Objective: to analyze complications after stereotactic radiosurgery for various diseases performed using the Elekta Leksell Gamma Knife Perfexion.
Materials and methods. This retrospective study of stereotactic radiosurgery outcomes included 3,148 patients with different brain lesions, including 1,621 individuals with metastases (51.5 %), 732 with meningiomas (23.3 %), 359 with neurinomas (11.4 %), 71 with arteriovenous malformations (2.3 %), 118 with cavernomas (3.7 %), 114 with neuroepithelial tumors (3.6 %), 46 with pituitary adenomas (1.5 %), 54 with functional diseases (1.7 %), and 33 with other diseases (1 %).
The diagnosis was based on the results of neurological examination, magnetic resonance imaging, computed tomography, and positron emission tomography.
The severity of radiation complications was evaluated using the Eastern Cooperative Oncology Group (ECOG) scale.
Results. Among all patients who underwent stereotactic radiosurgery, 96 individuals developed 97 different complications. The most common complications included radionecrosis (n = 43) and perifocal edema (n = 38). Alopecia (n = 3) and increased frequency of epileptic seizures (n = 3) were less common. We observed very few specific complications, such as non-obstructive hydrocephalus (n = 3), cranial nerve lesions (n = 3), and endocrine disorders (n = 1). The total rate of radiation-induced complications was 3.08 %.
Conclusion. Our findings suggest that stereotactic radiosurgery is a safe treatment for various brain diseases and is characterized by a low rate of postoperative complications. The incidence of postoperative complications in this study did not exceed that reported in Russian and foreign literature.

The objective of the research: to compare the outcomes of three surgical methods used in a large cohort of patients with hemorrhagic stroke.
Materials and methods. We performed a retrospective analysis of surgery outcomes in 500 patients with hypertensive intracranial hemorrhages (ICHs) operated on in N.V. Sklifosovskiy Research Institute of Emergency Medicine between 1997 and 2020. Mean patients’ age was 53.1 ± 12.2 years. The sample included 335 men (67 %) and 165 women (33 %). Mean time to surgery was 3.3 ± 2.6 days. More than half of the patients underwent open surgeries (n = 271; 54.2 %); 98 patients (19.6 %) had puncture aspiration and local fibrinolysis of intracranial hemorrhages; 131 patients (26.2 %) had endoscopic aspiration. Radicality of ICH removal was evaluated using brain computed tomography performed within 24 h postoperatively. Outcomes were assessed 30 days postoperatively using the Modified Rankin Scale (mRS).
Results. Open surgery had the highest radicality (94.0 % [range: 79 %; 100 %]), whereas the radicality of endoscopic aspiration and puncture aspiration with local fibrinolysis was 80.0 % [range: 58 %;95 %] and 72.0 % [range: 58 %; 84 %], respectively (K.-W. = 52.7, p < 0.0001). The highest ICH recurrence rate (27.6 %) was observed after puncture aspiration and local fibrinolysis. Endoscopic aspiration and open surgery resulted in relapses in 16.8 % and 9.2 % of individuals, respectively (χ² = 19.7, p = 0.00005). The mRS outcomes were as follows: type 0 in 84 patients (16.8 %); type 1 in 37 patients (7.4 %); type 2 in 46 patients (9.2 %); type 3 in 38 patients (7.6 %); type 4 in 43 patients (8.6 %); type 5 in 142 patients (28.4 %); type 6 in 110 patients (22.0 %). The outcomes depended on ICH location and surgical method. Patients with lobar ICHs had better outcomes after open surgery, while patients with lateral and cerebellar ICH had better outcomes after puncture aspiration, local fibrinolysis, and endoscopic aspiration (χ² = 8.1, p < 0.02).
Conclusion. Each surgical technique (open surgery, puncture aspiration, local fibrinolysis, and endoscopic aspiration) has its advantages and disadvantages depending on ICH location. Open surgery ensured better outcomes in patients with lobar ICHs, while individuals with deep ICH and cerebellar ICH demonstrated better outcomes after puncture aspiration, local fibrinolysis, and endoscopic aspiration.

Neurorehabilitation of patients with spinal cord injury and severe muscle spasticity have always been one of the most challenging tasks for neurologists. Muscle spasticity significantly impairs patients’ quality of life and is often resistant to pharmacotherapy. Over the last 10 years, intrathecal baclofen therapy has become the most effective treatment for spasticity in Russia. In this study, we tried to systematize the data on intrathecal baclofen therapy in patients with spinal cord injury complicated by spasticity and to evaluate their treatment outcomes, as well as the incidence of adverse events. Our findings will ultimately help to clarify the need for intrathecal baclofen therapy in routine clinical practice.

Introduction. Patients must be fully informed about their disease, about different variants of the treatment of their disease, complications and prognosis to make decisions to accept the treatment. The most important they should be able to remember this information.
The aim of the study was studying the level of learned information by patients about the upcoming surgery “removal of vestibular schwannoma”.
Materials and methods. 44 patients with vestibular schwannoma were included in this prospective study. Average age was 39,8 + 7,2 years, gender distribution was 16 males and 28 females. Education: secondary special – 56,82, and higher – 43,18 %. We used scales for evaluation “Checklist. Surgery to removal of vestibular schwannoma” developed by authors, State-Trait Anxiety Inventory (STAI) in the adaptation by Y.L. Hanin, assessment of depression – The Hospital Anxiety and Depression Scale by Zigmond A.S., Snaith R.P. (HADS). R-Studio (Version 1.0.1532009–2017 RStudio) was used for statistical analisis.
Results. Patients were able to remember correctly 24,8 % of medical information on the next day after consultation by a neurosurgeon on average. We got negative correlation between anxiety, depression to the level of information assimilated by patients (r = –0,52; r = –0,47; r = –0,85, respectively). The higher level of anxiety and depression before surgery led to decrease remembering of medical information by the patients.
Conclusion. The level of remembering of the medical information by the patient about their disease was low. Quantity of the remembering information depends on the level of anxiety and depression of patients. It is necessary to increase remembering of medical information by patients because of it is allowing to improve the results of treatment.

Introduction. Trigeminal neuralgia is a fairly rare disease manifested by acute paroxysmal pain of the type of electric shock in the innervation zone of one or more branches of the trigeminal nerve. Trigeminal neuralgia is usually sporadic, but familial cases have also been described. The study of familial cases of the disease can help in understanding the causes and mechanisms of the development of trigeminal neuralgia. We present a series of 4 families in which 2 family members in one generation suffered from trigeminal neuralgia, all patients underwent surgical treatment in our center.
The study objective. The study of familial cases of the disease can help in understanding the causes and mechanisms of the development of trigeminal neuralgia.
Materials and methods. For the analysis, data were collected on patients with familial trigeminal neuralgia who were operated on in our center from August 2015 to October 2020.
Results. In our series, the majority of patients were women, the average age was 36.5 years, in all cases right side was involved, and, in most cases the second trigeminal division was affected. Most of the patients had neurovascular conflict. All patients underwent microvascular decompression as a primary operation in our center. Intraoperative neurovascular conflict was identified in all cases; in half of the cases, complete regression of pain syndrome was noted after first surgical procedure.
Conclusion. In our study, no clinical or anatomical factors were found in comparison to sporadic cases of trigeminal neuralgia.

Objective: to report a case of recurrent chronic subdural hematoma treated using endovascular superselective embolization of the middle meningeal artery with the SQUID-18 non-adhesive embolic agent.
Materials and methods. A 73-year-old male patient had an open head injury after own height falling. Multislice computed tomography demonstrated chronic subdural hematoma in the left parietooccipital region. The patient had surgery with a positive effect; however, 1 month postoperatively he developed recurrent hematoma. He was diagnosed with recurrent chronic subdural hematoma and underwent endovascular embolization of the distal branches of the middle meningeal artery with a non-adhesive embolic agent; repeated hematoma drainage was not required.
Results. Follow-up multislice computed tomography performed 7 months postoperatively demonstrated total resorption of chronic subdural hematoma.
Conclusion. This case illustrates the variety of methods that can be used for the treatment of chronic subdural hematoma and shows that endovascular embolization of the middle meningeal artery is a minimally invasive and effective procedure for such a disorder.

We report a case of simultaneous microsurgical clipping of 5 cerebral aneurysms in a patient with multiple aneurysms of the anterior brain.
We analyzed the existing treatment approaches to multiple cerebral aneurysms, including endovascular isolation, microsurgical clipping, as well as surgical tactics in case of subarachnoid hemorrhage. We covered the recommendations for screening, surgical risks, and approaches to aneurysm isolation (single-stage and multiple-stage).
Using our own experience (since no strict guidelines are currently available), we concluded that it is important to screen cerebral vessels of all close relatives of patients with multiple and familial cerebral aneurysms.

Introduction. Ventriculoperitoneal shunt carries a non-negligible failure rate often requiring multiple surgical procedures during patient’s lifetime. The most common cause is obstruction of the ventricular catheter that can be embedded in adhesions with choroid plexus, ependymal tissue, and fibrous material. In such cases, or when an intraventricular tumor is present, particular attention must be paid when removal of the ventricular catheter is required. The potential adhesions with the tip of the ventricular catheter results in an increased risk of life-threatening hemorrhage.
Materials and methods. We present the case of a ventriculoperitoneal shunt proximal revision in a von Hippel–Lindau affected patient. The neuroendoscopic exploration to restore the patency of the ventricular system made it possible to notice a fibrous adhesion between the tip of the catheter and a pituitary hemangioblastoma abutting into the third ventricle.
Discussion. Pituitary stalk hemangioblastoma is an infrequent localization, although it represents the most common supratentorial site of hemangioblastoma in patients affected by von Hippel–Lindau syndrome. In this and in similar cases, endoscopic-assisted shunt revision allows visualizing the tip of the ventricular catheter and eventual adhesions that can be coagulated and cut by simple maneuvers, without any morbidity for patients.
Conclusion. In a ventriculoperitoneal shunt revision with the concomitant presence of an intraventricular tumor or lesion at risk of bleeding, the surgical procedure should be performed under neuroendoscopic observation to reduce the risk of intraventricular hemorrhage.

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 high-grade 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. In the 2nd part, the issues of stereotactic radiosurgery of high-grade gliomas, the features of the practical application of the “gamma knife” device in this pathology are highlighted; the effectiveness of the multimodal approach to the treatment of malignant gliomas is analyzed.

The study objective: to review the Russian and foreign studies and to identify an optimal classification system for thoracolumbar spine injuries.
Materials and methods. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We conducted a search for articles published in English (PubMed database) and Russian (eLIBRARY.ru). The inclusion criteria were as follows: available full text, patient age ≥18 years, and information on one of the validation phases for classifications according to L. Audige et al.
Results. Out of 207 abstracts, 14 articles met all the required criteria and were included into the systematic review. The F. Denis and AOSpine classifications demonstrated the highest reliability and reproducibility of the results. However, both of these classifications does not lacked predictive value to aid treatment decisions and have some other disadvantages (e. g., this classification does not address the neurologic status of the patient, and injuries of the posterior ligamentous complex (PLC)). Our analysis clearly demonstrated the need for a more thorough evaluation of all available scales and classifications.
Conclusion. The F. Denis and AOSpine classifications are the most reliable and reproducible classification systems. However, these classifications have deficiencies and the data available in literature is not sufficient for a full comparison of all existing scales and systems. Further multicenter study on the reliability of classifications are needed to select an most optimal one.
In order to determine the most optimal classification system in the daily routine practice, a multicenter study should be conducted with the object of determining. Further multicenter studies on the reliability of classifications are needed to select an optimal one.

In the lecture to follow, we provide an in-depth review of superficial temporal artery to middle cerebral artery (STA-MCA) bypass for flow augmentation. We begin with a brief review of the two broad categories of cerebral bypasses as well and the relevant pathologies treated. We then discuss some important landmark trials on the subject of STA-MCA bypass. Next, we focus on patient selection with an emphasis on hemodynamic assessment using non-invasive quantitative imaging methods. Revascularization technique is then described with a corresponding case example and a subsequent discussion on complications and future directions.

A practicing physician is faced with decision-making problems in uncertainty terms in his daily activities such as a lot of different information about the patient. Diagnostic issues, identification of patient management leading modalities is associated with the demand for high-quality prognosis of the disease course, calculating the risks of complications and adverse outcomes that especially problematic in emergency situations. The human brain is significantly surrender to modern computers in processing power, but it is able to instantly interpret information and analyze it, and also it is able to learn, form ideas, make conclusions. Attempt of association both the computational power and human brain intuitive analysis was reflected in the construction of computer programs based on the “Neural networks”. Together with the information technology development, the design of new neural networks configurations, and their training principles, its chances turn up in the physician daily activity decision making sphere.