Study of the documents from 1928–2015 allowed to determine historically accurate date of foundation of the National Center for Neurosurgery. On this date, due to the initiative from N. N. Burdenko and V. V. Kramer and according to the Decree of the Small Council of the Peoples’ Commissars of the RSFSR, the first Moscow neurosurgical clinic under the State Roentgen Institute opened its doors. Note in the preserved operation journal of the clinic states that the first patient was operated on by N. N. Burdenko on February 15^th, 1929. In the context of surgical facilities, the date of first surgery is considered the date of their opening.

In 1932, the Scientific Research Neurosurgical Institute was established at the first neurosurgical clinic which in 2015 in accordance with the Decree of the Government of the Russian Federation was transformed into the N. N. Burdenko National Medical Research Center for Neurosurgery.

Background. Brain metastasis occurs in 10–30 % of patients with different malignances. Despite of successes, achieved in the treatment of extracranial malignances in last decade, tendency to increase of the survival and duration of the disease-free period in patients with brain metastasis is absent. Several treatment modalities: chemotherapy, radiation, immune and target therapy, stereotactic radiosurgery, different types of surgical procedures, however, an optimal combination of these methods remain unclear.

The aim of the study: to summarize experience of complex treatment of patients with brain metastases in hospital with opportunity of both surgical removal, chemo- and radiotherapy and review literature on the topic.

Materials and methods. The retrospective analysis of medical data of patients with brain metastases performed with assessment of most frequent sources of metastases, there value, localization, median survival duration from metastasis revealing due to different types of therapy, main period of recurrences and hospital state duration, early and late complications. Inclusion criteria were: patients with surgical treatment of brain metastases, availability of medical data. Exclusion criteria were: multiple brain metastases, contraindications for surgical treatment, sensitive to chemo- and radiation therapy malignances (leukoses, lymphoma, germinative tumors etc.). The assessment of degree of metastasis resection was made by postop CT and MRI with intravenous enhancement or by operation records. Intraoperative florescence was used for evaluation of tumor borders. In case of localization of metastasis in sensory or motor zones intraoperative electrophysiological monitoring acquired. Few operations for metastasis localized in speech zones were made with «asleep–awake–asleep» method. Follow-up assessed by questioning of patients and their relatives. Statistical analyzes performed in IBM SPSS Statistics 23.

Results. 52 patients meet criteria and were included to the study. Male to female ratio was 1 : 1, main age – 60 years.  The most common sources of brain metastases were (in decreasing order) melanoma, lung cancer, kidney cancer, breast cancer, rectal cancer, prostate cancer, ovarian cancer and uterus cancer. Two patients had 2 brain metastases at the time of assessment, other 50 – single. Most common localizations of brain metastases (in decreasing order) were: parietal lobe, frontal lobe, cerebellum hemispheres, occipital lobe, temporal lobe, ventricular system and brain meninges. In 46 % of cases metastases involves significant functional areas of brain. Median value of metastasis was 11 cm³; midline dislocation appeared in 65,4 % of cases; 6 patients have hemorrhage in the tumor, 2 – seizures, 2 – occlusive hydrocephalus. Main Karnofsky performance index – 73,8. Total resection performed in 84,6, subtotal resection – in 7,7 % of cases gross. Intraoperative fluorescence used in 73 %. In 10 cases metastasis localized in motor and sensory zones, all these cases were treat with intraoperative neurophysiological monitoring. Postoperative hemiparesis noticed in 1 patient; 3 surgeries performed with awake; no aphasias mentioned. Follow-up was assessed in 44 patients, 20 of them were dead at the time of the study. An assessment of dependence of overall survival median on primary tumor morphology performed. Prognostic factors of brain metastases: its morphology and value, extent of resection, Karnofsky status and early complications.

Conclusions. Most patients with brain metastasis are in satisfactory condition. Most frequent tumors which form brain metastasis: melanoma and lung cancer, they are characterized by poorer prognosis. Most metastasis are supratentorial, intracranial hypertension is obvious. Metastasis localization, time from its evaluation to surgery, significant functional areas involvement and primary tumor resection aren’t fluent on survival.

Background. The comparison of external ventricular drainage and endoscopic surgery in patients with intraventricular hemorrhages is carried out.

The aim of the study is to perform comparative analysis of external ventricular drainage and endoscopic surgery results in patients with intraventricular hemorrhage.

Materials and methods. A retrospective analysis was performed in 29 patients with intraventricular hemorrhage who underwent surgery at the N. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, and the Yaroslavl Regional Clinical Hospital. Endoscopic surgery for intraventricular hemorrhage was performed in 15 cases (treatment group), and in 3 cases endoscopic removal was accompanied by external ventricular drainage. External ventricular drainage without endoscopic surgery was performed in 14 cases (control group), and in 3 of these cases local fibrinolysis was also performed. In the treatment group, mean age was 59.6 ± 16.7 years, level of consciousness per the Glasgow Coma Scale prior to surgery was 9.9 ± 3.3, severity of intraventricular hemorrhage per the Graeb Scale was 7.3 ± 2.5. In the control group, mean age was 52.8 ± 9.6 years, level of consciousness per the Glasgow Coma Scale prior to surgery was 10.7 ± 3.2, severity of intraventricular hemorrhage per the Graeb Scale was 5.0 ± 2.6. Outcomes were assessed on the 30^th day after hemorrhage using the modified Rankin Scale.

Results. Endoscopic method allows to effectively remove clots from the lateral and III ventricles, decreasing the volume of intraventricular hemorrhage from 7.3 ± 2.5 to 3.9 ± 2.5 points per the Graeb Scale. Comparative analysis showed no difference in hydrocephalus resolution in the treatment and control groups. There were no intracranial infectious complications in the treatment group, but in the control group bacterial meningitis was diagnosed in 2 (14.3 %) of the 14 patients. Favorable outcome (score 0–2 per the modified Rankin Scale) was observed in 40.0 % of patients in the treatment group and 28.6 % in the control group. Mortality was 13.3 % in the treatment group and 57.1 % in the control group (χ² = 8.6, p <0.01).

Conclusion. Endoscopic surgery is an effective and safe method for intraventricular hemorrhage management and third ventriculostomy for occlusive hydrocephalus resolution, allowing to achieve better functional results and decrease mortality in patients with nontraumatic intraventricular hemorrhage.

Background. The dura mater tear are quite common in patients with thoracic and lumbar fractures. Prevention and management of cerebrospinal fluid leakage and sealing of the dura mater suture is an important stage in the treatment of such patients.

Objective: to find an optimal surgical tactics for patients with fractures of the thoracic and lumbar spine and dura mater tear.

Materials and methods. This study included 167 patients operated on for fractures of the thoracic and lumbar spine with concomitant traumatic spinal canal stenosis. We analyzed their clinical data and results of instrumental examination. All patients underwent laminectomy at the level of their fractures and transpedicular fixation. The main group included 55 patients with dura mater tear, whereas the control group comprised 112 patients without dura mater tear.

Results. Dura mater tear was found in 32.9 % of patients with fractures of the thoracic and lumbar spine. Of them, 21.8 % had compression of the spinal cord or nerve roots at the sites of dura mater tear. This fact should be taken into account when performing decompression and the reduction maneuver to prevent additional injuries to the neural structures. Thirty-three (60.0 %) patients underwent direct suturing aimed to restore the dura mater integrity. Their mean size of the dura mater tear was 13.2 ± 7.4 mm². Thirteen patients (23.6 %) with larger dural tear (27.5 ± 6.3 mm²) underwent their repair using either a fragment of dura mater from a deceased donor (n = 2), Reperen implants (n = 5), or Durepair patches (n = 6). In 9 patients (16.4 %), the integrity of dura mater was restored without suturing (the «sandwich»-sealing method) (mean size of the dura mater defect 5.0 ± 2.6 mm²). Twenty-one patients had additional sealing of dura mater suture using bioglue.

Postoperative wound cerebrospinal fluid leakage was registered in 5 out of 55 patients from the main group. Cerebrospinal fluid leakage was most common in patients who had undergone dura mater repair with implants (23.1 %), while those who had undergone direct dura mater suturing were less likely to develop it (6.1 %). No cerebrospinal fluid leakage was observed in patients with small defects (≤3 mm²) or in those whose dural tears were located at the nerve root cuffs. Patients with postoperative cerebrospinal fluid leakage had no additional sealing of dura mater suture using bioglue.

Postoperative wound infection was registered in 4 (7.3 %) patients from the main group and 6 (5.4 %) patients from the control group.

Conclusion. Sealing of dura mater sutures with glue compositions is an effective method to prevent postoperative cerebrospinal fluid leakage. Sealing of dura mater sutures with a collagen sponge does not prevent wound cerebrospinal fluid leakage.

Introduction. Volume of glioma resection positively correlated with treatment results. Advance in extent of resection due to various additive methods leads to prolonged overall survival and delays progression. Our aim was to evaluate the value of intraoperative magnetic resonance imaging.

Objective – to present the first experience of using intraoperative magnetic resonance imaging and evaluate the effectiveness and safeness of this technique in surgery of glial brain tumors.

Material and methods. Prospective analysis of surgical interventions performed using the intraoperative magnetic resonance imaging and the results of neuroimaging in 9 patients with different grade brain gliomas treated in Federal Brain and Neurotechnology Center was carried out.

Results. In all patients we detect variable residual tumor volume after first resection. Additional resection was performed in all cases after the intraoperative magnetic resonance imaging. Mean scan time were 45 minutes overall time for scan were decreasing as we gain experience in using intraoperative magnetic resonance imaging.

Conclusion. Intraoperative high-field intraoperative magnetic resonance imaging can be successfully used in the surgery of brain gliomas. The technique allows increasing the radicality of tumor removal without increasing the risk of complications.

Ependymoma is a brain tumor accounting for 1.9 % of all benign brain tumors and 3.1 % of glial tumors and 2–9 % of all neuroepithelial tumors. Approximately one third of intracranial ependymal tumors are supratentorial. They may be attached to the ependymal walls of the III ventricle and lateral ventricles or may be sited in the white matter without direct connection to the ventricular system pressing the adjacent cortex. In very rare cases ependymomas may lie cortically with blood supply from the dura – so-called «cortical» ependymomas.

Posterior fossa ependymomas are more common in pediatric population with mean age of 6 years, whereas supratentorial ependymomas manifest in adults. In adults Grade III anaplastic ependymomas are most commonly seen.

These tumors have no specific features and clinical manifestations of extraventricular anaplastic ependymomas may vary greatly depending on localization and size of the tumor.

Supratentorial anaplastic ependymomas have no specific neuroimaging features either. Tumors are often hypo- and isointense in T1 and iso- or hyperintense in T2 sequence, Gd -inhancement is variable.

Ependymomas are considered to be non-invasive and to have a strict border with brain tissue thus leading to clinical manifestations because of mass-effect.

Surgical resection is the main treatment option for ependymoma. Patients with local Grade II tumor recurrence and patients with Grade III ependymomas should under go radiotherapy on the tumor r esection cavity.

We present a rare case of a supratentorial extraventricular anaplastic ependymoma. A 21‑year-old female presented to the clinic with paresthesia and numbness in right hand, right half of lower lip and astereognosis. The magnetic resonance imaging of the brain showed a mass lesion in left fronto-parietal region. At 10.10.2017 surgery was performed and tumor was resected. Histological findings matched with features of anaplastic ependimoma, WHO Grade III. There was no tumor progression during 3 months after surgery.

Introduction. Arachnoid cysts are benign lesions comprising about 1 % of all intracranial space occupying lesions. The majority are asymptomatic, while surgical intervention, consisting of fenestration, is suggested in the presence of mass phenomena.

The aim of the study – to present the case of a patient with arachnoid cysts in the cerebellopontine angle and its treatment.

Materials and methods. A 53‑years old female patient was referred to our Department of Neurosurgery for the surgical management of a cerebellopontine angle mass. The patient reported tingling sensation and causalgia of her left hemiface, dysarthria, hoarseness, difficulty swallowing solid food and liquids, tinnitus and pain distributed along the ophthalmic branch of the trigeminal nerve.

Results. The patient was subjected to retrosigmoid craniotomy with fenestration of the cyst and concurrent placement of a Torkildsen shunt. No complete resection of the capsule of the cyst was attempted, due to its tight adhesions to the adjacent structures. Postoperatively, there was an improvement in the dysarthria and swallowing of the patient.

Conclusions. Cerebellopontine angle cystic lesions while histologically benign, may become clinically apparent due to compression of adjacent structures. Simple fenestration of the cyst may be sufficient for the remission of symptoms.

Introduction. Currently, one of the effective methods of treatment of intracranial metastases is stereotactic radiosurgery. The main factors limiting its use are the size (volume) of the tumor or the location of the metastasis in critical proximity to radiosensitive brain structures, such as the optic pathways, thalamus, brain stem, due to the high risk of developing local radiation necrosis. To reduce the risk of adverse radiation effects, hypofractionated radiotherapy by linac or staged Gamma Knife radiosurgery is used. However, large brain metastases that cause dislocation of the brain midline structures are traditionally considered an object for surgical excision, the main purpose of which is to eliminate the mass effect caused by the tumor.

The objective of the publication: to demonstrate a case of successful application of staged Gamma Knife radiosurgery of large brain metastases accompanied by brain compression and dislocation.

Materials and methods. Patient, 38‑year-old, with right-sided hemiplegia (0 score) and large (Ø = 3 cm, V = 12.9 cm³) breast cancer metastasis in the deep site of the left hemisphere, accompanied by severe perifocal edema and braindislocation (midline shift up to 15 mm). The treatment was carried out by Gamma Knife in two stages with an interval of 1.5 months.

Results. As a result, not only a complete regression both of the perifocal edema and midline shift were noted, but also a significant decrease of the tumor volume and dramatical improvement in the patient’s neurological status already in the interval between the stages of radiosurgery: restoration of active movements in the right limbs (up to 4 score).

Conclusion. This case demonstrates the possibility of effective and safe non-invasive treatment of large brain metastases accompanied by brain compression and dislocation, which makes it possible to achieve regression of the mass effect and improve the neurological quality of life of cancer patients.

A clinical example of surgical treatment of a patient with long-term consequences of a gunshot blind non-penetrating wound of the lumbar spine received 15 years ago is presented. The indication for performing surgical intervention was the development of recurrent retroperitoneal phlegmon in the last year and a half against the background of the presence of a foreign body (bullet) in the interbody gap L1–L2. In the “cold” period of the inflammatory process, the least invasive operation was performed. The article describes the course of percutaneous transforaminal endoscopic removal of a foreign body, and demonstrates the possibilities of such access. The above clinical observation indicates that the method of percutaneous transforaminal endoscopic surgery may not be limited in its indications only to degenerative-dystrophic diseases of the spine.

Malignant neoplasms remain the leading cause of death worldwide. The spine is a target for metastasis more often than other skeletal bones. This article details the principles of diagnosis, treatment, and the clinical picture of secondarylesions of the spinal column. The causes of pain syndrome in cancerous lesions of the spine are reviewed: compression of nerve structures, pathological fractures, spinal instability, lytic foci and paraneoplastic pain syndrome. The causes and patterns of each type of pain syndrome are described in detail. The article presents the scales used to predict the life expectancy of these patients: Tokuhashi, Tomita and Bauer. The effectiveness of these scales is compared. The selection criteria for surgical treatment of patients with metastatic lesions of the spine are described in detail. Modern methods of surgical treatment of secondary lesions of the spinal column are presented: palliative, subtotal, total (enblock resections). The indications and contraindications for each type of surgical treatment are described. Methods of intraoperative hemostasis are described, with the special attention given to preoperative tumor embolization. The errors and complications of this technique are described in detail. The correlation dependence of intraoperative blood loss volume on the embolization terms is presented. Modern trends in the development of surgical methods in metastatic spinal tumors are described in conclusion.

Problems epidemiology, classification, diagnosis, and treatment of spinal tumors are considered. Data on morbidity and characteristics of different histological forms of benign and malignant vertebral tumors are presented. Features of spinal tumor diagnosis, classic radiological signs, and current noninvasive visualization and invasive (biopsy) techniques are discussed. Literature data on techniques and capabilities of surgical treatment are analyzed. Current trends in selection of surgical intervention radicality level depending on the type of spinal tumor using staging classifications by Ennеking, Weinstein–Boriani–Biagini and Tomita are described. Current indications for radical en bloc resection performed in a limited number of cases is considered. Minimally invasive spine surgery is discussed: from vertebroplasty, radiofrequency ablation and intervention removal of metastatic tumor to separation surgery for epidural compression. Apart from surgical treatment, neoadjuvant and adjuvant radiotherapy of vertebral tumors are analyzed: conventional, conformal, including stereotaxic, beam therapy and radiosurgery. Data on current trends in treatment selection depending on histological nature of the tumor, its radiosensitivity and probability of post-radiation malignant transformation are presented. Drug treatment, in particular chemotherapy, is an indispensable in treatment of secondary and some primary spinal tumors. Data on chemosensitivity of various tumors and tactics of combination and complex treatment are presented. Evidently, the current trend is to decrease the level of surgical invasiveness and selection of minimally invasive methods of surgical treatment. Moreover, it is concluded that considering the biological nature of hemopoietic tumors and some sarcomas, currently surgical treatment is not the main method of treatment of these malignant tumors.

Monitoring of motor evoked potentials in surgery of supratentorial tumors estimates integrity of cortical motor centers and subcortical pathways. Violation of motor evoked potentials takes place in mechanical injury or ischemia of motor neurons. Decrease of amplitude of motor evoked potentials more than 50 % is predictor of permanent neurological deficit.

Cortical mapping gives a possibility to discover eloquent brain areas before their resection. To reveal motor centers activating stimulation is applied, to find out speech or sensory areas – the inhibiting one. Positive brain mapping allows to exclude technical fault in selection of stimulation threshold but it demands a wide craniotomy. Negative mapping is more widespread, gives opportunity to use tailored craniotomy that reduces surgical injury and duration of operation. One of the most valuable factors in cortical and subcortical brain mapping is the stimulation threshold. With monopolar «train» stimulation current 1 mA spreads into approximately 1 mm. The safe value of current intensity during tumor resection in eloquent areas is 3–5 mA.

Monopolar stimulation demands less time for location of eloquent brain areas, it is as accurate as the bipolar mapping and more rarely leads to intraoperative seizures. Combination of monopolar stimulator with aspirator gives opportunity to continuously allocate pyramidal tract in tumor resection.

In ischemic stroke, the condition of cerebral collateral circulation is one of the key factors determining the outcome. Digital subtraction angiography is considered the gold standard of evaluation of cerebral collateral circulation. However, computed tomography angiography is the most widely used method characterized by high level of conformity with subtraction angiography. Currently, several scales of visual evaluation of collateral circulation development in images obtained by computed tomography angiography are used. The scales describe the territory of stroke-associated cerebral artery, as well as details of various areas of the territory. The association between the score and severity of neurological deficit and volume of cerebral ischemia was demonstrated in numerous studies. However, consensus on the most reliable method of description of cerebral collateral status has not been reached. Use of modern methods of processing of medical images and artificial intelligence allowed to make a significant step towards automatization of collateral status evaluation with such benefits as high processing speed and resistance to subjective opinion. Despite low number of studies on this subject, implementation of automated solutions has already showed its effectiveness. In this review, scales for manual evaluation of cerebral collateral status are considered, their reliability is described, and current approaches to automated evaluation of collateral circulation in ischemic stroke are presented.