); control group (group 4) included 25 patients with similar clinical and instrumental data. Results. Incidence of unfavorable outcome and symptomatic cerebral vasospasm was 83 and 83 %, respectively (in group 1), 36.8 and 47.4 % (in group 2), 9.1 and 9.1 % (in group 3), 76 and 60 % (in group 4). Conclusion. The proposed intrathecal fibrinolytic therapy with recombinant staphylokinase may be effective and safe to reduce the severity of cerebral vasospasm, improve clinical outcome and lower frequency of normal pressure hydrocephalus after aneurysm rupture.

The study objective is to describe the technique of intraoperative Doppler ultrasound (DU) of brain arteries and to determine the indications for its use during endoscopic transsphenoidal operations. Materials and methods. The study included 100 patients with skull base tumors (pituitary adenomas, trigeminal schwannomas, chordomas), operated via standard or extended transsphenoid endoscopic approaches. For DU, the location of the internal carotid artery (ICA) relative to the surface of the tumor or dura mater was determined as a red and/or blue color of the monitor screen in the M-mode window, accompanied by a characteristic sound signal. Results. DU was used to remove pituitary adenomas in 95 cases, trigeminal schwannomas in 3 cases, chordomas in 2 cases. Intraoperative DU helped to locate the ICA during removal of the laterosellar part of the tumor in all observations. In none of the cases presented were no injuries to the ICA. Сonclusion. DU is an effective and non-invasive method for detecting ICA during endoscopic operations which contributes to the safe disposal of laterosellar tumors. Adequate use of the method does not carry well-known and potential risks. DU should be performed when the tumor is removed from the cavernous sinus or its projection via the lateral extended transsphenoidal endoscopic access (to determine the safe boundaries of the dura mater section in the cavernous sinus projection).

The study objective is to analyze surgical outcomes in patients with hemorrhagic stroke treated by endoscopic aspiration in five regional vascular centers in Russia and to evaluate capabilities and benefits of this surgical procedure. Material and methods. The study included 296 patients with hemorrhagic stroke (with various locations of the hemorrhage) that underwent endoscopic aspiration between 2006 and 2018 at one of the following institutions: N.V. Sklifosovsky Research Institute for Emergency Medicine (Moscow), City Clinical Emergency Hospital No. 1 (Omsk), Regional Clinical Hospital (Yaroslavl), N.A. Semashko Republic Clinical Hospital (Simferopol), Irkutsk Regional Clinical Hospital. Neurosurgery departments of these healthcare institutions are the parts of regional vascular centers. We used Glasgow Outcome Scale to evaluate outcomes of surgical treatment. Results. Complete recovery was observed in 52 (17.5 %) patients, while 52 (17.5 %) patients developed moderate disability and 131 patients (44.5 %) developed severe disability. Four (1.5 %) patients developed a vegetative state. Fifty-seven (19 %) patients died after surgery. Conclusion. The experience of treating hemorrhagic stroke in five neurosurgical centers demonstrates that endoscopic aspiration of hypertensive intracerebral hemorrhages is in no way inferior to microsurgery. It ensures satisfactory results and can be used in patients with various hemorrhages.

The study objective is evaluate the effectiveness and risks of using intradural and extradural decompression of the optic nerve channels during standard transcranial removal of meningiomas of the chiasmal-cellar region region. Materials and methods. The results of 161 decompression of channel of optic nerve in 129 patients are analyzed. In most patients (n = 122), an intradural decompression (resection) of the canal roof was performed. In 7 patients, an extradural decompression of the upper and lateral walls of the canal was performed. Results. In assessing the risks of visual impairment as a result of channel decompression, we found that decompression itself, without attempts to separate the tumor from the nerve, causes vision impairment in 8.6 % of cases. Attempts to separate the tumor from the optic nerves increase the risk of vision impairment from 16.7 to 26.9 %, depending on the radicality. Conclusion. A small number of complications (iatrogenic amaurosis and nasal liquorrhea) make it possible to recommend the described technique as an effective and safe addition to standard transcranial operations to remove the meningiomas of the chiasmal-cellar region.