Objective: to examine the features of clinics, diagnostics and surgical treatment of multiple gunshot facial and head wounds caused by limited weapon as the most often occurred and poorly studied type of peace-time gunshot wounds. Material and methods. The gunshot wounds of various localizations were seen at 602 clinical cases among all patients admitted to St Petersburg hospitals within 10 years (from 2004 till 2013) according to our biometric analysis. The maxillofacilal wounds were revealed at 107 (17,8%) patients. These patients were divided into the following groups according to the type of used fire-arms: limited weapon - 44 (62,0%) patients; portable firearms - 11; shot-gun - 4; air weapon - 10; pyrotechnics (signal rockets) - 2. There were no gunshot wounds caused by high-speed shooting automatic firearms (which are specified for war-time) among examined patients. Results. This conducted study allowed making conclusion that gunshot wounds by limited weapon have the characteristics of wounds caused by low-speed fire-arms. The optimal method for diagnostics of such gunshot wounds is computer tomography. Conclusion. The surgical strategy for treatment of patients with gunshot wounds from the limited weapon is similar to the guidelines used for the treatment of gunshot wounds but it must be mercifully. Endoscopic surgery is the advantageous method for treatment of such wounds in the regions of midface and upper face zone.

One of the most relevant problems at patients with orbital trauma is the estimation of orbit damage degree, including the changes of normal anatomy of bone and soft tissues orbital components according to multispiral computer tomography (MSCT) data. Nowadays there are no common methods to measure the linear dimensions of orbit and to estimate the enophthalmos/exophthalmos and hypophthalmos/hyperphthalmos degree according to MSCT data. Objective. To develop the methods to measure the linear dimensions of orbit and to estimate the enophthalmos/exophthalmos and hypophthalmos/hyperphthalmos degree according to MSCT data. Material and methods. We examined 25 patients with posttraumatic defects and deformations of orbit before and after surgical treatment for developing the methods of measurement of orbital linear dimensions and estimation of enophthalmos/exophthalmos and hypophthalmos/hyperphthalmos degree. Results. The developed methods allowed measuring the longitudinal, vertical and horizontal dimensions of orbit and estimating the enophthalmos/exophthalmos and hypophthalmos/hyperphthalmos degree at all examined patients with posttraumatic defects and deformations of orbit. Conclusions. The usage of offered methods to measure the linear dimensions of orbit and to estimate the enophthalmos/exophthalmos and hypophthalmos/hyperphthalmos degree according to MSCT data allows conducting the comparative analysis of received data of measurements before and after surgical treatment to estimate the efficacy of surgical reconstruction of orbit.

The acute developing dislocation syndrome is the emergent condition in neurosurgery and the leading cause of unfavorable outcomes at patients with head injury (HI). The patients with HI and acute dislocation syndrome, regardless number, type, volume and localization of brain damaged foci, are suffered from developing brain stem compression which is characterized by uniform clinical presentation including depression of consciousness level and secondary signs of brain stem damages masking the focal and hemispheric symptoms. The rapid, in-time and accurate estimation of functional condition of every part of brain stem (mesencephalon, pons, medulla oblongata) plays a critical part in choice of surgical strategy as well as in prediction of outcomes at patients with HI. The presented scale for estimation of acute dislocation syndrome severity suggested by author is based on quantitative evaluation of consciousness level and functions of brain stem parts. The efficacy of this developed scale was estimated during clinical examination of 43 patients suffered from HI. The statistically significant correlation was revealed between stage of acute dislocation syndrome development according to our scale and condition of basal cisterns as well as strategy and outcomes of surgical treatment (p<0,05). The developed scale of severity of acute dislocation syndrome may be recommended as additional diagnostic and prognostic parameter during pre-hospital and hospital care about patients with HI.

Objective - to estimate the surgical treatment efficacy at patients with degenerative disease of lumbar spine with the usage of interspinous dynamic implant. Material and methods: the operative treatment was performed at 100 patients with degenerative disease of lumbar spine. These patients were divided into two groups including 50 persons each. All patients in both groups underwent microsurgical diskectomy with curettage of disk bed and decompression of neural structures. The placement of interspinous dynamic implant was performed at patients in main (examined) group. Computer tomography (CT), magnetic resonance imaging (MRI) and functional roentgenograms were done in pre- and postoperative periods. We used VAS (Visual Analogue Scale) and Oswestry scale for estimation of treatment quality. Results: the number of surgical complications didn’t significant differ between patients of two examined groups. Patient operated on with the usage of interspinous dynamic implant showed statistically significant better outcomes with the fewer score according to VAS and Oswestry during first postoperative year. There was no progressive degeneration of adjacent intervertebral disks at patients in both groups. Conclusion: the usage of interspinous dynamic implant leads to decrease of residual pain and increase of life quality with the following stabilization of patients’ condition.

Objective. To study the individual variability of posterior part of the circle of Willis and posterior cerebral arteries. Material and methods. We examined 50 basilar arteries, 100 posterior communicating arteries and 100 posterior cerebral arteries on 50 anatomical specimens of human brain. We conducted the morphometric examination of the types of posterior part of the circle of Willis, basilar artery (BA), posterior cerebral artery (PCA), posterior communicating arteries (PCoA) and perforating arteries. This anatomical study was conducted using the method of step-by-step microsurgical dissection with microphotography as well as modeling of surgical approaches and morphometry. Results. We revealed three types of posterior part of the circle of Willis: normal type was seen at 48% of cases while abnormal type (hypoplastic and fetal) - at 52% of cases. We stated the dependence between the diameter of Р1-segment of PCA and type of posterior part of the circle of Willis. The forming principle of straight perforating and circumferential arteries arising from the main segments of PCA, PCoA and BA as well as principles of posterior choroid arteries forming was described. The 4 models of vascular architectonics of PCA cortical branching were revealed and described. The 3 types of proximal bi(tri)furcation of Р2Р-segment of PCA and features of its localization in retrouncal area are described. Conclusions. The knowing of anatomical types of posterior part of the circle of Willis, basilar apex, PCA and topography of perforating arteries is necessary for choice of optimal approach to posterior part of the Willis circle whole clipping the vertebrobasilar aneurysms. The topography of proximal bi(tri)furcation of Р2Р-segment of PCA must be taking into account during subtenporal approaches for prevention the traction damage of brain.

Objective. To determine the correlation between configuration and dimensions of tentorial incisura and craniometric indexes. Material and methods. We examined 100 anatomical specimens of tentorial incisura (TI). The measurement of longitudinal TI indexes, cranial indexes and angular parameters of cranial base relief was conducted. The morphometric analysis was performed with calculation of coefficients and indexes. Data processing was conducted using STATISTICA Statsoft. Microsurgical anatomy of incisural spaces of TI was studied using operative microscope МБС-10 and digital camera «Sony» HDR - CX 560 Е. Results. We distinguished 4 types of tentorial incisura configuration (А, В, С, D) based on the data of craniometric and morphometric analysis. It was stated that the mean values of TI parameters for mesocephalic cranium were determined by configuration of tentorial apex. Type А was characterized by pointed and tall apex, type B - by base and flat apex. TI was longer in the case of dolichocranial type comparing with other cranium types. The free edges of tentorium were more abrupt in the area of tentorial apex with minimal protrusion of upper vermis in posterior incisural space in the case of subbrachiocephaly. TI had small dimensions and width in the case of brachiocephaly. The algorithm of MRI data analysis for estimation of TI dimensions allowing predicting its configuration is defined. Conclusion. There are correlations between configuration of TI and cranium type. The suggested classification and morphometric analysis of TI configurations allows predicting TI shape at patients with oncologic and vascular brain pathology in preoperative period and justifying the adequacy of chosen surgical approach. The type of cerebral hernia depends on dimensions of anterior, middle and posterior parts of TI.

This literature review presents the problem of prevention and treatment of angiospasm at patients with ruptured cerebral aneurysms as well as enlights the main mechanisms of angiospasm pathogenesis and risk factors. The various methods for prevention and treatment of angiospasm as well as their efficacy and safety at patients with non-traumatic subarachnoid hemorrhage (SAH) are discussed. The main attention is paid for intracisternal and intraventricular introduction of drugs, such as vasodilators and fibrinolytics, as well as for transluminal balloon angioplasty of affected arteries. The data of conducting trials are presented.

This article is dedicated to endoscopic surgery of hypertensive intracranial hemorrhages and presents the historical aspects of endoscopic surgery development, indications for minimally invasive surgical treatment, surgical approaches and techniques of surgical interventions depending on anatomical and topographic characteristics of hemorrhage. This article also enlights the analysis of treatment results including surgical treatment outcomes and radicality of operations depending on severity of patients’ state, hemorrhage characteristics as well as time and technique of operation.

The frequency of various types of acute cerebrovascular accident are widely differ: ischemic stroke - approximately 70-75%, hemorrhagic stroke - 15%, subarachnoid hemorrhage - 5% and ПНМК - from 10% till 15%. More than 70% of ischemic strokes (IS) are occurred within the territory of middle cerebral artery (MCA) blood supply. It is quite obvious that IS as the most common type of stroke requires the most careful attention for examination, treatment and prevention. There are only a few trials considering the problem of the surgical treatment of acute IS in accessible literature sources. The deadlines for various surgical interventions at patients with IS within the territory of MCA are still under consideration. Till nowadays there is clear agreement of opinion concerning deadlines of carotid endarterectomy performance at patients with IS as well as there are no retrospective data of treatment at those patients with massive hemispheric stroke who underwent hemicraniectomy. The long-term results of various corrective operations as well as comparative results concerning endovascular operations and their surgical, hemodynamic and neurological estimation are still under-investigated.

This article presents the description of transorbital endoscopic approaches used for surgical treatment of orbital fractures. Moreover the treatment strategy of posttraumatic nasal liquorrhea and different techniques of liquor fistulas plasty are enlighted.

This article presents the detailed review of clinical case of female patient with cavernous hemangioma (CH) of cervical spinal cord which was presented as acute massive hematomyelia. The hemorrhage from CH leaded to development of upper paraparesis and lower paraplegia. The repeated cervical MRI was not be able to reveal CH. CH was considered as the most probable reason of hemorrhage while determine the indications for surgical treatment, but the final diagnosis was stated only intraoperatively and as a result of histological examination. This case is considered to be of interest taking into account the complexity of correct diagnostics making as well as the choice of optimal surgical strategy for treatment of spinal cord CH.

This article describes the clinical case of complicated head injury (HI) as a result of genuine evolution of brain traumatic disease and incorrect performance of first operation. The severity of state was shown by: 1) instability of cardiac rhythm; 2) progressive deterioration of neurological deficit with refractory dysfunction of brain stem oral parts and well-marked meningeal symptoms; 3) wound process in the area of damaged brain with useless of drugs administration. The following three factors were the morphological base: 1) necrotic encephalitis of brain tissue prolapsing into bone defect, 2) accumulation of subdural exudates and 3) postoperative wound liquorrhea. The surgical strategy which was applied in this case for repeated surgical intervention allowed eliminating brain compression and brain dislocation as well as arresting the infectious process in the operative wound and thus preventing the development of life-threatening complications and achieving patient’s rehabilitation. The presented variant of planning and surgical treatment performance occurred justified.

The methodological and worldview role of philosophy in modern neurosurgery is discussed. The components of philosophic approach to the problems of neurosurgery and their synergetic cooperation are distinguished. The perspective of philosophy implementation via medical judgment and system conceptual solutions during treatment of various brain and spinal cord pathology is shown including real clinical cases. It is stated why the philosophy of neurosurgery is necessary. The necessity of philosophic estimation of various situations in developing preventive neurosurgery is justified. The usage of developed philosophy of neurosurgery is the safe antidote against atrophy of medical judgment, hyposkills and syndrome of isolation of physician from patient.