Background. Surgical treatment of complex neurovascular pathology remains an important problem requiring use of a combination of various techniques. Utilization of a hybrid operating room allows to simultaneously or sequentially combine microsurgical and endovascular surgical methods which can improve treatment outcomes.

Aim. To improve surgical treatment of patients with cerebrovascular pathology by utilizing the capabilities of a hybrid operating room.

Materials and methods. Surgical interventions were performed in a hybrid operating room with a combination of endovascular and microsurgical methods for treating the following cerebrovascular pathologies: complex dural fistulas, complex aneurysms, arteriovenous malformations. The type of surgical intervention – hybrid, combined, staged – was chosen in accordance with the nature of the pathology.

Results. In 5 years, 41 patients underwent surgery in the hybrid operating room. Among them, 33 patients had arteriovenous malformations, 6 had complex aneurysms, 2 had complex dural fistulas. Combination interventions were performed in 27 patients, staged – in 12, hybrid – in 2. According to the Modified Rankin Scale (mRS) the following outcomes were observed: no complications in cases of complex aneurysms (6 patients) – mRS 0 (points), as well as in cases of dural fistulas (2 patients) – mRS 0 (points); in arteriovenous malformation, 30 patients did not have any complications – mRS 0; 3 patients had complications (of different types) – mRS 1.

Conclusions. The combination of microsurgical and endovascular methods of treatment in a hybrid operating room allows to combine the positive features of the two methods in accordance with surgical needs which improves the outcomes of neurosurgical interventions in complex neurovascular pathology.

Background. Tumors of the sinonasal region represent a large group of both benign and malignant formations affecting the nasal cavity, paranasal sinuses, structures of the anterior and middle cranial pits of the base of the skull.

Aim. Evaluation of the results of surgical treatment of patients with adenoid cystic carcinomas of sinonasal localization treated in the period from 2007 to 2021.

Material and methods. The present study is a retrospective analysis of the results of surgical treatment of patients with adenoid cystic cancer of the base of the skull operated at the N.N. Burdenko National Medical Research Center of Neurosurgery in the period from 2007 to 2021.

Results. The radicality of tumor removal was assessed based on an MRI analysis performed no earlier than 3 months after surgery. Total (95–100 %) tumor removal was achieved in 8 (25 %), subtotal (80–95 %) in 15 (46.9 %), partial (50–80 %) in 5 (15.6 %) patients; extended biopsy was performed in 4 (12.5 %) cases. At the same time, total and subtotal removal was more often achieved with open surgery, which was due to the topographic and anatomical features of the location of tumors.

Discussion. In this paper, we present an analysis of the results of treatment of 32 patients with adenocystic cancer of sinonasal localization.

The main method of treatment is an integrated approach – radical surgical resection of the tumor together with adjuvant radiation therapy. Surgical treatment is aimed at the maximum possible resection of pathological tissues to prevent recurrence of the disease.

One of the most common approaches is transfacial with or without bifrontal craniotomy, which includes craniofacial resection.

Conclusion. Adenoid cystic carcinoma is an aggressive malignant tumor that requires a comprehensive approach to treatment. Important factors that positively affect the results of treatment are the conduct of chemoradiation treatment and the age of patients, as well as the initial stage of the disease at which treatment was initiated, which necessitates strengthening dispensary monitoring and raising awareness of the population about the possibility of developing such diseases for timely access to a doctor.

Introduction. Lateral ventricular neoplasms (tumors, vascular neoplasms, cysts) are rare and according to different sources comprise between 0.64 and 3.5 % of all brain tumors. Due to relatively slow growth, tumors can reach significant size before patient develops neurological symptoms. Surgery is the main method of treatment of lateral ventricular neoplasms, and in many cases radical removal can be achieved. The main complications after surgery are hydrocephalus and hemorrhages. The later frequently lead to escalation of neurological symptoms and sometimes require repeat surgical intervention. The success of intraventricular surgery consists of reasonable radicality and absence of complications.

Aims. To evaluate the radicality and safety of lateral ventricular tumor removal through traditional approaches–transcallosal and transcortical – using arterial spin labeling (ASL perfusion) and to analyze the risk of hemorrhagic complications in the early postoperative period in the context of tumor location and blood supply.

Materials and methods. At the N.N. Burdenko National Medical Research Center of Neurosurgery between 2017 and 2019 48 patients with space‑occupying lesions of the lateral ventricles were examined and treated with surgery. All patients were examined using the same MRI protocol before and after surgery: Т1‑weighted, Т1‑weighed contrast‑enhanced, 3D SPGR, Т2‑weighted, Т2‑FLAIR, DWI, T2‑FLAIR CUBE, SWAN, ASL perfusion. In 28 (58 %) cases, transcortical approach was used (through the frontal lobe in 24 cases, through the upper temporal lobe in 2 cases, through the parietal lobe in 2 cases); transcallosal approach was used in 16 (33 %) cases; combination approach (for advanced tumors of the lateral ventricles) was used in 3 (6 %) cases; supracerebellar infratentorial approach was used in 1 (2 %) case. Radicality of lateral ventricular tumor removal and risk factors for postoperative hemorrhagic complications using different approaches were evaluated based on the following parameters: tumor volume and location, sex, blood flow characteristics, presence of hydrocephalus.

Results. In the compared groups I and II, similar rates of radical tumor removal were observed: 63 % for transcortical approach and 71 % for transcallosal approach. Hematomas in the tumor bed were more frequently observed in patients operated through transcortical approach (64 % vs. 31 % in transcallosal) without statistical significance. Generally, there were no statistically significant differences between surgical treatment results in groups I and II (p >0.05); this conclusion was confirmed in pseudo‑randomized patient subgroups selected through propensity score matching. Analysis of the association between hematoma in the postoperative period and baseline blood flow level showed that in the group with such hematomas mean tumor blood flow prior to surgery was almost twice as high as in the group without hemorrhagic complications after resection (80.6 vs. 49.4 ml/100 g/min, respectively).

The following postoperative parameters are statistically significant for development of hematoma in the tumor bed: presence of hydrocephalus, Evans index in the early postoperative period.

Conclusions. Correct and adequate choice of surgical approach considering anatomical location and advancement of the tumor, presence of hydrocephalus and surgeon’s preferences ensures high radicality of removal. Factors affecting the risk of hemorrhagic complications in the early postoperative period should be taken into account: sex, presence of hydrocephalus, neoplasm location and blood flow level.

Introduction. Metabolic navigation with 5‑ALA is one of methods for intraoperative imaging in neuro‑oncology.

Aim. To perform a comparative analysis of sensitivity of metabolic navigation with 5‑ALA during surgery of primary and secondary brain tumors of various histological nature and degree of malignancy.

Materials and methods. During the period from 2013 to 2020, our group have performed surgery to 403 patients using metabolic navigation: microsurgical resections were performed in 384 people with brain tumors, 220 of them were with glial tumors, 101 were with intracranial meningiomas, 63 were with metastatic brain damage. Among patients with metastases, 39 patients had a solitary injury, 16 had a multi‑focal injury, so 72 cases of metastatic nodes were considered in this group. Stereotactic biopsies with 5‑ALA‑assistance were performed in 19 people. Metabolic navigation was performed with the drug 5‑ALA, which was taken orally at a dose of 20 mg/kg 2 hours before surgery. Intraoperative fluorescence was evaluated using microscope with a fluorescent module.

Results. Metabolic navigation using microscope has a high sensitivity when employed during microsurgery (including repeated implementation of surgery) in cases of anaplastic gliomas (65 % in total, 58 % with bright glow), glioblastomas (94 % in total, 53 % with bright glow), intracranial meningiomas (94 % in total, 64 % – with bright glow). The use of 5‑ALA has significant limitations in sensitivity in cases of diffuse gliomas (46 % – in total, 27 % – with bright glow) and brain metastases (in total 87 % – for the solid part, 52 % – for the bed, with bright glow – 51 %). In diffuse gliomas, the glow areas had significantly higher proliferative index and cell nuclei density than the fluoronegative zones. Among the most important factors affecting the glow of gliomas it can be noted: the status of the IDH1 mutation, the volume of the contrasting part of the glioma according to MRI data, the methionine accumulation index according to positron emission tomography, the tumor blood flow indicators according to the arterial spin marking method – ASL perfusion.

Conclusions. Implementation of 5‑ALA navigation with the use of microscope provides high sensitivity in cases of glioblastomas, anaplastic gliomas (especially for detecting of non‑contrasting part of tumor that is not visually altered in the white light of operating microscope) and brain meningiomas. The method is less effective in low‑grade gliomas and intracranial metastases.

Background. C1–2 transarticular fixation according to the F. Magerl technique is one of the most reliable methods of C1–2 screw stabilization. An important aspect of the precise placement of implants during transarticular fixation under X‑ray control is the use of correct selection of start‑ and end‑points of the installation trajectory. At certain values of the height and width of C2 isthmus some screw installation trajectories may be accompanied by a zero probability of vertebral artery damage that might be due to the screw malposition.

Aim. To evaluate CT morphometric characteristics of the C2 vertebra to assess the possibility of safe C1–2 transarticular fixation.

Materials and methods. The analysis performed was based on the data obtained from 7672 patients having admitted with suspected injury to the N.V. Sklifosovsky Research Institute of Emergency Medicine during the period from 01.01.2019 to 31.07.2019. The study involved 6 neurosurgeons and 6 medical doctors of the X‑ray diagnostics department. The measurements were carried out in 2 stages. Each parameter (isthmus height – IsthH, isthmus width – IsthW, lateral mass height – LmH) was measured 2 times. In case of high intraclass correlation, the mean value of the measurements was calculated, which was included in the final analysis.

Results. The intraclass correlation coefficient for all measurements approached an excellent correlation values and was 0.852 (95 % CI 0.844–0.860). Morphometric characteristics were calculated basing on data from 795 patients. The IsthH value was 7.45 ± 1.66, IsthW – 8.56 ± 1.48, LmH – 5.56 ± 1.84 mm. In men, the transarticular fixation was significantly more likely to be performed without injury of the vertebral artery (in 66.1 % of cases; χ²‑test, p <0.000001), whereas in women – only in 29.9 % of cases.

Conclusions. The results obtained suggest that percutaneous bilateral transarticular fixation with the use of posterior spinolaminar point and middle of the atlas anterior arch as landmarks potentially serves as a method of choice in 88.3 % of patients. Of all patients with normal anatomy of C2 isthmus, men are twice more likely to undergo transarticular fixation without damage of vertebral artery than women, the probability exceeds 66 %. However, the risk of injury of this blood vessel in other patients does not exceed 2.3 %, which is comparable with outcomes of other methods of C1–2 screw stabilization.

Background. The article is extremely relevant due to growing traumatism, current condition of craniofacial traumatology, debatable and incomplete tactics of restoring traumatic defects and deformations of bones of the skull and face. Plastic surgery of the skull defects has developed from simple defect closure to restoring an aesthetically attractive area of the skull, which shape repeats the individual structure of the area lost due to trauma or surgical treatment (trepanation surgery, osteoplastic trepanation, treatment of a depressed skull fracture, etc.). To restore the defects specialists use auto‑ and allografts. In recent years, materials to manufacture implants are simulated using a 3D‑shape.

Aims. To describe the clinical case of a combined approach for the restoration of post‑traumatic deformation of the bones of the arch, base of the skull and bones of the middle zone of the face. To show the importance of multidisciplinary teams in providing assistance to this group of patients, as well as the use of individual 3D simulated titanium plates for reconstructive operations. Emphasize the need to perform reconstructive operations as soon as possible.

Materials and methods. Patient Sh., 43 years old, was admitted to the neurosurgical department of the City Clinical Emergency Hospital (Minsk), in the long term severe traumatic brain injury, with defects of the arch and base of the skull and deformation of the bones of the facial skull on the left. Titanium implants were modeled on a 3D printer, which were used during the operation performed by a multidisciplinary team consisting of a neurosurgeon, maxillofacial surgeon and ophthalmologist‑surgeon. Us for closing defects in the cranial vault, the bottom wall of the orbit and in eliminating deformation skeleton midface line. Titanium implants are made by specialists of Medbiotech SP LLC, Minsk, Republic of Belarus.

Results. The late postoperative period proceeded without peculiarities, the wounds healed by primary tension. Post-operative CT showed that the condition of the implants is satisfactory.

Conclusion. This clinical observation demonstrated the need for a multidisciplinary approach, as well as the priority in using 3D simulated titanium implants to restore post‑traumatic deformation of the bones of the arch and base of the skull and midline bones.

Introduction. The new coronavirus infection (COVID‑19) has a wide spectrum of complications. Frequency of neurological symptoms varies between 17.3 and 36.4 %. In 8 % of cases, COVID‑19 can be accompanied by bacterial or fungal infection. Since few descriptions of bacterial meningitis in adult patients with COVID‑19 and a single description of surgical treatment of purulent meningitis complicated by empyema of the 4^th ventricle in a patient with COVID‑19 were found, and there are no meta‑analyses in this area, descriptions of such cases are of high scientific and practical value.

Aim. The describe a case of surgical treatment of purulent ventriculitis in an adult (during treatment of the new coronavirus infection COVID‑19).

Materials and methods. A man, 69 years old, with previously established diagnosis of the new coronavirus infection COVID‑19 and a comorbid pathology was admitted to the Moscow City Clinical Hospital No. 40 with newly diagnosed seizure disorder. Computed tomography imaging showed ventriculitis confirmed by MRI with obstructive hypertensive triventricular hydrocephalus.

Results. The patient underwent treatment: three‑time endoscopic lavage of the ventricular system, removal of newly formed fibrin membranes with interventricular septostomy, removal of obstruction at the level of the Sylvian aqueduct; the surgery was concluded by external draining of the lateral ventricles, administration of an antibiotic intro the ventricular system and intravenously. Cerebrospinal fluid flow was restored, ventriculitis manifestations completely negated.

Conclusion. Development of ventriculitis as one of the first signs of bacterial infection accompanying COVID‑19 is a very rare and life‑threatening complication requiring active surgical intervention. In was shown that endoscopic lavage of the ventricular system for ventriculitis treatment is an effective action against infection and cerebrospinal fluid flow disorders. Use of intraventricular endoscopy for ventriculitis treatment has several advantages compared to needle ventriculostomy. Further studies and analysis of treatment of bacterial ventriculitis using endoscopic surgical techniques in patients with and without the new coronavirus infection are needed.

Background. Cerebral arteriovenous malformations and dural arteriovenous fistulas are relatively rare pathologies with frequency of 1–1.5 and 0.1–0.2 cases per 100 000 people per year, respectively. Probability of a combination of these pathologies in a single patient is extremely low. The authors were not able to find publications describing a combination of these pathologies of the cerebral vasculature.

Aim. To present a clinical case of successful surgical treatment of combined cerebral pathology – dural arteriovenous fistula and angiographically occult arteriovenous malformation – in a patient with intracranial hemorrhage.

Materials and methods. Analysis of the results of treatment of patient with dural arteriovenous fistula with hemorrhagic disease course at the N.V. Sklifosovsky Research Institute of Emergency Medicine (Moscow) was performed. The patient underwent osteoplastic cranial trepanation, resection of the dural arteriovenous fistula. Intraoperatively an angiographically occult arteriovenous malformation was detected which caused the hemorrhage.

Results. Surgical treatment allowed to achieve a satisfactory outcome. Intraoperatively diagnosed angiographically occult arteriovenous malformation was confirmed histologically.

Conclusions. The presented clinical observation shows the necessity of careful revision of hematoma cavity in the presence of isolated intraparenchymal hemorrhage from dural arteriovenous fistula.

Background. The primitive trigeminal artery is a fetal anastomosis connecting carotid and vertebrobasilar basins during embryonic period of development. After birth, this artery in the child is obliterated and reduced in most cases. Sometimes the obliteration does not occur and as a result the aneurysms may be formed on this artery (due to change in ordinary hemodynamics in carotid basin), as a consequence, it produces a risk of subarachnoid hemorrhage that sharply worsens prognosis of the disease outcome. The usual microsurgical treatment methods of aneurysms of such localization are of little use and are highly traumatic due to the very “low” location of the neck, because the surgery may need extended basal accesses requiring resection of skull base bones. Also, an “open” surgery produces risks of perforating arteries injury that often extend from trigeminal artery and feed the brain stem, the injury will immediately result in brain ischemic damage. That is why the preferred method for treatment of that kind of pathology may include endovascular intervention both of non‑reconstructive type employing microcoils only and those of reconstructive requiring implantation of assisting or flow‑redirecting stents.

Aim. To demonstrate a case of successful treatment of patient with a primitive trigeminal artery aneurysm.

Materials and methods. A woman, who was admitted to clinic with complaints of convergent strabismus, undergone surgery for large aneurysm located on primitive trigeminal artery. CT brain angiography revealed large aneurysm of primitive trigeminal artery on the right, the result was later confirmed by data of selective cerebral subtraction angiography. Taking into account oculomotor disorders in the patient, it was decided to refrain from microcoils use due to risk of the mass‑effect preservation. Under double disaggregant therapy (ticagrelor 90 mg twice daily + acetylsalicylic acid 100 mg once daily in the evening) and monitoring the functional activity of platelets, a flow‑deflecting stent was implanted into the right internal carotid artery.

Results. The patient was discharged from hospital on the 1^st day after the surgery and returned to work. A control angiography performed 3 years later revealed a total shutdown of the aneurysm from bloodstream as well as a partial regression of oculomotor disorders. Intravascular treatment in this situation served as an effective method of choice and made it possible to reliably turn off the aneurysm from bloodstream without impairing the functional outcome of patient’s treatment.

Conclusions. It can be assumed that intravascular intervention in case of such aneurysms serves as an effective method of choice as minimally invasive and low‑traumatic surgery in the treatment of patients with that type of pathology.

Isthmic spondylolisthesis is a common pathology in the population, often diagnosed in people of working age. On the issues of etiopathogenesis, as well as the classification of this pathology, researchers have no consensus. Currently, the literature provides different opinions on clinical features, evaluation, and treatment tactics. The presented work includes current information from the world literature on the etiology, classification, clinics, diagnostics, and treatment of patients with isthmic spondylolisthesis.

The purpose of the work is to present current information from the world literature on the features of etiology, classification, clinic, diagnosis, treatment of patients with isthmic spondylolisthesis.

Background. According to WHO, severe traumatic brain injury is among the top ten leading causes of death worldwide. Despite the centuries‑old history of development of the treatment methods to patients with traumatic brain injury their results according to large randomized studies remain unsatisfactory – mortality and severe disability are observed in more than 50 % of patients. Some experimental studies indicate that decompressive craniectomy can aggravate the severity of cerebral edema by creating conditions for traction of nerve fibers and can lead to hemorrhagic transformation of injury foci and ischemia. During the last decade, experimental studies and technological progress have significantly expanded the understanding of brain normal and pathological physiology and made it possible to develop new methods of surgical interventions. In particular, a number of publications have shown significant advantages of dissection of arachnoid spaces of brain base in case of severe traumatic brain injury as compared with classical decompressive craniectomy.

Aim. To analyze the literature data on pathophysiological justification, surgery technique and results of dissection of arachnoid spaces of the brain base in case of severe traumatic brain injury as well as the advantages and disadvantages of the method as compared with standard treatment methods of such patients.

Materials and methods. Literature search through in the main databases was carried out. The methods of opening of basal subarachnoid spaces in case of severe traumatic brain injury, pathophysiological justification and surgery techniques as well as results of clinical studies of the techniques employed are analyzed.

Results. Information on pathogenesis of cerebral edema and pathophysiological justification of effectiveness of opening of brain base cisterns for treatment of traumatic brain injury, data on cisternostomy surgery technique and results were revealed, systematized and analyzed. Publications of individual clinical cases and series of observations indicate acceptable results of cisternostomy in comparison with decompressive craniectomy for treatment of traumatic brain injury.

Conclusions. Dissection of arachnoid spaces of the brain base with perforation of the terminal plate and the Liliequist membrane is a promising method of surgical treatment of severe traumatic brain injury.

Intramedullary metastases are a rather rare manifestation of the underlying cancer. Their presence indicates an unfavorable prognosis and leads to a noticeable decrease in the quality of life. The absence of pathognomonic symptoms prevents the rapid and accurate identification of this pathology, which leads to a late diagnosis. The main methods of treating spinal metastases include surgical treatment; radiation and chemotherapy; steroid therapy. Refining diagnostic algorithms and optimizing protocols for managing patients with intramedullary metastases can help play a role in improving overall prognosis and patient survival. The review covers the epidemiology, the mechanisms of metastasis, the clinical picture, modern methods of diagnosis and treatment of intramedullary metastases, as well as the outcomes of this pathology. The main methods of treatment of spinal metastases include surgical treatment; radiation and chemotherapy; steroid therapy.