The study objective is to analyze characteristics of distal aneurysms of the posterior inferior cerebellar artery (PICA) using the results of surgical treatment of 11 patients with this disorder.

Materials and methods. Eleven patients with distal PICA aneurysms (7 men and 4 women aged between 32 and 57 years (mean age 44 years)) were operated in N.V. Sklifosovsky Research Institute for Emergency Medicine. Aneurysms were visualized using cerebral angiography in 2 patients and using computed angiography in 9 patients. The aneurysms were classified using the classification system developed by J.R. Lister and A.L. Rhoton. Aneurysms located in the tonsillomedullary segment were most common. Saccular aneurysms were found in 7 (64 %) patients, whereas fusiform aneurysms were observed in 4 (36 %) patients. Two saccular aneurysms had a large neck. The size of aneurysms varied between 2 and 9 mm. The majority of patients (70 %) had aneurysms less than 7 mm.

Results. Five patients were operated via median suboccipital approach, while the remaining 6 patients were operated via lateral suboccipital approach. We performed either reconstructive (n = 9) or deconstructive (n = 2) aneurysm clipping depending on the possibility of preserving the PICA lumen and presence of damage to the perforating arteries of the brain stem. Nine patients (82 %) had Glasgow Outcome Score of 5; two patients (18 %) died (one of them was admitted in sopor with occlusive hydrocephalus; another one had grade III–IV obesity and developed purulent septic respiratory complications and secondary purulent meningitis). Two patients (18 %) developed dysarthria and dysphagia in the postoperative period, but these symptoms disappeared by the moment of discharge.

Conclusion. Distal PICA aneurysms are quite rare and require tailored approach to treatment. A surgeon should bear in mind specific anatomical characteristics of aneurysms, control arterial patency when isolating the aneurysm from the bloodstream, and use revascularizing methods whenever possible. In addition to that, a surgeon should be extremely careful during manipulations with perforating arteries of the brain stem and distal cranial nerves, because their damage result in a more difficult postoperative period.

Conflict of interest. The authors declare no conflict of interest.

Informed consent. All patients gave written informed consent to participate in the study and to the publication of their data.

The study objective is to present the results of applying stent retriever pRESET as assistance device in embolization of brain aneurysm.

Materials and methods. Between January 2017 and May 2018, were threated 10 patients with brain aneurism using temporary stent-assistant method. The average aged was 41. Asymptomatic aneurysmal disease was observed in five patients, two patients were operated on in the acute period of subarachnoid hemorrhage, in two cases temporary stent assistance was used for pre-embolization of previously operated aneurysms. Temporary stent assistance was performed using a stent retriever pRESET (Phenox, Germany).

Results. The technical success of the intervention was 100 %. Total embolization of aneurysms was achieved in seven patients, in three patients subtotal embolization was observed. All observations had positive neurological outcomes on discharge.

Conclusion. Temporary stent assistance using a stent retriever pRESET is an additional option for endovascular treatment of brain aneurysms.

Conflict of interest. The author declares no conflict of interest.

Informed consent. All patients gave written informed consent to participate in the study

The study objective is an objective assessment of the treatment outcome with a gamma knife radiosurgery (GKRS) in different types of supratentorial cavernous malformations on the basis of their sizes and clinical symptoms dynamic changes after the treatment.

Materials and methods. GKRS outcomes in 145 patients with hemisphere cavernous malformations (58 male, 87 female, the mean age 43,3 ± 11,9) were analyzed by comparing the initial and control data in all the patients and the telephone interview of 91 (37 male, 54 female, the mean age being 42,2 ± 11,9) patients.

Results. On the basis of the “CM size reduction” criterion the efficacy of GKRS in the first magnetic resonance imaging control was 70 %. It was comparable in type I and type II CMs (76,3 and 72,5 % accordingly), but it was evidently worse in type III CMs (p = 0,0032). Repeated hemorrhages were noted in 3 observations in deep type I CM. Totally, statistically evident dependence on CM size reduction (p = 0,0413) was obtained on the clinical efficacy criterion with initially developed symptoms, which in turn means does not prove its effectiveness in type III CMs. In epileptic syndromes accompanying CMs, the efficacy of GKRS was selective, and did not correlate with CM size reduction, but mostly depended on the genesis and course of epileptic seizures.

Conclusion. GKRS appears to be a justified method of treatment for clinically compensated mobile patients with type I and type II CMs. The clinical effectiveness of GKRS in such patients is in no way inferior to open surgery and does not exceed the number of its complications. CM type III should be excluded from the objects of treatment by GKRS.

Conflict of interest. The authors declare no conflict of interest.

Informed consent. All patients gave written informed consent to participate in the study and for the publication of their data.

The study objective is to demonstrate our experience of employment of O-Arm intraoperative portable сomputed tomography scanner combined with navigation system Stealth Station Treon Plus (Medtronic Navigation) during decompressive-stabilizing surgeries for patients with primary and metastatic spinal tumors.

Materials and methods. We have reviewed results of surgical treatment of 44 patients (24 males and 20 females, average age is 54.3 ± 1.8), who were hospitalized and operated in the department of spinal neurosurgery in Federal Centre of Neurosurgery (Tyumen). All surgeries were performed by one surgical team in the period of April 2011 to June 2017. All patients underwent full clinical examination according to diagnostic algorithm, including assessment of general condition, degree of bone and visceral dissemination, neurological status, quality of life, pain syndrome intensity. The most common cause of vertebral lesions was plasma cell myeloma (15 patients, 34.1 %), metastatic spinal lesions (12 patients, 27.3 %). Patients were subjected to posterior decompression and stabilization with total and subtotal excision of mass lesions. Assessment of degree of decompression and transpedicular fixation were carried out visually using O-Arm combined with navigation station.

Results. In 6 to 12 months after surgery 79.5 % of patients demonstrated significant improvement of neurological status, specifically a decrease of conduction and sensory disorders. Degree of pain syndrome was reduced by 3.6 times. Using O-Arm combined with navigation station we placed screws adequately in 99.6 % of the cases. The main technical problem that occurred during the surgery was the failure of navigation system caused by: defect of reflective spheres, distant installation and shift of referential frame, aging of Jamshidi needle, malfunction of navigation camera, failure of data transfer from navigation station.

Conclusion. The use of O-Arm combined with navigation station for decompressive and stabilizing surgeries in patients with spine and spinal cord tumors let us perform surgeries with 3D control and navigation, conduct surgeries in areas where it is hard to determine surgical landmarks, ensure precision of transpedicular screw implantation, accomplish total resection of mass lesions with minimal blood loss and less aggressive surgical intervention and properly decompress the spinal canal which, eventually, result in positive anatomical and functional characteristics, and contribute to good general outcome of surgical intervention.

Conflict of interest. The authors declare no conflict of interest.

Informed consent. All patients gave written informed consent to participate in the study and to the publication of their data.

The study objective is to assess the effectiveness and safety of videoimage endoscopy during minimally invasive surgery in fractures of the upper orbital roof.

Materials and methods. We examined and operated 9 patients (7 men and 2 women) aged 16 to 53 years (mean age 28.4 years) with fractures of the upper orbital roof with intraorbital (n = 7) and intracranial (n = 2) fragments displacement. Surgery was aimed at eliminating oculomotor disorders, preventing purulent-septic complications and restoring tightness of the intracranial space and orbital anatomy. All patients were operated using 4 mm rigid endoscopes with 0 and 30° viewing angles.

Results. All patients underwent fraction resection and intraorbital structures decompression. No case of intraoperative liquorrhea was registered. The surgery did not change visual acuity. Ocular motility disturbances were eliminated in all patients. Videoimage endoscopy made it possible to avoid wide craniotomy used to approach orbital roof and to shorten the rehabilitation period and hospitalization time. With intraorbital fragments displacement it allowed to reconstruct the orbit with minimal eyeball traction, while preserving important neurovascular bundles, as well as simultaneously revise dura mater and anterior cranial base in order to exclude intraoperative liquorrhea. No complications of surgical treatment were reported.

Conclusion. The results demonstrate the wide possibilities of endoscopy in cranioorbital lesions surgery.

Conflict of interest. The authors declare no conflict of interest.

Informed consent. All patients gave written informed consent to participate in the study

The study objective is to assess the effectiveness of interlaminar decompression in patients with degenerative lumbar stenosis.

Materials and methods. A prospective study was conducted among 100 patients with degenerative lumbar stenosis. All patients were operated, interlaminar decompression of the symptomatic side was made. Outcomes were assessed by using a visual analogue scale and Oswestry questionnaire 1 and 2 years after surgery. Among patients with an unsatisfactory result, the cause of the unsatisfactory outcome was studied.

Results. One year after surgery a satisfactory result was noted in 71 patients, and 2 years after surgery a satisfactory result was noted in 67 patients. The following causes of unsatisfactory outcome were found in 33 patients: 9 – spinal canal restenosis, 2 – herniated disc at the operation level, 4 – the facet syndrome, 4 – development of clinical instability, 3 – pain in the opposite leg (there was no pain before the operation), 2 – development of delayed radiculopathy, 9 – decompensation of concomitant diseases (4 – coxarthrosis, 3 – gonarthrosis, 2 – chronic ischemia of the lower extremities). Among the risk factors for restenosis, statistically significant relationship was found only with the presence of spondylolisthesis.

Conclusion. Interlaminar decompression is an effective surgical option in patients with degenerative lumbar stenosis. The presence of spondylolisthesis is a risk factor for the inefficiency of this operation.

Conflict of interest. The authors declare no conflict of interest.

Informed consent. All patients gave written informed consent to participate in the study

The study objective is to evaluate long-term effectiveness of extracranial-intracranial (EC-IC) bypass in patients with symptomatic occlusion of the internal carotid artery (ICA).

Materials and methods. From 2013 to 2015, 129 patients (aged 41 to 78, average age – 60 years) were applied EC-IC bypass on the side of ICA symptomatic occlusion at the Department of Neurosurgery of N.V. Sklifosovsky Research Institute for Emergency Medicine. We revealed right ICA occlusion in 54 patients, left ICA occlusion – in 67, bilateral occlusion – in 8. Symptomatic ICA occlusion was 5 times more often in men. We assessed neurological status in 1, 2, and 3 years using modified Rankin Scale, National Institutes of Health Stroke Scale, and Rivermead Mobility Index. Computed tomography (CT) angiography of extracranial and intracranial arteries, ultrasound of the anastomosis zone, single-photon emission computed tomography (SPECT) were performed.

Results. In the early postoperative period, according to CT angiography and ultrasound, the anastomosis functioned in 125 (97 %) patients; improvement of regional cerebral perfusion according to SPECT was observed in all examined patients (n = 62). We examined 31 patients in the remote postoperative period. According to CT angiography and ultrasound, anastomosis functioned in 30 (97 %) patients, 30 (97 %) patients demonstrated positive dynamics of neurological status and brain perfusion. There were no repeated ischemic-type cerebral circulatory disorders and repeated transient ischemic attacks in the long-term postoperative period.

Conclusion. Positive dynamics after EC-IC bypass was revealed both in early and in distant periods (within 1–3 years). During the surgery, it is necessary to take into account cases of ischemic strokes or transient ischemic attack, ICA occlusion according to CT angiography, a decrease in cerebrovascular reserve (<10 %) according to brain SPECT when tested with acetazolamide. To prevent complications, EC-IC bypass should not be used in patients with severe neurological impairments and concomitant pathology. Properly selected patients and postoperative drug therapy helps prevent repeated ischemic cerebral circulatory disorders.

Conflict of interest. The authors declare no conflict of interest.

Informed consent. All patients gave written informed consent to participate in the study.

The objective is to present 2 clinical cases of complete vision loss after bifrontal access during craniotomy due to vascular brain pathology.

Materials and methods. In one case, a bifrontal skin incision was used during subfrontal craniotomy to remove frontal lobe arteriovenous malformation, in the other one – to apply intracranial side-to-side anastomosis between A3 segments of both anterior cerebral arteries, and to clip proximal aneurysms of the anterior connecting artery and the anterior cerebral artery on the right. After the surgery, patients developed bilateral amaurosis and ophthalmoplegia. We analyzed data on patients’ general clinical condition and their ophthalmological status prior to the surgery, as well as surgical videos and anesthesia records.

Results. Intraoperative iatrogenic damage of cranial nerves and arteries was excluded. We distinguished that a suspected intraoperative factor, playing a decisive role, was a piece of skin applying direct pressure on the eyeballs. It was removed during the surgery.

Conclusion. To prevent the development of such a complication as vision loss, it is necessary to carefully evaluate all possible risks at preoperative and intraoperative stages. During the surgery, all organs and systems at risk should be monitored. It is important to prevent a sudden drop in blood pressure and massive blood loss. During craniotomy, any eyeballs compression must be avoided.

Conflict of interest. The authors declare no conflict of interest.

Informed consent. All patients gave written informed consent to publication of their data.

The objective of the present article is to describe a rare clinical case of progressive post-traumatic cervical syringomyelia after spinal cord injury with fracture of proximal metaepiphysis of the right humerus. The patient had a progressive neurological loss after spinal cord injury.

Materials and methods. The patient underwent surgical treatment: decompression and stabilization of spinal column, surgical technique of spinal cord detethering, cyst shunting.

Results. In the postoperative period the patient had increased spasticity in the lower extremities, increased weakness in the muscles of the upper extremities, aggravation of orthostatic hypotension, and inability to flex the first and the fifth fingers of the right hand. Magnetic resonance imaging of the cervical spine revealed progression of syringomyelia.

Conclusion. This case demonstrates differentiation between cervical myelopathy and plexus paresis in a patient with combination spinal injury and reveals the mechanisms underlying late progression of neurological deficit.

Conflict of interest. The authors declare no conflict of interest.

Informed consent. The patient gave written informed consent to the publication of his data.

The objective is to report 3 cases of intraneural cyst (ganglion) of the peroneal nerve and compare our own findings with the data from scientific literature.

Case reports. Three patients with intraneural ganglions of the common peroneal nerve were treated in the Department of Neurosurgery, A.Ya. Kozhevnikov Clinic of Nervous Diseases, I.M. Sechenov First Moscow State Medical University between 2013 and 2019. All patients underwent extensive dissection of the cyst wall, evacuation of secretion; 2 of them had ligation of the articular nerve branch, while in one patient, the articular branch was not revealed. Complete nerve recovery was registered in all cases.

Conclusion. We believe that ganglion dissection using microsurgical techniques with surgical microscope is a safe and noncomplex procedure; therefore, the avoidance of this manipulation seems unjustified.

Conflict of interest. The authors declare no conflict of interest.

Informed consent. All patients gave written informed consent to the publication of their data.

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. In the part 3, the description of cell therapy methods continues.

Conflict of interest. The authors declare no conflict of interest.