The objective is to study surgical anatomy of the vein of Labbé (inferior anastomotic vein) and venous drainage of the mediobasal surface of the temporal lobe, as well as to identify the most common variants of drainage of the lateral and basal parts of the temporal lobe which are necessary to take into account during surgical approach.

Materials and methods. The study was conducted on 50 non-preserved human brain hemispheres with homolateral surface of the base of the skull. Surgical part of the study was conducted on 25 cadavers. Anterior and posterior petrosal subtemporal transtentorial approaches were modelled. Standard neurosurgical set of microinstruments, surgical microscope and high-speed neurosurgical drills were used. At the intradural stage of the approach, the vein of Labbé was identified, its anastomotic type and the character of outflow into the venous collectors were determined.

Results. In total, 115 groups of veins draining the brain were identified. Venous drainage of the transversal group was identified in 100 % of cases, of the tentorial group – in 72 % of cases, of the petrosal group – in 58 % of cases. No significant differences between the locations of vein inflow were identified on the right and left. Three (3) variants of drainage of the lateral and basal parts of the temporal lobe were identified: 1) inflow of venous drainage groups into the sinodural angle, posterior third of the petrosa; sinus and anterior parts of the transverse sinus – 14 (28 %) cases; 2) inflow into the sinodural angle, anterior parts of the transverse sinus and tentorial surface – 21 (42 %) cases; 3) inflow into all of the venous collectors (sinodural angle, petrosal, transverse, tentorial sinuses) – 15 (30 %) cases. Two (2) anastomotic types of the vein of Labbé were identified: with direct (12 %) and indirect (88 %) outflow into the venous collectors of the base of the skull. In the indirect type, “venous star” was observed comprised of several venous trunks which converged near the sinodural angle. The veins of Labbé with indirect type of outflow entered the petrosal sinus (4 % of cases), sinodural angle (14 %), tentorium (10 %) and transverse sinus (60 %) through the posterior inferior superficial temporal vein (8 %), medial inferior superficial temporal vein (26 %) and posterior inferior superficial temporal vein (54 %). The vein of Labbé with direct type of drainage entered only the transverse sinus. In most cases, the vein of Labbé entered the transverse sinus 10 mm behind the sinodural angle. Large diameter veins (dominant veins) were observed in 38 % of cases, all of them entered the transverse sinus.

Currently, the effectiveness of medical and surgical treatment of focal forms does not exceed 75 %. In cases when control over attacks by means of conservative therapy is not possible, and resection indications for surgical intervention are not present, the use of vagus nerve electrical stimulation is recommended.

The study objective is to evaluate the effectiveness of vagus nerve electrical stimulation in treatment of drug-resistant epilepsy depending on the type of the disease and patient age.

Materials and methods. Retrospective analysis of treatment results of 45 patients (22 children between 2 and 17 years of age (mean age 12.3 years) and 23 adults between 18 and 62 years of age (mean age 29.4 years)) with drug-resistant epilepsy was performed. All patients were implanted with electric stimulator of the left vagus nerve. Control examination was carried out 1 year after surgery, the evaluation method – McHugh scale.

Results. In the child group, the results corresponded to class I per the McHugh sale in 30 % of cases, class II – in 26 %; class III – in 26 %, class IV – in 18 %. In the adult group, the results corresponded to class I in 18 % of cases, class II – in 19 %, class III – in 37 %, class IV – in 26 %. In patients with duration of the disease >10 years, results of electrical stimulation were good or excellent in 44 % of cases, for patients with duration between 5 and 10 years – in 40 % of cases, with duration <5 years – in 60 %, but due to small sample size the results are not statistically significant. In patients with simple partial seizures, the treatment was effective in 4 (54 %) of 7 cases, in patients with generalized seizures – in 16 (42.8 %) of 38 cases. The best results were also obtained for interventions in patients between 10 and 15 years of age.

Conclusion. Children respond better to vagus nerve electrical stimulation; in the adult age group, it is noted that patients with aura have a better response to therapy with vagus nerve electrical stimulation; smaller epianamnesis is associated with better efficiency; patients with symptomatic epilepsy have a worse response to therapy, than patients with cryptogenic epilepsy; there were no gender differences in the effectiveness of vagus nerve electrical stimulation.

The study objective is to test tactics of surgical treatment of patients with brachiocephalic artery pathology in the acute stage of ischemic stroke.

Materials and methods. In the period between 01.07.2014 and 31.12.2017 at the Neurosurgery Division of the N.V. Sklifosovsky Research Institute of Emergency Medicine and the Neurosurgery Division of the N.A. Semashko Republican Clinical Hospital (Simferopol), 125 surgeries were performed in patients with occlusion and stenosis of the precerebral arteries in the acute stage of ischemic stroke. Carotid endarterectomy was performed in 69 cases, among them 54 were performed by eversion technique, 15 traditionally, in 4 cases sympathectomy of the internal carotid artery (ICA) was performed, in 4 – endarterectomy from the external carotid artery, in 3 – redirection of the ICA, in 2 – ICA prosthesis, in 9 – thrombointimectomy. Extracranial-intracranial bypass anastomosis was performed in patients with acute ICA thrombosis (n = 16) and symptomatic ICA occlusion (n = 22).

Results. Good and moderate results (4–5 points per the Glasgow Outcome Scale) were achieved in 119 (95.2 %) observations. Level of consciousness impairment, evaluations per the NIHSS, Rankin, Rivermead scales, brain ischemia volume, presence of brain hypoperfusion prior to surgery, timetable of surgical intervention, postoperative characteristics of the volumetric blood flow and brain reperfusion characteristics significantly affected treatment results. Total rate of complications and deaths was 4.8 %. In 3 cases, death was caused by myocardial infarction, malignant hyperperfusion with hemorrhagic transformation of the ischemic lesion and repeat stroke.

Conclusion. Surgical treatment of patients with transient ischemic attacks, acute small or completed stroke should be performed as soon as possible: this tactic decreases the risk of repeat ischemic attacks and improves functional outcomes of treatment. In case of crescendo of a transient ischemic attack or progressing stroke, surgical treatment should be postponed and performed 24 hours after stabilization of the patient’s neurological status.

Background. Highly migrated disc herniations are usually localized in the area of pars interarticularis medially to the vertebral pedicle. Removal of disk herniations of this localization is a difficult technical task.

The study objective is to demonstrate the effectiveness of the transpedicular endoscopic discectomy in the treatment of patients with highly migrated disc herniations.

Materials and methods. The results of treatment of 12 patients with Macnab zone herniations who were in hospital from 2016 to 2018 were analyzed. All patients underwent transpedicular endoscopic sequestrectomy.

Results. Leg pain after surgery regressed in all patients from the initial 7.41 points (visual-analog scale) to 0.67 points by the end of the 1st day, and it was 0.35 points a year later. The average level of back pain by VAS before surgery was 5.25, on the 1st day after surgery – 1.25 points, 1 year after – 0.67 points. Neurological disorders completely regressed in 10 (91.6 %) patients, there were a slight residual L4 dermatome hypesthesia in 2 patients, without disrupting their quality of life. The average Oswestry Disability Index before surgery was 69.17, and 1 year after surgery was 14.12. There were no complications and reoperations.

Conclusion. Transpedicular endoscopic discectomy allowed us to achieve good treatment results in patients with migration of a lumbar hernia by the pedicle. It can be a safe and effective alternative to the transforaminal or interlaminar endoscopic technique.

Background. We developed a Protocol based on the results of a previous study of risk factors for infection of a postoperative wound: do not use monopolar coagulation on the skin and subcutaneous fat; remove hemostatic material from the wound; relax the established wound expander every 65 minutes; refuse to suture the muscles in the area of laminectomy, refuse to use an intradermal suture.

The study objective is a verification of the received Protocol.

Materials and methods. A comprehensive retrospective cohort study evaluated the results of surgical treatment of 575 spinal patients who were under the authors’ supervision in 2014–2016. Patients were divided into groups: operated in the period from 2014 to 2016 (control group), operated in 2017, in the treatment of which the Protocol for reducing complications was applied (main group).

Results. It was found that after the introduction of the Protocol, the percentage of patients with postoperative wound infection decreased from 6.0 to 1.3 %.

Conclusion. The resulting Protocol is an effective tool for reducing wound infection and can be recommended for prevention of the postoperative wound infection in patients with spinal with diseases and injuries.

In clinical practice, we use the term “fusiform aneurysm” for local expansion of artery. Under this generic term specialists understand heterogeneous arterial pathology, which is very important for diagnosis and choosing the treatment. We conducted an analysis of scientific literature published in 1987–2019, including 63 foreign and 4 Russian sources devoted to pathogenesis and types of non-saccular aneurysms. Among non-saccular aneurysms, dolichoectatic aneurysms are distinguished, rather of genetically or non-atherosclerotic origin and fusiform aneurysm acquired due to dissection processes. Features of mechanisms of their formation, variants of clinical course and methods of treatment are presented.

IgG4-related disease is a new and recently described and determined disease involving multiple organs. Its etiology and pathogenesis are still not fully understood. However according to multiple studies this disease should be considered as a unique pathological autoimmune unity involving various organs and tissues. IgG4-reladted disease was first considered as a form of pancreatic inflammatory process and diagnosed as IgG4-related autoimmune pancreatitis. However current data demonstrate the potential involvement of almost all tissues and organs including central nervous system. Diagnostic criteria are being reviewed annually resulting in IgG4-related disease diagnosis in many considered differently cases. This review presents current literature data related to IgG4-related disease etiology and pathogenesis, diagnostic criteria and potential forms of central nervous system IgG4-related injury.

The review examines the epidemiology of vestibular schwannomas (VS), classification, the pathogenesis of the main clinical symptoms of small tumors located in the internal auditory canal (intracanalicular), the principles of diagnosis and various treatment options. The main directions of curation of patients with intracanalicular VS are analyzed: observation, radiosurgery and microsurgery. The main advantages and disadvantages of the methods used are considered: observation is advisable in the absence of VS growth, with initially safe hearing or with completely lost hearing. Radiosurgery has a high chance of preserving hearing, including functional, and provides control of VS growth in more than 90 %. There is currently insufficient data to recommend microsurgery as the first choice in the treatment of intracanalicular VS.

The implementation of the navigational systems in the neurosurgical practice has led to the revision of generally accepted surgical approaches to the neurosurgical pathology, allowing to minimize the interoperative impact on brain tissues and to execute the pre-operative planning of the skin incision and the craniotomy, to determine the optimal trajectory of approaching the brain pathology, preserving the radicality of interventions. However, the use of this technology dictates the observation of many technical nuances in the preoperative and intraoperative periods in order to exclude potential errors at the stage of the registration of a patient and at the early stages of the surgery. Despite this, the brain shift caused by a number of physical, surgical and biological factors is the major error source of navigational systems that neurosurgeons face during the operation which can affect further stages of the operation. The present article contains the overview of the scientific research, the authors of which have tried to explain and give a quantitative assessment of the present phenomenon during all the stages of the operation.

Introduction. Epidural hematoma (EDH) is when bleeding occurs between the tough outer membrane covering the brain (dura mater) and the skull. The most common cause is typically head injury. Diagnosis is typically by a computed tomography (CT) scan or magnetic resonance imaging. If large EDH, treatment is generally by urgent surgery in the form of a craniotomy or burr hole. Without treatment, death typically results. We explore a surgical case of small frontal EDH in patient with Glasgow Coma Score 8.

Case report. Thirty years male patient was admitted at Emergency Hospital with Glasgow Coma Score 8 on ventilator. Rapid CT brain was done and showed massive brain edema with small EDH. Conservative treatment had been tried for 24 hours, but with no improvement as we could not give mannitol therapy to this patient. Follow-up CT showed the same EDH and brain edema. We tried new policy and evacuated EDH with giving mannitol and furosemide therapy postoperative. The patient became with Glasgow Coma Score 13 and improved in 7 days.

Conclusion. Evacuation of small EDH may be helpful in some conditions not responding to conservative treatment especially in severe brain edema.

The objective is to describe the clinical case of arachnoid cyst of occipital bone.

Case report. Patient with arachnoid cyst of occipital bone was treated in the clinic of the A.I. Evdokimov Moscow State University of Medicine and Dentistry. The patient had severe pain in the occipital region for several years, conservative treatment was ineffective. Neuroimaging revealed an unusual intraosseous defect in the occipital bone. A partial resection of the occipital bone was performed and cranioplasty was made. During operation it was discovered that the patient had an intraosseous arachnoid cyst, the diagnosis was further confirmed by histological examination. After surgery, regression of pain in the occipital region was noted.

Conclusion. The intraosseous arachnoid cyst of the skull is an extremely rare and can cause a severe local headache. Surgery is an effective treatment of this pathology.

The objective of the article is to present the clinical observation of a gunshot wounds of the head in peacetime, with the formation of a delayed carotid-cavernous fistula.

Clinical case. A patient aged 26 years received a penetrating parabasal single gunshot wound to the head. After transfer to the N.V. Sklifosovsky Research Institute of Emergency Medicine from a local hospital, intima dissection and occlusion of the left internal carotid artery (ICA) were diagnosed. Supraclinoid section of the left ICA, left anterior cerebral and middle cerebral arteries were filled from the right ICA through the anterior communicating artery. For prevention of suppurative-septic complications as well as decubitus of the left ICA and development of life-threatening hemorrhages, repeat surgery was performed. Acute subdural hematoma and brain detritus were removed. Using pterional approach, the chiasm and sellar region was accessed. Sequentially the ophthalmic, interpenducular, penducular cisterns, cisterna laminae terminalis and left carotid cistern were dissected. Sequentially the left ophthalmic nerve, left ICA, left choroid arteries were isolated. A metallic foreign object (bullet) located in the medial regions of the larger wing of the sphenoid bone and lateral wall of the cavernous sinus was found and removed. On day 14 after the second surgery, headache became worse, pulsing noise developed in the left part of the head, as well as moderate exophthalmos on the left. Left-hand type A (per the Barrow classification) carotid-cavernous anastomosis with retrograde inflow due to occlusion of the left ICA was diagnosed. Endovascular intervention was performed: separation of the carotid-cavernous anastomosis through retrograde occlusion of the supraclinoid segment of the left ICA with microcoils through contralateral ICA and anterior communicating artery. The patient was discharged at day 30 after hospitalization. Cerebral and meningeal symptoms regressed. Ptosis grade decreased, the left eye started to move.

Conclusion. This abovementioned observation is of interest due to the rarity of such pathology and the possibilities of modern multidisciplinary centers for the diagnosis and treatment of such patients as of this date.

The article traces the life of famous Soviet neurosurgeon Andrei Petrovich Romodanov from his school years and participation in the Great Patriotic War to headship of the Kiev Neurosurgery Research Institute. Dr. Romodanov was the full member of the Academy of Medical Sciences, deputy of the Supreme Soviet of the USSR, mentor of several generations of neurosurgeons. His contributions to organization of the neurosurgical service, pedagogical work, participation in All-Soviet Union research programs are described.