The article presents the definition and the epidemiology of endocrine ophthalmopathy. The main clinical manifestations of endocrine ophthalmopathy and the principles of treatment are described. Particular attention is paid to listing all possible methods of surgical decompression of the orbit, both internal and external. A comparative analysis of the available methods of orbitotomy, their advantages and disadvantages is presented. The main factors of the efficiency of orbit decompression, possible complications and measures for their prevention are analyzed. The paper also highlights the methods of treatment of optical neuropathy and predicting the results of surgical decompression of the orbit.

Dysphagia, dysphonia and injuries of the recurrent laryngeal nerve still remain the most frequent complications of anterior cervical spinal fusion despite rich world experience, high technological level of anterior supporting complex surgeries. These complications very seldom lead to life-threatening situations, but they reduce patients’ quality of life during the early post-surgical period and patients’ satisfaction with the results of the surgery. The main reasons of intraoperative damage of esophagus, larynx and recurrent laryngeal nerve, methods of dysphagia and dysphonia prevention are described in this work.

The study objective is to evaluate the results of pharmacologic provocative tests with neurophysiological intraoperative monitoring application during spinal cord arteriovenous malformation (AVM) embolization.

Materials and methods. In the period from 2016 to 2018, 38patients with spinal cord AVM of different types (according the J. Anson and R. Spetzler classification) underwent endovascular surgery at the Federal Neurosurgical Center (Novosibirsk, Russia). Fifteen of these patients were operated using pharmacologic provocative tests with neurophysiological intraoperative monitoring of motor (MEP) and somatosensory evoked potentials (SSEP). Aminoff and Logue Disability Scale was used to estimate neurological deficit before and after surgery, additionally Medical Research Council Muscle Scale was used to estimate motor deficit.

Results. In 15 patients, 37provocative samples with propofol and 38 samples with lidocaine with simultaneous registration of MEP and SSEP were performed. In the early postoperative period, a significant improvement in motor function was achieved in 2 patients, 3 showed a noticeable improvement, and 10 patients remained without dynamics. Urinary function improved in 2 patients, and in 13 remained unchanged. In 4 patients, the pharmacological test with propofol was positive, which was manifested by a decrease in the amplitudes of the MEP, and among the samples with lidocaine in 10 cases, a decrease in the amplitudes of the MEP was noted, with a simultaneous decrease in the amplitudes of the SSEP during 3 samples. In all patients, the decrease in the amplitudes of the evoked potentials was transient in nature and disappeared after a change in the place of administration of the pharmacological agent. This did not allow us to determine the sensitivity of the method for predicting persistent postoperative neurological deficit. To predict the development of motor deficiency in the early postoperative period, the specificity of lowering the amplitude of the MEP during the pharmacological test was: 57 % to reduce by 50 %; 87 % for a reduction of 80 % and 93 % for the complete disappearance of MEP. For the prognosis in the distant period (3 months after endovascular treatment), the specificity of decreasing the amplitude of the MEP by 50, 80 and 100 % was 46, 85 and 100 %, respectively.

Conclusion. The use of neurophysiological monitoring and provocative tests is a safe method that allows you to make the optimal tactical decision in the endovascular treatment of spinal cord AVM. As a provocative test, it is recommended to use two pharmacological drugs (propofol and lidocaine). A 80 % decrease in MVP amplitudes or the disappearance of MVPs are more accurate criteria for the clinical outcome of spinal cord AVM embolization. The specificity of MVP in detecting an increase in motor deficiency in the early and long-term postoperative periods was maximum (93 and 100 %, respectively), if the disappearance of MVP was chosen as a criterion of pathology.

The study objective is to evaluate the effectiveness of various endovascular techniques for treatment of patients with superior cerebellar artery (SCA) aneurisms (depending on anatomical location of the aneurisms).

Materials and methods. Between 2014 and 2018, 27 (7 men, 20 women) patients with saccular aneurisms underwent surgery implementing endovascular techniques. The patients’ mean age was 50.4 years. The relations between the basilar artery and the SCA, size, symptoms during manifestation were evaluated. For favorable aneurism geometry (neck diameter <4 mm, neck/dome ratio >2, absence of involvement of the parent artery branches in the pre-neck part of the aneurism) only microcoil occlusion was performed, in other cases various assisting techniques were used; if the aneurism deformed the distal part of the basilar artery, flow diversion stents (FDS) in combination with other techniques were used. Clinical results were evaluated using the modified Rankin Scale, occlusion grade — sing the Raymond—Roy scale immediately after the surgery and 6 months later.

Results. Microcoil occlusion was performed in 4 (14.8 %) patients, in combination with balloon assistance — in 4 (14.8 %) patients, with stent assistance — in 13 (48.2 %) patients, with balloon and stent assistance — in 2 (7.4 %) patients, implantation of FDS — in 1 (3.7 %) patient, implantation of an assisting stent — in 1 (3.7 %) patient, microcoil occlusion with balloon an stent assistance and implantation of FDS — in 2 (7.4 %) cases. Total occlusion immediately after the surgery was achieved in 15 (55.5 %) patients, subtotal — in 7 (25.9 %). Long-term, total occlusion was observed in 82.3 % patients: in 2 (7.4 %) patients with preserved pre-neck contrast spontaneous thrombosing of the aneurism was observed, in 2 cases aneurisms were excluded after installation of FDS. Functional outcome of the surgery was favorable in 18 (66.7 %) patients, deterioration was observed in 4 (14.8 %) patients. Long-term, 6patients experienced improvement, condition of 11 patients did not change. In 1 (3.7 %) male patient, thromboembolism with occlusion of the posterior cerebral artery and hemianopsia developed during surgery; in 1 female patient cerebral subarachnoid hemorrhage occurred which led to death; 2 (7.4 %) patients developed ischemic complications associated with distal thromboembolism aggravating overall cerebral and neurological symptoms; in 1 (3.7 %) female patient, damage of the oculomotor nerve occurred.

Conclusion. Endovascular treatment of SCA aneurisms using microcoil occlusion and/or other intravascular techniques is effective and sufficiently safe. Treatment tactics should be decided taking into account anatomical characteristics of the aneurism, structure of the Willis artery, condition of the precerebral vessels. Indication for use of FDS in SCA aneurisms require specification, but our results demonstrate their effective use in complex aneurisms of this localization.

The study objective is to present our experience in the treatment of ruptured cerebral aneurysms using intracranial low-profile braided stents in the first 72 hours of subarachnoid hemorrhage.

Materials and methods. A retrospective analysis of 5 patients’ data was performed. All patients were treated for a ruptured cerebral aneurysm in the period from June 2017 to December 2018 at the Surgut Clinical Hospital for Traumatology. Patients were operated using a low-profile braided stent in the first 72 h of subarachnoid hemorrhage. Clinical data, Hunt—Hess grade, morphology of aneurysms, Raymond— Roy angiographic results, outcomes according to a modified Rankin Scale were evaluated.

Results. All 5 aneurysms are turned off from the bloodstream in the first 72 hours from rupture. The preoperative condition was assessed as mild in 1 patient (Hunt—Hess grade I—II), moderate in 3 (grade III), and ssevere in 1 (grade IV). Stent placement was used to “bail out" situations with coil migration saccular aneurysm (n = 2), for occlusion the broad-based aneurysms (n = 2), for dissecting neurysm occlusion without of coils using (n = 1). Total aneurysm occlusion was achieved in 4 cases (Raymond—Roy I), subtotal in 1 (Raymond—Roy II). Technical difficulties were in 1 case: transient intraoperative in-stent thrombosis, regressed with the super-selective administration of tissue plasminogen activator. A follow-up angiographies demonstrated complete aneurysm occlusion in 4 cases, including “solo" stent placement (Raymond—Roy I); recurrent aneurysm occurred in 1 (Raymond—Roy III), retreatment was required. The favorable outcome of treatment (modified Rankin Scale 0—2) was achieved in 5 cases.

Conclusion. The use of low-profile braided stents for occlusion ruptured cerebral aneurysms in the first 72 hours of subarachnoid hemorrhage is relatively safe and can be used to prevent re-rupture. However, it could be associated with a relatively high risk of periprocedural thromboembolism.

Background. Inflammatory reactions, neurotoxicity cascade and secondary ischemia are aftermath of spinal cord injury. The neurotoxicity biomarkers can help to assess severity of injury.

The study objective is to detect level of the potential biomarkers of neurotoxicity and neuroinflammation — antibodies to glutamate receptors in blood serum of patients with spinal cord injury in comparison with standard diagnostic data.

Materials and methods. We enrolled 17 patients with spinal cord injury, 10 patients with uncomplicated spine trauma, and 15 healthy volunteers. All participants underwent a neurological examination on the scale of the American Spinal Injury Association and 1.5 Т magnetic resonance imaging (MRI) of the spinal cord. The concentration of antibodies to ionotropic glutamate receptors (NR2A NMDA-recep-tors, AMPA/kainate receptors) were measured by enzyme-linked immunosorbent assay. The results were compared with the size of the lesion according to MRI data and a neurological scale.

Results. The concentration of AMPA/kainate antibodies in patients with spinal cord injury were increased (p = 0,006 andp = 0,01 respectively) compared to controls and those with uncomplicated spine trauma. We observed a direct correlation (r = 0.57, p <0,05) between the concentration of antibodies to the kainate receptor and the size of the lesion (hyperintensive signal) according to MRI.

Conclusion. The results shows the potential effectiveness of the neurotoxicity biomarkers and the significant role of the antibodies to glutamate receptors in the diagnosis of spinal cord injury.

The study objective is to develop and test on cadaveric materials a new technique for reinnervation of facial muscles at an early stage from the moment of paralysis occurrence for introduction into neurosurgical practice.

Materials and methods. Eighteen (18) fresh non-embalmed cadavers (10 men and 8 women, ages between 18 and 67 years without pathology of the craniomaxillofacial area) were used. During the intervention, a cadaver was put on its back, access to the area of interest was performed in esthetically insignificant areas. For plastic surgery of the facial nerve, the masseteric branch of the trigeminal nerve and the subtotal hypoglossal nerve, calf sural nerve and great auricular nerve autotransplants were used as donor material.

Results. The presented technique inflicts minimal damage to the patient during autotransplant collection as no functionally significant structures are affected.

Conclusion. It is anticipated that in clinical practice the technique will result in movement of the mimic muscles of the upper and middle areas of the face (closure of the eyelids, raising of the eyebrows, etc.) concurrent with swallowing, because upper group of the facial nerve branches is reconstructed using the hypoglossal nerve. Mimic movements of the lower part of the face (smile, lip pursing, teeth baring, etc.) will be performed during teeth clenching as lower group of the facial nerve branches are repaired using the masseteric branch of the trigeminal nerve.

The study objective is to assess the effectiveness of spinal cord electrostimulation in patients with degenerative lumbar spinal stenosis.

Materials and methods. A study was conducted among 20 patients with degenerative lumbar spinal stenosis. All patients had radicular symptoms or neurogenic claudication. Most patients (n = 18) were rejected from open decompression because of severe concomitant somatic pathology. Two patients refused from open intervention, they were offered electrostimulation. All patients (n = 20) were implanted of the test epidural electrode for spinal cord electrostimulation. Outcomes were assessed by using a visual analogue scale and increasing of the distance of non-stop walking in 8 days after surgery. Among patients with chronic spinal cord electrostimulation, outcomes were assessed in 6 months after implantation. A satisfactory result was considered as a decreasing of pain more than 50 %.

Results. А satisfactory result of test electrostimulation was noted in 18 patients, all of them were implanted of system of the chronic spinal cord electrostimulation. The average value of lumbar pain changed from 4.2 to 3.1 points, and the average value of leg-pain changed from 7.2 to 2.2 points. The average value of the non-stop walking distance changedfrom 58 to 245 meters. At the same time, the motor component of neurogenic claudication decreased in only 1 patient. In some patients, after regression of radicular pain, heart complaints became the main factor limiting walking. Before electrostimulation, only 3 patients had no walking restriction. After electrostimulation 7 patients had no walking restriction.

Conclusion. Spinal cord electrostimulation is an effective palliative option in patients with degenerative lumbar spinal stenosis.

A clinical observation of successful transoral removal of a giant tumor (lipoma) located on the anterior surface of the C₁—C₄ vertebral bodies with spreading into their structures is described. The presented case demonstrates that the use of minimally invasive surgical techniques and approaches can achieve good clinical results of surgical treatment when the pathology is localized in the parapharyngeal space for a significant length.

Malignant gliomas consist 15.6 % of all primary brain tumors. Amidst the group of neoplasms, glioblastoma remains the most common primary malignant brain tumor in adults. Mortality of patients with glioblastoma remains the highest among all cancer patients, approaching the absolute. At the present stage, a combined multimodal approach based on adjuvant chemotherapy and radiotherapy after the most safe microsurgical resection of the tumor is considered to be the standard protocol for the treatment of glioblastoma, but the median survival of patients does not exceed 24.5 months.

Recently, the role of stereotactic radiosurgery in the treatment of glioblastoma recurrence is increasing, which is due to the high efficiency and organ-preserving specifics of the radiosurgical effect. Our clinic uses stereotactic radiosurgery on the gamma knife, which is a successful combination of surgical and radio-oncological treatment technologies, using a high dose of focused radiation (in one or several procedures) and a sharp drop in the dose, which results in a pronounced radiobiological effect, along with a gentle attitude towards adjacent anatomical structures.

As part of this work, a clinical example of long-term survival with a high quality of life is given in the treatment of recurrent glioblastoma on the gamma knife.

The objective is to describe an atypical case ofBernhardt-Roth syndrome, manifested without paresthesia and hypesthesia in the zone of innervation of the lateral femoral cutaneous nerve and accompanied by an intermittent limp and to demonstrate the effectiveness of surgical treatment of an atypical variant of this tunnel syndrome.

Materials and methods. A pain intensity (on a visual analog scale), neurological status, walking ability, lower extremity function (on a Lower Extremity Functional Scale), and quality of life (using a NeuroQoL questionnaire), as well as the results of electroneuromiography, ultrasound examination of the nerves of the lower extremities, and magnetic resonance imaging of the hip joint were assessed before and after surgery in patient with Bernhardt-Roth syndrome.

Results. A patient with an atypical variant of Bernhardt-Roth syndrome underwent neurolysis of the lateral femoral cutaneous nerve. The positive effect of surgical treatment (improving the quality of life and restoring the functional status of the lower limb) was revealed.

Conclusion. Neurolysis of the lateral femoral cutaneous nerve is effective in the atypical version ofBernhardt—Roth syndrome.

Based on first-hand experience and literature data, the authors present detailed descriptions of different types of endoscopic interventions for intracerebral and intraventricular hemorrhages removal using rigid and flexible endoscopes, ports and trocars for ventricular surgery. Knowledge on techniques of endoscopic aspiration of hypertensive intracranial hemorrhages is structured and summarized, recommendations on use of different techniques depending on the type of hemorrhage and available equipment are presented. Endoscopic aspiration is described as an effective technique allowing to solve the problem of low-injury intracerebral and intraventricular hemorrhages removal in almost any localization.

The article is devoted to the comparison of standardized and individualized approaches to treatment, issues of the possibilities and limitations of a standardized approach, the irreplaceability of “clinical thinking”, the cost of medical error, the value of professional culture and a humanistic paradigm in medicine.