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 part 4, the use of human cord blood cells in SCI is discussed, in particular, the advantages of this type of therapy are considered, the composition of the cord blood cell mixture is described, and the results of preclinical and clinical studies are reported.

The review provides current data on the available literature on pathophysiology and clinical features of degenerative spinal canal stenosis in age-related patients. The possibilities of modern instrumental diagnostics of this pathology are described, a differential clinical diagnosis of lumbar stenosis is presented. Methods of surgical treatment of degenerative stenosis are described. The data on the effectiveness of surgical treatment, including in elderly patients. The features of anesthesia and risk factors for the adverse outcome of the surgical treatment of degenerative stenosis in elderly patients are described.

The study objective is to analyze literature and evaluate based on the obtained data the effectiveness of decompression of neural structures using different methods of facet fixation.

Materials and methods. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following inclusion criteria were used: full-text article in English, patient age above 19 years, presence of evaluation of the results of facet fixation, degenerative disease of the lumbar spine in patients.

Results. First search in the PubMed database returned 198 results. Among them, 38 articles complied with the inclusion criteria, and 33 articles didn’t contain full data on patient outcomes in the context of the studied stabilization methods. The selected 5 articles contained data on treatment results, rates of fixation and complications. Many authors note good clinical effect and decreased rate of intra- and postoperative complications for facet fixation compared to transpedicular fixation.

Study limitations. Absence of systematic reviews and availability of only 1 article for each method of facet fixation. Small patient samples and short follow-up.

Conclusion. Decompression and facet fixation in a single spinal motion segment in combination with posterior lumbar, transforaminal and lateral lumbar interbody fixation including use of minimally invasive technologies and other methods in many cases allows to achieve good clinical effect and firm stabilization.

The study objective is to determine the effectiveness, safety and information content of robot-assisted implantation of deep electrodes for invasive stereoelectroencephalography (stereo-EEG) monitoring in patients with pharmacoresistant epilepsy.

Materials and methods. The study group included 27 patients from 2016 and 2018, who underwent a robot-assisted implantation of stereo-EEG electrodes followed by a 24-hour video-EEG monitoring. Unilateral implantation of electrodes was performed in 22 patients, bilateral – in 6 patients (in 1 patient, due to the ineffectiveness of the operation to remove the epileptogenic focus, implantation was performed twice). MRI-negative epilepsy was in 16 (59 %) patients; 11 (41 %) patients with multiple structural changes. The average time for invasive video-EEG monitoring was 96 hours (from 46 to 253 hours).

Results. Based on the information obtained during invasive monitoring, the epileptogenic zones and early distribution were verified: in the temporal lobe in 9 (33 %) patients, in the frontal lobe – 6 (22 %), in the parietal lobe – 2 (8 %), in the occipital lobe – 3 (11 %), in more than 2 lobes – 4 (15 %), in both hemispheres – 3 (11 %) patients. Nineteen (70.4 %) patients underwent surgery to remove the epileptogenic zone. In 11 (58 %) patients extratemporal resection was performed and 8 (42 %) patients underwent anterior-medial temporal and amygdal-hippocampectomy. Follow-up history of more than 6 months after removal of the epileptogenic zone detected by stereo-EEG was monitored in 13 patients. The outcomes of surgical resection were as follows: in 8 (61 %) patients – Engel I, in 1 (8 %) – Engel II, in 3 (23 %) – Engel III, in 1 (8 %) – Engel IV.

Conclusion. Robot-assisted implantation of deep electrodes for invasive stereo-EEG monitoring is a safe and effective diagnostic method in patients with pharmacoresistant epilepsy. In patients with MRI-negative epilepsy, stereo-EEG allows to localize and determine the boundaries of the epileptogenic zone, thereby increasing the effectiveness and safety of surgical resection.

The phenomena of the mass effect of hemostatic material in the removed tumor area without the presence of a hematoma that causes or worsens the patient’s neurological status after surgery are difficult to diagnose and, with untimely help, causes irreversible neurological disorders. In world literature, we have found isolated sources describing similar complications. In the article, we present 7 clinical cases recorded from 2005 to 2019 in N. N. Burdenko National Medical Research Center of Neurosurgery and own experience in solving these difficult problems.

Introduction. Until now, the most informative methods for selecting patients with idiopathic normal pressure (iNPH) for neurosurgical treatment were invasive diagnostic methods: tap test, lumbar infusion test, external lumbar drainage. Nevertheless, choosing the sequence of using these diagnostic tools and the assessment of their results cause number of questions for doctors in everyday practice.

The study objective is to assess the informational content of invasive tests for differential diagnosis of iNPH and to create an algorithm of applying mentioned methods for clinical purposes.

Materials and methods. At least one of the invasive diagnostic methods was used for 374 patients, who were treated in the period from 2006 to 2018 in the neurosurgical clinic of S. M. Kirov Military Medical Academy. The patients with final diagnosis of iNPH (n = 231), aged 58–87 years old, were selected for shunt surgery. The informativeness measures were calculated for each method on the basis of revealed data.

Results. Sensitivity and specificity of tap test were 57.5 and 86.4 %, respectively, positive predictive value – 92.5 %, negative predictive value – 41.3 %, accuracy – 64.9 %. For lumbar infusion test sensitivity was 39.1 %, specificity – 63.6 %, but we calculated low negative predictive value (20.0 %) and accuracy (43.9 %) of the method despite of relatively high positive predictive value (81.8 %). External lumbar drainage revealed the highest significance of positive predictive value (92.9 %).

Conclusion. Excluding of lumbar infusion test from the pre-operative diagnostic algorithm of iNPH and recommendation for sequential using of tap-test and external lumbar drainage after questionable result of the last one are an advisable option for practitioners.

The study objective is to compare pre- and intraoperative characteristics, and the results of neurosurgical treatment in patients with Cushing’s disease, non-visualized adenoma and microadenoma of the pituitary gland.

Materials and methods. The results of transsphenoidal adenomectomy were analyzed in 102 patients with non-visualized corticotropinomas and 360 patients with microcorticotropinomas. The pituitary genesis of endogenous ACTH-dependent hypercorticism in 182 patients was proved by the results of selective blood sampling from inferior petrosal sinus with stimulation desmopressin. The study included 369 women and 93 men aged 16 to 64 years. All patients were operated by transnasal approach using endoscopic techniques.

Results. The group with non-visualized adenoma was dominated by men (p = 0.005) and patients with severe hypercorticism (p = 0.021). When comparing intraoperative characteristics in this group, invasive growth was statistically significantly more frequent (53 % vs 39 %) (p = 0.017), which in turn led to more aggressive intraoperative tactics (p <0.001) and more frequent development of hypothyroidism (11 % vs 4 %) (p = 0.028) in the early postoperative period. Early postoperative remission occurred in 73 (72 %) of 102 patients with non-visualized adenoma and in 314 (87 %) of 360 patients with microadenoma (p <0.001).

Conclusion. Early results of primary transsphenoidal adenomectomy in patients with non-visualized pituitary adenoma were significantly worse in comparison with patients with microadenoma detected by 1.5 T magnetic resonance imaging, which have more frequently invasive growth, what leads to an increase in the volume of surgery and a possible increase in postoperative hypopituitarism.

The study objective is to compare the effectiveness of different methods of radiofrequency denervation of the sacroiliac joint (SJ): standard neurotomy (SN) of the posterior medial branch L₅ and lateral branches S₁–S₃, ligamentous neurotomy (LN) and a combination of ligamentous and standard methods – a combined neurotomy (CN).

Materials and methods. The results of the treatment of 311 patients with SJ dysfunction were analyzed. LN was perfomed in 117 patients, SN – in 102, CN – in 92. The effectiveness of SJ neurotomy was assess using the visual-analog scale (WAS) and the Oswestry Disability Index (ODI) 3 days, 3, 6 and 12 months or more after denervation.

Results. The most significant improving the patient’s condition occurred after CN, the average ODI decreased from 35.14 ± 7.49 before the intervention to 22.64 ± 10.26 a year after it (p = 0.006). After SN and LN, a decrease in the degree of maladaptation occurred, respectively, from 36.00 ± 7.32 to 28.08 ± 7.03 (p = 0.021) and from 34.50 ± 6.75 to 26.45 ± 7.18 (p = 0.018). The intensity of the pain syndrome according to WAS after CN decreased from 7.2 ± 2.0 to 3.6 ± 2.5 a year after denervation (p = 0,00024). After SN and LN, a decrease in pain intensity according to WAS occurred respectively from 7.2 ± 2.0 to 4.8 ± 2.3 (p = 0.0025) and from 7.1 ± 2.3 to 5.7 ± 2.5 (p = 0.00016) a year after denervation.

Conclusion. All methods of denervation in case of defeat of SJ lead to a statistically significant decrease in pain syndrome and an improvement in the quality of life. A positive result of denervation persists for a year after the intervention. CN leads to a more significant improvement and its results exceed the results of SN and LN for most of the period of postoperative observation.

Treatment strategies for dural arterio-venous fistulas (DAFs) include single or multimodal schemes, including microsurgery, endovascular transarterial or transvenous embolization, or stereotactic radiosurgery (SRS).

In the scientific medical resources, only 9 cases of bilateral DAFs of the brain are described, which required surgical intervention, and 4 were treated with endovascular or microsurgical approach; SRS was used in 5 cases, of which in 4 cases with previous or subsequent endovascular embolization.

We have presented a case of successful SRS with Gamma Knife of bilateral DAF from the branches of meningo-hypophyseal trunks from inner carotid arteries without preliminary embolization or surgical resection.

The use of SRS with Gamma Knife is possible with low-flow DAFs, as well as a part of a multimodal strategy with high-flow DAFs, which requires further study.

The objective is to describe the case of successful endovascular treatment of residual chronic subdural hematoma.

Clinical case. Patient A., 77 years old, was admitted to the hospital with a directional diagnosis of stroke. During further examination, left hemispheric chronic subdural hematoma with a volume of 100 cm³ was revealed. The patient was twice performed closed external drainage of hematoma. And for each subsequent control computed tomography studies, a residual hematoma with a volume effect on the brain was determined. Endovascular selective embolization of the left middle meningеal artery was performed. During the examination after 5 months, a complete reduction of hematoma, cerebral and focal neurological symptoms was noted.

Conclusion. Endovascular embolization of the middle meningeal artery may be a pathogenetically substantiated, minimally invasive alternative to repeated surgical interventions for residual and recurrent chronic subdural hematoma. It will be reasonable to continue research to assess the effectiveness and safety of the methodology.

Introduction. The literature showed a limited number of cases of facial pain caused by pathology at the level of the craniovertebral junction, however there is no a single case of pain caused by the migration of elements of the shunt systems.

The objective is to describe a clinical case of successful surgical treatment of facial pain caused by the Torkildsen shunt migration.

Clinical case. A female patient, 58 years old, applied to the clinic complaining of constant pain with a paroxysmal component in the left part of the face and back of the skull associated with head movements. Other complaints included a headache accompanied by nausea, numbness in the limbs, instability in vertical position, urinary incontinence, abnormal proprioceptive sensitivity in the limbs. Medical history showed that in 2000 the patient underwent Torkildsen procedure (ventriculo-cisternostomy) due to occlusive hydrocephalus after a neurological infection. In 2013, due to shunt dysfunction endoscopic third ventriculostomy was performed with a good clinical effect. Deterioration started in January of 2018. At hospitalization, tomography of the brain showed migration of the distal end of the shunt into spinal matter, syringobulbia at the C₁ vertebra level. No signs of neurovascular conflict of the trifacial nerves were observed. Removal of the ventriculo-cisternal shunt irritating the spinal nucleus of the trifacial nerve was performed. In the postoperative period, intensity of the paroxysmal component of facial pain decreased. At day 5 after surgery, the patient was discharged in a satisfactory state. For 1 year and 6 months after the surgery, facial pain has been absent. Manifestations of hydrocephalus and spinal disorder (numbness of the limbs, instability, urinary incontinence) persist, but due to the patient’s compensated state, negative result of the tap-test, signs of functional third ventriculostomy, it was decided to abstain from further interventions.

Conclusion. This clinical case demonstrated successful treatment of facial pain developed due to a rare cause – migration of a Torkildsen shunt that currently is rarely encountered.

The study objective is to describe a clinical case of a rare disorder of the cerebellum, Lhermitte–Duclos disease.

Clinical case. The Federal Neurosurgical Center (Novosibirsk) admitted a male patient, 40 years old. Medical history showed that in 2017 he underwent ventriculoperitoneal shunt due to hypertensive hydrocephalus syndrome caused by space-occupying mass of the right hemisphere of the cerebellum. In June of 2017, the patient was consulted by a neurosurgeon. Later, an increase in the mass, partial atrophy of the optic disks were observed. Due to the patient’s complaints of headache, ataxia, vertigo, as well as insufficient effect of the shunt, microsurgical removal of the space-occupying mass in the cerebellum by right paramedian suboccipital craniotomy was performed. Gangliocytoma removal was performed under constant neurophysiological control which allowed to fully resect the gangliocytoma inside intact brain tissue. Histological and immunohistological examinations allowed to diagnose grade I dysplastic gangliocytoma of the cerebellum (Lhermitte–Duclos disease). In the postoperative period, brain symptoms regressed fully, vestibulocerebellar syndrome persisted. The patient was discharged in satisfactory condition. No negative dynamics were observed in 7 months of follow-up.

Conclusion. Due to the rareness of Lhermitte–Duclos disease, currently there are no established approaches to treatment, however, in symptomatic course there are indications for surgical removal of the gangliocytoma. Radicality of resection should be correlated with the risk of neurological defects. In our case, surgical treatment allowed to improve the patient’s condition, prevent further progression of the gangliocytoma and obtain an accurate histological diagnosis.

The article describes the main personal and professional events in the life of Professor A. V. Triumfov, organizer of neurological departments and divisions in educational and medical institutions in Novosibirsk and Leningrad. Prof. Triumfov founded the first neurological division in the Naval Academy of Medicine and developed a course on neurosurgery, as well as legendary guidelines on topical diagnosis of neural disorders.