The study objective is to evaluate early results of radiosurgical treatment (RST) of drug-resistant trigeminal neuralgia (TN) of various etiology.

Materials and methods. Between 01.01.2016 and 01.07.2018 at the Radiosurgery Center of the N.V. Sklifosovsky Research Institute for Emergency Medicine, 14 patients with drug-resistant TN underwent RST. Per magnetic resonance imaging, prior to treatment 7 patients had neurovascular conflict, 2 had demyelination of the root of the trigeminal nerve due to multiple sclerosis, and 5 patients showed no pathologies of the brain. Irradiation of the cisternal portion of the trigeminal nerve at the distance of 7.5 mm from the entry into the brainstem with prescribed dose of 90 Gy was performed. Follow-up period was 8–20 months. The difference in fractional anisotropy (FA) at the affected and healthy sides was evaluated in patients with TN prior to RST to divide them into 2 groups: with significant FA decrease and with moderate FA decrease.

Results. All patients who underwent RST with PD >80 Gy (85.7 %) noted decreased level of pain or its full disappearance. In 11 (78.5 %) patients, anesthetic effect manifested itself 3–6 weeks after RST, in 1–3 months after RST. Full analgesic effect was achieved in a patient with idiopathic type II TN (PD 84 Gy) 3 months after RST, in a patient with neurovascular conflict and type I TN (PD 86 Gy) 6 weeks after RST, in a patient with multiple sclerosis and type I TN (PD 81 Gy) 3 weeks after RST. In the last-mentioned patient, pain returned 12 months after RST but with lower intensity. In 2 (14.3 %) patients (PD 80 Gy), no positive effect was observed in 6 months of follow up. Hypesthesia of a face area (RST complication) was diagnosed in only 1 (7.2 %) patient 8 months after RST, and it persisted for 6 weeks gradually regressing. There was no statistically significant correlation between FA decrease and RST outcome, but it was observed that outcome was more favorable in patients with moderately decreased FA.

Conclusion. RST of drug-resistant forms of TN with PD >80 Gy significantly reduces pain syndrome 3–6 weeks after treatment and is characterized by low risk of complications.

The study objective is to identify the features of diagnosis of patients with spinal cord injuries, resulting from falls from a height.

Materials and methods. The data from 148 patients who were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 01.01.2011 to 04.01.2016 were analyzed. Of these, 98 patients (the studied group) were injured in the spinal column as a result of a fall from a height of more than 2 m, 50 people (the comparison group) suffered in traffic accidents. We used clinical data, laboratory and radiological diagnostic methods. The severity of injuries in spinal injury was assessed according to the Injury Severity Score. When assessing the neurological status in spinal patients, the ASIA (American Spine Injury Assosiation) scale was used.

Results. Significant differences in age (p = 0.57) and sex (p = 0.24) in the groups were not observed. More often at night: in the period from 00:00 to 6:00 in the morning – 44 (44.9 %) patients. There were significantly more patients with combined spinal injury in the studied group – 60 (61.2 %) than in the comparison group – 24 (48 %) (p <0.05). The assessment of the severity of the patients showed that the proportion of victims with severe neurological disorders (ASIA A) in the studied group was 30.6 % (30 victims), while in the comparison group the number of such patients was significantly lower – 3 (6.0 %) patients (p <0.05). The average score on the Injury Severity scale in the studied group was 25.7 ± 5.5, in the comparison group – 26.3 ± 6.1. There were no significant intergroup differences in this indicator.

Conclusion. Spinal cord injuries in catatrauma in 61.2 % of patients were accompanied by combined injuries of the internal organs and the musculoskeletal system. In 25.5 % of patients with catatrauma craniocerebral lesions were detected. On the ASIA scale, the proportion of victims with the most pronounced neurological disorders (ASIA A) was 30.6 %, and in the event of an accident – 6.0 %; to ASIA E – 36.8 % (in case of an accident – 64.0 %).

Background. Minimally invasive technology of fusion broadly introduced in clinical practice represent one of modern trends in spinal surgery on the other hand those technical solutions lack to provide posterior fusion. As a consequence, patients treated with minimally invasive techniques are vulnerable in terms of pseudarthrosis and implant instability therefore measures focused on those complications’ prevention are still actual.

The study objective is to evaluate efficacy and safety of suggested percutaneous facet joints arthrodesis technique as an auxiliary option to interbody fusion.

Materials and methods. This is a prospective non-randomized study of 80 patients with degenerative diseases of the lumbar spine who were treated applying minimally invasive transforaminal lumbar interbody fusion, lateral lumbar interbody fusion and anterior lumbar interbody fusion. In 20 cases out of those enrolled interbody fusion was supplemented with percutaneous posterior facet joints arthrodesis. Computed tomography was administered at the period of 6 and 12 months after surgery to assess anterior and posterior fusion. The minimal follow-up period accounted for 12 months.

Results. The suggested percutaneous facet joints arthrodesis fifty-fold increased the probability of posterior fusion formation compared to the rate of spontaneous spinal fusion (p <0.0001, logistic regression was applied). In three cases posterior fusion formed prior to interbody fusion providing stability of segment operated on. No adverse events and no complications associated with percutaneous arthrodesis were detected.

Conclusion. The suggested percutaneous facet joints arthrodesis is safe and effective minimally invasive technique that facilitates additional posterior spinal fusion formation in a short-term period herewith decreasing symptomatic pseudarthrosis development in patients operated on using minimally invasive spinal fixation and fusion.

Background. Intraoperative brain mapping is one of the most critical stages of neurosurgical intervention in the eloquent area of the cerebral cortex. Traditionally direct cortical electrical stimulation is used for these purposes, but it can lead to seizures and loss of consciousness that makes it impossible to continue the procedure. Moreover, it significantly changes the surgery plan, especially in case of speech mapping during awake craniotomy.

The study objective is to create a setup for intraoperative eloquent cortical areas passive mapping, and to compare informativity and safety of passive and active speech mapping.

Materials and methods. We have created and tested a mobile device for high-resolution mapping of the Broca’s area that uses the analysis of the desynchronization processes in high-gamma oscillations in 64 micro-contact grid electrode for electrocorticography during awake craniotomy when patient pronounces the objects and actions.

Results. We found precise coincidence for localization of the Broca’s area, determined by analyzing of bioelectric signal obtained from the electrocorticography and cortical mapping performed by bipolar direct cortical stimulation using Penfield method.

Conclusion. The passive cortical speech mapping expands the potentialities of neurosurgical operations in the eloquent area of the brain and can increase the number of patients for whom this study is achievable. Further studies needed to evolve algorithms and sets of stimuli to expand the list of functional zones that can be mapped passively.

Background. The main problem is to differentiate idiopathic normal pressure hydrocephalus (iNPH) with other neurodegenerative diseases accompanied by similar clinical presentation. For this purpose, a number of neuroimaging and invasive methods were proposed.

The study objective is to assess most reliable magnetic resonance (MR) symptoms of iNPH and to create a prognostic model for differential diagnosis of iNPH by these criteria.

Materials and methods. MR-data of 213 iNPH, 144 neurodegenerative (Alzheimer disease, Parkinson disease and early mild cognitive impairment) patients and 79 healthy age-matched controls were retrospectively analyzed. Following criteria were assessed: Evans Index, size of the third ventricle, size of temporal horns, disproportionately enlarged subarachnoid space hydrocephalus, focal convexital sulci enlargement, callosal angle, periventricular hyperintensities, focal subcortical gliosis and perivascular spaces enlargement. One-way ANOVA was used to explore differences between groups. Classification matrix was formed by discriminant analysis.

Results. Differential model was established and Excel-tab-calculator was created for complex computed assessment of MR data and differential diagnosis of iNPH patients. Prognostic accuracy of model for iNPH reaches 99.5 %, for degenerative disorders – 89 %, common diagnostic accuracy is 92 %.

Conclusion. Advantages of complex approach for assessment of MR-data in iNPH patients were underlined. Prognostic model for prediction of iNPH based on MR criteria was established.

The study objective is to examine the anatomical characteristics of transnasal endoscopic and transorbital endoscopic approaches to perform medial orbitotomy and decompression of the optic nerve.

Materials and methods. The study was based on the results of anatomical approaches on cadavers. The comparison was carried out according to the following anatomical-surgical parameters: 1) the area of interest in mm2 ; 2) the area of orbitotomy in mm2 ; 3) the area of the optic nerve decompression in mm2 ; 4) the length of periorbital incision in mm; 5) the depth of the wound in mm; 6) the horizontal angle of attack in degrees; 7) the vertical angle of attack in degrees. The measurements were carried out using the Russian optical navigation system “Neuroplan”.

Results. It has been established that the area of orbitotomy is noticeably larger, and the depth of the operative wound is smaller with the transorbital approach. It was also revealed that there are no noticeable differences in the area of the optic nerve decompression between the transnasal endoscopic and transorbital endoscopic approaches. In addition, there is a tendency for large angles of attack in both horizontal and vertical planes with transorbital access, which is probably due to the smaller depth of the wound and the possibility of lateral traction of the eyeball. It was determined that as with transnasal, as with transorbital approaches, the length of the periorbital incision did not differ significantly.

Conclusion. The study demonstrates the equivalent possibilities of both transnasal and transorbital endoscopic approaches in the implementation of the medial orbitotomy and decompression of the optic nerve in patients with endocrine ophthalmopathy. Some advantages, in particular, a large area of orbitotomy, as well as the preservation of the paranasal structures, make it possible to speak out in favor of choosing transorbital endoscopic approaches to the medial wall of the orbit and the optic nerve when performing surgical decompression in this group of patients. Further collection of clinical material is needed for final results.

At the present time in connection with the growth craniotomies interventions cranioplasties operations is widespread. The introduction of a significant number of heterogeneous implants to restore the integrity of the structures of the skull is accompanied by an increase in the frequency of complications in the area of their installation (up to 34 % of cases), which first and foremost must include the formation of ulcers of the skin and purulent inflammation. The basic principles of surgical treatment of such category of victims now provide implant removal, long-term conservative preparation of wounds and repeated reconstructive intervention in the long term. The article presents an analysis of four clinical observations of successful treatment of patients with defects of the skin of the skull over the implants using a number of methods of combined skin plastics. It is shown that surgical interventions using skin-fascial flaps and free split grafts can prevent implant removal, preserve foreign structures and avoid complications in the early postoperative period.

The study objective is to describe the clinical cases of ligamentum flavum hematoma in patients with degenerative lumbar stenosis.

Materials and methods. Three patients with lumbar stenosis because of ligamentum flavum hematoma were treated in Clinical Medical Center of the A.I. Evdokimov Moscow State University of Medicine and Dentistry. All patients had radicular pain and neurogenic claudication.

Results. Surgical decompression was performed in all cases, intraoperative we discovered ligamentum flavum hematoma, which was the main cause of stenosis. After decompression, all patients were free of pain and claudication.

Conclusion. Ligamentum flavum hematoma is extremely rare in patients with degenerative lumbar stenosis. Surgical decompression is an effective treatment of this pathology.

The study objective is to describe current views on pathogenesis, molecular biology, diagnosis, treatment of primary germ cell tumors of the central nervous system, as well as treatment prognosis.

Materials and methods. The review includes 51 literature sources (4 in Russian, 47 in English). All articles were published in the last 20 years.

Results and conclusion. The review reflects both established principles and characteristics of the national protocol of treatment of germ cell tumors, treatment nuances determined by histological type of the tumor. The most effective treatment method for germ cell tumors are radiation and neoadjuvant chemotherapy. For non-germinal germ cell tumors chemotherapy with subsequent complete removal is optimal. Total tumor resection by itself is the ideal treatment of mature teratomas. In the future, molecular and cytogenetic studies will allow to additionally identify subtypes of germ cell tumors of the central nervous system which will become the basis of new directions for therapy, improved treatment results and methods of prognosis.

Treating traumatic spinal cord injuries is one of the most complicated and relevant problems in the modern medicine. In the vast majority of cases spinal cord injury (SCI) leads to persistent disability, with medical, social and economic consequences ensuing for the patient, the family and the state. Modern SCI therapy has a very limited effectiveness and does not allow to sufficiently restore the lost functions of central nervous system. Regenerative methods and particularly cell therapy are very promising to effectively treat SCI. The review highlights SCI epidemiological and pathogenetic problems, existing therapy, as well as promising methods of regenerative therapy. We emphasize the results of preclinical and clinical studies in the field of cell therapy. The review is divided into 4 parts. Part 2 describes the methods of noncellular regenerative therapy and cell therapy.

Deep brain stimulation (DBS) involves implantation of electrodes in the basal ganglia of the brain. Dysregulation of neuronal activity in these structures is the cause of motor disorders. DBS is used in many motor (Parkinson’s disease, essential tremor, dystonia, ticks, tardive dyskinesia and others), psychological, behavioral and affective (depression, obsessive-compulsive disorder, epilepsy and others) disorders, as well as in severe pain syndromes resistant to drug therapy. However, the mechanisms of action of DBS are not fully understood. Currently, different theories and hypotheses are considered which explain its mechanism of treatment: rate model, “jamming” theory, hypotheses about the effect on neurogenesis, astrocyte activity, increased brain circulation, electrotaxis, etc.

The article is devoted to life and work of Max Skoblo (1899–1963), an outstanding professor of neurology, who was a director of the Institute for Surgical Neurology in Leningrad. A devoted communist, he was twice purged (in 1937 he was convicted to 10 years of imprisonment at concentration camps in Kolyma, and in 1949 he was sent to exile for 5 years to Siberia). In 1955 he was rehabilitated and restored his membership in the Communist Party in 1956.