Introduction. Postoperative angiographic examinations after endovascular treatment of cerebral aneurysms may demonstrate unstable results, both in the form of recurrence formation, and in the form of increased degree of occlusion with initially incomplete occlusion of the aneurysm sac. Cerebral aneurysm recurrences represent an important medical and social problem comparable in terms of hemorrhage risks with nonoperated aneurysms.

Aim. To estimate the early and long‑term results of endovascular treatment of patients with cerebral aneurysms ope rated on using different endovascular techniques. Materials and methods. The present study included 167 patients (48 men and 119 women) with 195 cerebral aneurysms aged from 18 to 75 years who were operated on using endovascular techniques at the neurosurgical department No. 3 of the Russian Research Neurosurgical Institute named after Prof. A. L. Polenov from 2013 to 2016. The average age of the patients was 52 ± 12 years, the minimum age was 18 years, and the maximum age was 75 years. The choice of endovascular treatment method in the patients included in the study was based on anatomico‑topographic and morphometric features of aneurysm, as well as taking into account the period of aneurysmal disease course.

Results. The study of data of control angiographic examinations after endovascular treatment of patients with cerebral aneurysms showed that in the remote postoperative period the degree of aneurysm occlusion may differ from that initially achieved. The probability of aneurysm recurrence after its isolated occlusion with coils may reach 13.1 % already in 6 months after surgical treatment, 31.7 % after 12 months and 22.3 % after 36 months, averaging 22.5 % (p < 0.05).

Conclusion. The personalized approach in choosing optimal surgical tactics for the treatment of patients with cerebral aneurysms allows to achieve stable radical aneurysm occlusion, to decrease the incidence of postoperative complications and aneurysm recurrences in the long‑term postoperative period.

Introduction. In the surgery of gliomas, various techniques are currently being applied that allow the maximum resection of the tumor while maintaining a good or satisfactory functional status of the patients. A rare method is intraoperative contrast‑enhanced ultrasound imaging (CEUI) of the brain substance.

Aim. To present the first experience of using contrast‑enhanced ultrasound imaging CEUI in surgery of brain tumors (large hemispheres and cerebellum), as well as an assessment of the prospects of the technique in routine use in a neurosurgical hospital.

Materials and methods. The features of the application of the technique CEUI, its advantages over routine ultrasound studies and the limitations identified during testing of the technique in 5 patients with various brain tumors.

Results. In some cases, the CEUI allows for the intraoperative detection of a tumor, which is similar in sensitivity to magnetic resonance imaging. This greatly facilitates both the search for the neoplasm, and the formation of the optimal trajectory of surgery. In the case of benign brain tumors, ultrasound contrasting of the tumor is not always observed, but it often helps to determine the boards of the tumor with greater accuracy than the routine ultrasound search.

Conclusion. The use of CEUI in the surgery of brain tumors seems to be a promising direction. A pilot study has confirmed its effectiveness, but more cases are needed to fully study the problem.

Background. Clinically significant herniated intervertebral discs in the thoracic spine are quite rare, and the tactics of surgical treatment of a group of patients with this pathology remains debatable. The thoracoscopic technique has a number of advantages in the form of a shorter hospital stay and less severe pain in the surgical area compared to standard posterior surgical access.

Aim. To evaluate the results of videothoracoscopic treatment of patients with discogenic thoracic myelopathy.

Material and methods. The article analyzes the results of treatment of 21 patients hospitalized at the Federal Neurosurgical Center (Novosibirsk). According to the results of the examination, the patients were divided into 2 groups: with mild (10 patients) or ossified (11 patients) hernias. Each patient underwent video‑assisted thoracoscopic microdiscectomy. The median follow‑up was 29 (4 to 72) months.

Results. At the time of discharge, 18 (85.7 %) patients showed no deterioration in neurological status, 2 (9.5 %) patients showed positive dynamics in the form of a decrease in the degree of hypertonicity and the degree of lower paraparesis. A satisfactory result of treatment in the late postoperative period was achieved in 14 (66.7 %) patients.

Conclusion. Video‑assisted thoracoscopic surgery is an effective and safe method of surgical treatment of patients with discogenic thoracic myelopathy.

Introduction. The dramatic increase in the cost of treating patients with spinal cord injury is associated with the currently accepted active surgical tactics, as well as the use of new technologies, more expensive implants. Currently, a standardized method for calculating the costs of treating patients has not been developed, which may in the future lead to an incorrect assessment of the economic effectiveness of a particular treatment strategy.

Aim. To assess the cost of diagnosis and treatment of patients with spinal injury of the thoracic and / or lumbar spine in a multidisciplinary emergency hospital.

Materials and methods. The study was carried out in the Clinic of Emergency Neurosurgery of the N. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department during 2018–2021. A working group was formed from the doctors of the neurosurgical department. Further, a model of the therapeutic and diagnostic process was compiled with a reflection of all its characteristics: 1) compilation of a mo dified operogram, 2) transformation of the operogram into a technological map, 3) comparison of the obtained characteristics of the process of diagnosis and treatment of patients with spinal injury with actual data, correction.

Results. The operogram included 136 steps of the process from the moment of admission of a patient with spinal injury to the emergency department to the moment of discharge (surgery is the 77th step), and also reflected the interactions of 38 participants in the process and took into account the variety of possible methods and tactics of treatment, taking into account the average frequency of their use. Based on the developed process model, a technological map was prepared, which combined quantitative parameters for all key resource characteristics of the process.

Conclusions. Hospital costs for the treatment of a patient with isolated complicated spinal injury at the level of the thoracic and lumbar spine in a specialized hospital amount to 600,652.41 rubles. Out of the total amount of expenses, surgical intervention costs amount to 48.7 %.

Objectives. To evaluate the effects of laminectomy surgery on pain, functional disability, sensitization and active trigger points in subjects with lumbar disc herniation.

Methods. This study was a prospective pre‑post single group study. Seventy‑one patients (42 male and 29 female) have been enrolled in the research with an age range of 20–60 (48 ± 13.41). During 48 hours before surgery, patients were examined by a physiotherapist. Pain intensity were measured by visual analogue scale, disability by oswestry index (Persian version) and sensitivity level using pressure algometer. Three month after laminectomy, the patients were re‑examined for mentioned outcomes again.

Results. The majority of the patients (23 cases, 32.4 %) revealed 3 active trigger points of the muscles before surgery. 60 subjects (84.5 %) experienced a gradual onset of leg pain without a trauma history. Lumbar multifidus (74.9 %), medial gastrocnemius (73.2 %), soleus (70.4) gluteus medius (62 %) were the most involved muscles with trigger points before laminectomy. On the other hand, after laminectomy medial gastrocnemius (54.9 %), lateral gastrocnemius (53.5 %), soleus (50.7 %), multifidus (39.4 %) and quadratus lumborum (39.4 %) were the most involved muscles with trigger points. The existence of trigger points in longissimus thoracis (p = 0.04), quadratus lumborum (p = 0.001), gluteus maximus (p = 0.04) and tibialis anterior (p = 0.02) were decreased significantly after laminectomy. Pain, disability and pain pressure threshold revealed significant differences before and after surgery.

Discussion. The pattern of active trigger points of muscles was different before and after surgery. Multifidus and gastrocnemius were the most prevalent muscles with myofascial pain syndrome before and after surgery respectively.

Conclusion. The present study revealed that pain, disability, number and prevalence of trigger points decreased after lumbar laminectomy. Nevertheless, pressure pain threshold of trigger points increased after surgery. The pattern of active trigger points of muscles was different before and after surgery. Multifidus and gastrocnemius were the most prevalent muscles with myofascial pain syndrome before and after surgery respectively. In fact, current results showed that active trigger points should be considered before and after laminectomy surgery

Introduction. Doctors of various specialties face difficulties in diagnosing chronic subdural hematomas (CSDH) at different stages, usually due to the lack of an evident causal relationship between neurological manifestations of subdural hematoma and the head injury sustained several weeks or even months prior to the patient's examination. Clinically, CSDH can mimic multiple neurological disorders, and before the patient is referred to a neurosurgeon, they might be inspected by various specialists such as neurologists, physicians, traumatologists and even psychiatrists. As a results, the patient initially does not receive specialized treatment, which directly affects postoperative mortality and disabi lity in patients with this pathology.

Aim. In this paper we aim to describe a rare clinical case of atypical course of CSDH. A clinical case. A 54‑year‑old woman, after falling from a ladder about 2 m high, 1.5 months after the injury, developed depression of consciousness and tetraparesis up to 2–3 points according to the Medical research counsil Weakness scale. After examination, the patient was verified to have a chronic hemispheric subdural hematoma of large volume, transverse dislocation of the median structures of the brain by 16 mm. An injury to the cervical spine was ruled out. The patient was operated on, HSDG was removed from 2 milling holes, achieving complete washing of the hematoma and, subsequently, complete restoration of motor functions in the patient – 5 point by Glasgow outcome scale (5‑point Glasgow scale).

Discussion. This paper presents the results of treatment and observation of patients with atypical course of CSDH of traumatic origin. The main method of treatment is the surgical removal of chronic subdural hematoma by a minimally invasive method: the imposition of 2 trefination holes with removal by evacuation of CSDH.

Conclusion. The problem of early detection of chronic subdural hematomas is extremely relevant. Careful collection of anamnesis, the alertness of doctors of related specialties on this problem, the mandatory use of neuroimaging methods (computer and magnetic resonance imaging) will often help to correctly and timely diagnose, start treatment on time and increase the patient’s chance of recovery, even in cases of atypical course.

Background. The problem of concomitant pituitary adenomas and intracranial aneurysms is extensively covered in literature. According to various authors, the prevalence of such a combination of lesions is as high as 9 %, most commonly involving hormone‑producing pituitary adenomas and aneurysms of the anterior circulation, up to 69 % of which originate from the carotid artery.

Aim. To analyze and demonstrate the treatment of patients with developed internal carotid artery aneurysm (ICA) against the background of successful conservative therapy of prolactinoma. Materials and methods. In this article we review the literature and present two clinical cases of patients with development of internal carotid artery (ICA) aneurysms after successful conservative treatment of prolactinomas.

Results. In both of the described cases, ICA aneurysms with intrasellar extension developed after successful conservative treatment of large invasive prolactinomas. In both cases ICA occlusion were performed and in one of them extra‑intracranial bypass surgery was performed as well.

Conclusion. The presented clinical cases suggest potential direct destructive effect of tumor tissue on vessel walls. Currently, it seems reasonable to carry out computed tomography angiography in all patients with adenomas invading the cavernous sinus.

Introduction. Intracranial meningiomas are the most common primary central nervous system tumors and are mostly benign, arising from the meninges surrounding the brain, nerves, and vessels. An obstacle to the surgical resection of meningiomas is the risk of injury to the superior sagittal sinus and the resulting compromise to the integrity of the venous drainage. This article describes a circular multiple trepanation technique, which can be used to safely perform resection of extracranial and intracranial meningiomas, aiming to reach the largest possible tumor area, since patient prognosis is directly proportional to tumor resection.

Surgical technique. The first step is to make a horseshoe incision, then drill burr holes, forming a circumference around the bone meningioma. The next step is to connect the orifices, incising the dura mater affected by the tumor along the periphery of the extracranial meningioma. Subsequently, the bone and the dura mater are elevated. Thus, the bone and dural part are separated from the intradural part, which is, in turn, removed later. Results. The circular multiple trepanation technique was performed and a gross total resection of the extracranial and intracranial meningioma (Simpson grade I) was achieved. The postoperative period showed positive results, with an improvement in the patient’s eye disorder and interruption of generalized tonic‑clonic seizures.

Conclusion. The circular multiple trepanation approach for treating extracranial and intracranial meningiomas described in this note is performed safely and effectively, with good patient prognosis. Although it is a recognized option, it has been insufficiently described, and it is therefore important to expand the knowledge and proper use of this technique among neurosurgeons.

The last decade of the XXI century was marked by the active development and introduction into clinical practice of the technology of Enhanced recovery after surgery. It allows you to ensure a quick and high‑quality recovery after surgery, reduce the number of complications, reduce the time of hospitalization and medical costs without increasing repeated hospitalizations, postoperative morbidity and the need for observation in the intensive care unit, minimize differences in the provision of perioperative care in various medical institutions and improve the quality of medical care to the population.

Aim. To describe the history of development and current state of Enhanced recovery after surgery (ERAS or fast‑track), to present the ERAS Society protocol for spine surgery in adults and a consolidated protocol in children, and also have determined the results of the implementation of ERAS in various sections of spinal neurosurgery.

Aim. To improve awareness of existing treatment regimens of cerebral edema by dexamethasone among doctors of various specialties (neurosurgeons, neurologists, intensive care specialists, endocrinologists). Based on scientific literature data the authors presented detailed descriptions of previously used and relevant now treatment regimens of cerebral edema by glucocorticoids (dexamethasone in particular). The authors estimated various dexamethasone prescribing schedules (2–64 mg doses fractionally used per day and one‑time 20 mg dose) for glioma tumor patients for understanding the effectiveness of therapy. The authors analyzed the risks of possible therapy by‑effects and complications. The risks were divided into the following groups: early (carbohydrate metabolic disorders, psychoemotional symptoms, hypertension, weight gain), later (exogenous hypercorticism, lipid metabolic disorders, proximal myopathy, osteoporosis, gastric and duodenal ulcer disease, immunosuppressive conditions) and withdrawal syndrome (adrenal insufficiency). In conclusion, the authors noted the ways to possibly prevent and reduce the side effects.

Introduction. The effectiveness of the method of revascularization of the brain using extra‑intracranial bypass in chronic insufficiency of blood supply to the brain has been studied in several randomized multicenter studies. The analysis of available publications devoted to this technique for 10 years with acute strokes in the carotid basin and for 20 years with ischemic strokes in the vertebrobasilar basin was carried out.

Aim. To improve the results of treatment of ischemic strokes with the help of emergency extra‑intracranial low‑flow bypasses in the acute and acute period. In 12 publications over the past 10 years, selected from the PubMed search engine, 194 cases of the use of emergency extra‑intracranial microbypasses in the acute and acute period of ischemic stroke in the carotid basin were identified, 127 cases of emergency extra‑intracranial bypass were found in 6 articles during the last 20 years in the acute phase of vertebra‑basilar area stroke. Middle patient age in carotid group was 61.9 years, and 65 years in vertebral patient’s group. The male / female ratio was 3 / 1. The main indications for the bypass creation were: worsening of neurologic deficit from 4 and more according to the Stroke Severity Scale of the US National Institutes of Health, mini mal or not significant computed tomography (CT) or diffusion‑weighted magnetic resonance imaging (DW‑MRI) ischemia brain changes (not lower than 8 points on the scale of assessment of initial changes in the computed tomographic (CT) examination for stroke Alberta Stroke Program Early CT Score, ASPECTS), signs of significant brachiocephalic arteries atherosclerotic stenosis. In 83 carotid group cases perfusion‑diffusion mismatch was distinguished before bypass creation. In 111 carotid cases and in priority of vertebra‑basilar cases clinic‑diffusion mismatch was the only indication for emergency extra‑intracranial bypass creation. During the first 24 hours 65 % of carotid group bypass were performed, in other 35 % of cases bypasses were performed during 1 week after the stroke onset. There were 78 % of good results (<2 on the Rankin outcome scale, mRS) and 22 % of poor (mRS >2) in carotid stroke group. Mortality was 3 %. In vertebral group, coma was not contraindication for emergence extra‑intracranial bypass creation. In most cases, 70 % of bypass were performed between superficial temporal artery and superior cerebellar artery. Mortality in vertebral stroke group was 5 %, mostly because of somatic pathology worsening. Good results were achieved in76 % of cases.

Conclusion. In some cases of atherosclerotic carotid and vertebrobasilar ischemic stroke, results of recovery can be approved greatly with use of emergency low‑flow extra‑intracranial bypass, if intravenous thrombolysis and endovascular tromboextraction were failed.

Introduction. Brain tumors are a complex problem of modern neurosurgery. Meningiomas, mostly benign tumors, can become a problem when they are difficult to locate. The complexity is also caused by tumors affecting the sinuses of the brain. In this case, the surgeon faces a number of issues related to the diagnosis, preoperative planning and the choice of treatment tactics for these patients. The choice in favor of revascularization of the venous bed is also not always unambiguous due to the lack of clear indications and contraindications to this type of intervention. The purpose of the work was to analyze articles on the topic of surgical treatment of meningiomas of the brain venous system.

Conclusion. Based on the results of the work, a critical analysis of the cited literature is presented, showing the insufficient development of the problem of treating patients with such tumors at the moment. In further clinical studies, it is necessary to clarify both the technical aspects when removing these tumors, and to work more deeply on the indications and contraindications for surgery in the group of these patients.

Introduction. Since modern technologies have managed to bypass the bone barrier for ultrasound waves, the arsenal of neurosurgical instruments has been replenished with transcranial focused ultrasound (FUS). The combination of this method with magnetic resonance imaging (MRI) allows you to perform operations under the direct control of the location of the focus of destruction and the degree of its severity during the procedure.

Aim. To present a review of the literature on the modern application of the focused ultrasound under MRI control (MRgFUS) method in neurosurgery. Ultrasound has been used in medicine mainly for diagnostic purposes for decades. Modern technologies have led to the possibility of using ultrasound in neurosurgery for therapeutic purposes without open intervention. Today transcranial MRgFUS is an innovation in medicine, expanding the horizons of minimally invasive surgery. The conducted studies of the focused ultrasound method prove the effective treatment of tremor and a number of other pathologies, and many scientific projects represent promising areas.

Conclusion. The use of the MRgFUS method opens up broad prospects.

This article describes the treatise “De fractura calve” (“About skull fractures”) of the famous Italian Renaissance physician and anatomist Jacopo Berengario da Carpi, published in 1518. In this work, rightly considered a milestone in the history of neurosurgery and neurotraumatology, the author not only described the symptoms of head injuries, but also offered their classification, basics of differential diagnosis, surgical tactics, and the necessary instruments.