Introduction. In spite of medication treatment being today the basic form of treatment for Parkinson’s disease, surgical methods may be preferable to improve symptoms of the disease. Radiosurgery is one of them, but in Russia, to date, there are no publications summarizing data about the experience of using this method throughout the country.

The study objective is to evaluate the effect of radiosurgical thalamotomy (destruction of the intermediate ventral nucleus of the thalamus) on the severity of tremor in patients with Parkinson’s disease, as well as to estimate the frequency of complications of this intervention, the frequency of different variants of radiological and clinical-neurological response.

Materials and methods. One hundred and one (101) patients with medically refractory Parkinson’s tremor received Gamma Knife radiosurgery in our centre over a 10‑year period, of whom 10 patients were treated bilaterally. Pre-treatment evaluation was done using tremor assessment scales and video recordings of tremor intensity. Gamma Knife radiosurgery was provided with Leksell Gamma Knife 4C and Leksell Gamma Knife Perfexion (Elekta AB, Sweden) preceded by magnetic resonance tractography the day before treatment. The same planning protocol was used for all patients, the target was ventral intermediate nucleus and the prescription dose of 130 Gy was delivered with a 4 mm isocenter. After treatment, patients were evaluated radiologically and neurologically at regular 6‑month intervals, as well as through telephone interviews and video recordings.

Results. Ninety-two (92) patients were included in the analysis of the results of radiosurgical treatment. Median follow-up time after radiosurgery was 26 months, from 6 to 113 months. Tremor reduction was achieved in 76 % of the patients, 61 % of whom had almost complete tremor arrest. Decreased tremors were observed from 1 to 6 months after treatment, with a mean of 4 months. Three (3) patients experienced tremor resurgence after 3–7 years. Complications were observed in 6.5 % of patients and were transient in character. Some of the patients developed severe depression. Only 1 patient had a serious complication in the form of thalamic haemorrhage (at 22 months after treatment). Ten (10) patients who were treated bilaterally all showed considerable clinical improvement and absence of complications.

Conclusion. Gamma Knife radiosurgery is a safe and effective functional neurosurgical procedure for tremor correction to improve patients’ quality of life, especially when deep brain stimulation is not accessible. Patients with severe medically refractory tremors are good candidates for Gamma Knife treatment, which showed high efficacy and a low risk of complications.

The study objective is to present the results of the treatment of metastatic brain patients by the staged radiosurgery with the Gamma Knife.

Materials and methods. The retrospective analysis included 31 patients (13 men and 18 women) with brain metastases, whose radiosurgery treatment was carried out in 2 sessions. The operation was contraindicated in all patients due to the risk of neurological deficits or due to the high anesthesiological risk.

Results. Local control of metastases growth was achieved in 31 (96.9 %) of 32 foci 3 months after treatment, and in 92.5 and 83.8 %, after 6 and 12 months, respectively. The age <50 years were associated with higher progression-free survival respectively. The median time of grade I–II radiation complications was 3.0 months, complications were observed in 11 (45.8 %) of 24 patients. Radiation complications of grade II (perifocal edema) were observed in 8 (33.3 %) patients, grade III (radionecrosis) – in 2 (8.3 %) patients. Overall survival at 6 and 12 months was 55.6 and 40.8 %, respectively (median 6.9 months), in patients receiving antitumor drug treatment – 80.0 and 56.8 %, respectively. All patients who did not received antitumor drug therapy died within 6 months.

Conclusion. Two-stage radiosurgery, carried out in 2 sessions with an interval of 2–4 weeks, provides satisfactory local control with an acceptable level of post-radiation complications. This method of treatment can be used in patients with large brain metastases who are not subject to surgical treatment.

The study objective is to assess the outcomes after stereotactic radiosurgical treatment (SRS) in patients with pilocytic astrocytomas after non-radical surgery and after continued tumor growth.

Materials and methods. The report includes 56 patients (37 males and 19 females) who have undergone SRS in N. N. Burdenko National Medical Research Center of Neurosurgery from March 2005 to January 2018.

Results. The majority of patients (75 %) were children. Almost 43 % of patients underwent SRS as part of the primary treatment after biopsy or incomplete removal, other patients – in the event of continued tumor growth after non-total surgery. Tumors involved the cerebellum (41 %), brainstem (23 %), thalamus (19.6 %) and cerebral hemispheres (16.1 %). The median tumor volume was 1.9 cm3 (0.14–19.00 cm3), 23 % of patients had cysts in the tumor. The prescribed dose was 12 to 22 Gy (median 18 Gy) over 50–80 % isodose line. The follow-up was available for 54 (96.4 %) patients. The median follow-up was 67 months (3–151 months). All patients were alive at the end of the follow-up examination. In 14 (25 %) patients, the development of pseudo-progression (PSP) was noted. The median detection of PSP is 11 months (3–65 months). Of these, in 7 (50 %) patients PSP was accompanied by clinical deterioration: in 5 – an increase in general cerebral symptoms and in 1 patient – an episode and an increase in cerebellar symptoms. Eight (57 %) patients with PSP were reoperated: 4 underwent removal of the tumor, 4 – emptying of the cyst and placement of the Ommaya reservoir, which led to regression of the existing symptoms. No other toxicity was observed in patients. At the time of the completion of the follow-up examination (with a given median follow-up), no relapses were detected. There was no clinical deterioration after SRS.

Conclusion. Radiosurgical treatment is an effective and safe method of radiation treatment for patients with primary pilocytic astrocytomas and recurrent pilocytic astrocytomas, providing control over tumor growth in all patients with a low risk of complications.

The study objective is to study the causes of repeated surgical treatment in patients of an older age group with degenerative pathology of the lumbar spine.

Materials and methods. A retrospective analysis of the treatment of 962 patients who underwent surgical treatment of degenerative pathology on the basis of the FCN of Novosibirsk from 2013 to 2017. A total of 360 men, 602 women; average age 66 years. 624 (64.9 %) patients underwent decompression, 338 patients (35.1 %) underwent stabilizing intervention in combination with decompression. The study group consisted of 98 (10.2 %) patients who underwent repeated operations taking into account the inclusion and exclusion criteria. On average, the period after the previous intervention is 17 months (from 1 day to 6 year). 68 patients (69.4 %) previously underwent decompression interventions, 30 (30.6 %) rigid stabilization. The indication for revision treatment was the presence of pain and (or) neurological deficiency, resistant to treatment for at least 6 weeks. Evaluation criteria are described, and the structure of complications is analyzed. The minimum follow-up period after repeated surgery was 1 year, the maximum 6 years.

Results. Iatrogenic factors were detected in 39 patients (39.8 %). Progression of degenerative pathology in 59 (60.2 %) patients. More often, repeated intervention was performed at the level of L4–L5 (36.1 %), the cranial adjacent segment was 76.5 %, and the caudal segment was 23.5 %. The minimum period of manifestation of continued degeneration is 3 months. The development of the disease of the adjacent segment after fixation is higher in the period of 3–4 years (p = 0.015). Patients with repeated surgical treatment after decompression for continued degeneration had a higher BMI of 32.3 (p = 0.12), as well as patients with damage to the adjacent segment 32.5 (p = 0.10), compared with the group of primary patients (BMI 30.6 on average). The similar dependance is registered for patients after stabilization: BMI of patients with repeated interventions is 34.5 that is higher than BMI of primary interventions group (on average 33.2, р = 0.13).

Conclusions. The main reason for repeated interventions in patients of an older age group is the progression of degenerative pathology on the segments on the segment operated as as well as the adjacent segments (60.2 % repeated interventions, 46.9 % at the adjacent level including).

Repeated surgical treatment of patients of an older age group in the early period (for up to 1 year) is most often due to insufficiently effective primary surgical intervention with prevailing early recurrence of disk herniation (1.6 % patients of total number of primarily operated). In the long term (more than 3 years), the reason for repeated surgical treatment is due to the development of an adjacent segment disease where the number of operations of patients with primarily made rigid fixation is increasing progressively in the course of time.

High BMI is a predictor of the development of instability of the vertebral motor segment and continued degeneration of the operated one as well as the adjacent level in the long follow-up time.

The aim of the study was development of the method for preoperative quantitative evaluation of pyramidal tract and tumor relationship in malignant intracerebral tumors.

Materials and methods. The retrospective analysis of 62 patients underwent surgery at the Department of Neurosurgery of Privolzhsky Research Medical University in 2017–2019, was performed. The patients were divide in 3 groups: metastatic brain tumor (n = 16); contrast-enhanced gliomas (grade III–IV); contrast-nonenhanced gliomas (grade II–III). The following protocol was implemented for all patients: preoperative DTI-tractography; intraoperative direct subcortical electrical stimulation with fixation of the minimum current intensity at receiving the motor response; pre- and postoperative motor function assessment using MRC-scale. Tract Involvement Index (TII) based on the ratio of the perimeter of the part of the tract involvement in pathological MRI-signal to its cross-section area was calculated using image processing of preoperative MRI and MRI-tractography data.

Results. The association between TII values (from 0 to 1.75) and the severity of pre-operative paresis was demonstrated. We have discovered that the greater value of the pyramidal TII was corresponded to the greater severity of the paresis in MRC (p <0.001, n = 62). The analysis of TII values and intraoperative motor direct subcortical mapping results showed an increase in risk of contact with a tract at higher TII value (B0 = −1.6; Bi = 6.61; χ2 = 30.53; n = 62, p <0.001). The TII demonstrates better prognostic value in patients without radiation therapy in anamnesis.

Conclusions. The method for preoperative quantitative evaluation of pyramidal tract and tumor relationship using TII calculation can provide additional information for planning surgical treatment in patients with intracerebral tumors without radiation treatment in the history.

Introduction. Since the appearance of the first flow-diverting stents (FDS) Pipeline (Covidien, USA) and Silk (Balt Extrusion, France) in 2008, numerous studies have been conducted that have shown their high efficiency in the treatment of difficult aneurysms, accompanied by a low frequency long-term recanalization with a moderate risk of developing intra- and postoperative complications, thus making them an alternative to the classic use of coils.

The study objective is to evaluate the results of the p64 PPS using in the treatment of patients with cerebral aneurysms of various localization in a single neurosurgical hospital.

Materials and methods. In the department of vascular neurosurgery of the Federal Neurosurgical Center, Novosibirsk for the period from June 2017 to December 2019, 90 patients (10 (11.1 %) male, 80 (88.9 %) female) with cerebral aneurysms were operated using p64 FDS.

Results. All 90 patients received 93 p64 FDS. In 79 (87.8 %) patients, only a stent was implanted, in 9 (12.2 %) – in combination with coils. Follow-up after 6 months was observed in 39 (43.3 %) patients, while it should be noted that no patient showed an increase in neurological deficit. The complete occlusion rate after 6 months was 76.9 %. A favorable treatment outcome according to the modified Rankin Scale at the time of discharge was obtained in 82 (91.1 %) patients. Mortality was in 1 (1.1 %) case.

Conclusion. The p64 FDS is an effective endovascular device in the treatment of patients with difficult cerebral aneurysms and has a rather low incidence of intra- and postoperative complications.

Introduction. Each of the pathologies is rare and can lead to compression of the brainstem and spinal cord, with the development of a “mixed” clinical picture. The tactics of treating such patients differs from one author to another.

The objective is to present the author’s experience in treating patients with basilar invagination associated with type I Chiari malformation and to analyze the literature on the methods of surgical treatment of this pathology.

Materials and methods. From 2014 to 2019, 3 patients with a basilar invagination and type I Chiari malformation were surgically treated at the N. I. Pirogov National Medical and Surgical Center. Indications for surgical intervention were long-term progressive neurological disorders, lack of effect from conservative therapy. Patients underwent anterior transnasal and posterior decompression of nerve structures followed by stabilization.

Results. All patients were evaluated 12 months after surgery. All patients in neurological status showed positive dynamics. According to magnetic resonance imaging of the craniovertebral junction, 2 patients showed positive dynamics: regression of the myelopathy, a decrease in the diameter of the syringomyelic cyst.

Conclusion. The criteria for anterior transnasal decompression are the predominance of bulbar disorders and / or paresis in the extremities in the clinical picture; posterior decompression of nerve structures, indicated in the presence of specific symptoms of type I Chiari malformation and / or syringomyelia. Taking into account the results of the latest published studies it can be assumed that stabilization is a necessary option in the treatment of patients with this pathology.

Background. Endoscopic skull base reconstruction of large defects is a difficult issue in neurosurgery, as there are problems associated with a wide dural resection, intra-arachnoid dissection (due to removal of the meningocele or resection of an intracranially spreading tumor), and exposure to high-flow cerebrospinal fluid within the cisterns. But perhaps the most significant influence is the larger nonvascularized reconstructive bed – cerebrospinal fluid on one side and sinus cavity (air) on the other.

The study objective is to analyze our own experience in treating patients with large defects of the skull base and, based on the results obtained, to optimize the method of reconstruction.

Materials and methods. A retrospective analysis of 30 cases of reconstruction of large defects of skull base of various etiologies. The results of surgery in the early and late postoperative period were evaluated. Statistical analysis was carried out using the exact Fisher criterion and the analysis of arbitrary contingency tables using the chi-square criterion. A literature review was conducted to compare the data obtained with the results of other studies.

Results. In the group of patients (n = 16) for whom reconstruction was performed only with free transplants the effectiveness of reconstruction was 75 %. In the group of patients (n = 14) who underwent the last stage of reconstruction using a vascularized pedicled nasoseptal flap, the plastic surgery efficiency was 100 %. According to statistical analysis, there is a relationship between the choice of transplant type and the multilayer technique (p <0.05). The use of lumbar drainage did not affect the recurrence of cerebrospinal fluid leak in the postoperative period (p >0.05).

Conclusion. Endoscopic skull base reconstruction can be effectively used for defects of the skull base >1.5 cm. When choosing the technique of reconstruction of large defects of the skull base, preference should be given to multilayer plastic using vascularized flaps. The use of lumbar drainage for reconstruction of large defects is a justified method in the case of a clear definition of indications for its use, based on a comparison of the possible benefits and risks associated with the invasiveness of the method.

The objective is to describe a case of hypofractioned skull base meningioma radiosurgery.

Clinical case. For 5 years, female patient S., 55 years old, suffered from headaches. In 2012, magnetic resonance imaging of the brain showed petroclival meningioma on the left actively and homogenously accumulating the contrast agent. The patient refrained from any type of treatment. Control magnetic resonance imaging showed an increase in tumor size up to 24 × 45 × 27 mm; at the lateral margin it spread to the left temporal area, at the medial margin it grew around the left optic nerve, chiasm spreading into the left maxillary sinus. We performed three-fraction radiosurgery for skull base meningioma according to hypofractionation scheme (7 Gr / fraction with 2 day interval). 37 months postoperatively, tumor volume had complete regression. There are no optic disturbances.

Conclusion. This case report demonstrates treatment results of difficult structure tumor and describe radiosurgical possibilities in big size meningiomas.

Neurofibromatosis 2 is one of the most prevalence disease among phakomatoses characterized by appearance of new central and peripheral nerve system tumors. The main treatment for this patient is a surgery, but in real time we observe the significant changes in treatment and rehabilitation in this patients including radiation therapy and pharmacotherapy. In this paper, we present the case of a different treatment options in young female with neurofibromatosis. She completed surgical treatment, Gamma Knife radiosurgery and bevacizumab on different stage of disease. Development of genetic and molecular methods and appearance of new way for treatment could help to achieve a good functional result and stable local control but new clinical and fundamental research are needed.

Cement embolism of the right chambers of the heart after vertebral surgery is an extremely rare complication and occurs in 4 % of cases. The strategies for choosing the treatment of this complication are open-heart surgery under conditions of cardiopulmonary bypass, conservative treatment, or endovascular support. In the case of a fatal complication of embolism, such as perforation of the heart with the development of tamponade or life-threatening arrhythmias, the patient is shown an open operation with infrared. According to the literature, only 14 such operations are described, performed to save the patient’s life. We performed a successful operation of embolectomy from the right heart chambers in a 69‑year-old patient who had previously undergone vertebroplasty of the thoracic vertebrae.

Malignant brain tumors remain one of the most complex problem in modern oncology, being among the most dangerous types of cancer not only because of their poor prognosis, but also due to the immediate consequences for quality of life and cognitive functions. It is expected that the number of such patients will increase as the life expectancy of the population increases.

The mortality rate of patients with malignant gliomas remains the highest among all cancer patients. The median survival rate in this population does not exceed 24.5 months. Despite serious progress in the study of the molecular biology of this type of tumor, the question of effective application of this knowledge in the treatment process remains open.

The review highlights the most advanced diagnostic methods and analyzes the effectiveness of a multidisciplinary therapeutic strategy. Special attention is given to the search for new approaches to radiosurgical treatment of highgrade gliomas in order to increase the duration and improve the quality of life of patients.

The literature review is divided into 2 parts. Part 1 covers the epidemiology, clinic, and diagnosis of high-grade gliomas, as well as a combined approach to the treatment of the disease.

Arteriovenous malformations (AVM) are quite rare, but they are dangerous pathology due to the risk of rupture and intracranial hemorrhage, which leads to disability. This review enlights the epidemiology of AVM and their symptoms, current methods of diagnostics and treatment as well as prognosis and treatment outcomes. Nowadays microsurgical removal, endovascular embolization, stereotactic radiosurgery and combination of these methods are used in clinical practice for AVMs treatment. Stereotactic radiosurgery is a highly effective non-invasive technique resulting in high degree of AVM obliteration with low risk of complications. The results of magnetic resonance imaging usage in assessing the degree of obliteration and the development of post-radiation complications are presented in this article. The optimization of magnetic resonance imaging algorithm is necessary for determination of statistically significant factors affecting the obliteration process.

The purpose of this review is to present an up-to-date look at the features of diagnosis and treatment of tandem spinal stenosis. Tandem spinal stenosis is a degenerative narrowing of the spinal canal of two or more parts of the spine column. Diagnosis of the one-level degenerative spinal stenosis is commonly quite easy in the practice of a spinal surgeons, while the diagnosis of tandem spinal stenosis is often difficult. The clinical presentation of tandem spinal stenosis presents a constellation of different symptoms and often cause late diagnosis. Data on the prevalence of tandem spinal stenosis are very variable, and the etiology cannot be fully studied. Thereby, comprehensive assessments of the symptoms and imaging provide assistance with the accurate and timely diagnosis. The choice of surgical method should consider possibility of staged decompression of each stenotic levels with priority for proximal parts of spine column.