Aim. To evaluate the efficiency of systemic (intravenous) application of cryopreserved human umbilical cord blood mononuclear cells (HUCBCs) in animal models of acute contusion spinal cord injury for the restoration of hind limb motor function and formation of posttraumatic cysts using clinically significant examination methods.

Materials and methods. Adult female Sprague–Dowley rats were used for the study. Severe acute contusion spinal cord injury model was performed using standard “weight‑drop” method. All samples of cryopreserved HUCBCs concentrate were prestored prior to infusion for 3 to 4 years at –196 °C. Hind limbs motor function was evaluated using open‑field technique and standard BBB testing system. Magnetic resonance scanning was performed using high‑field magnetic resonance CleanScan 7.0 T tomography (Bruker BioSpin, Germany).

Results. Intravenous infusions of HUCBCs were performed on Day 1 following acute severe spinal cord injury. Motor function assessment demonstrated significant (p <0.05) improvement of hind limbs motor function (up to 40–50 %) comparing to self‑healing outcomes. Moreover, by the Days 4 and 5 after severe spinal cord injury, the volume of posttraumatic cystic cavity decreases significantly (up to 40 %) (p <0.05).

Conclusion. The obtained results demonstrated that cryopreserved HUCBCs can be used as an effective source for cell therapy of acute contusion spinal cord injury.

Background. Meningiomas are the most common extracerebral intracranial neoplasms. Radicality of meningioma resection largely depends on its consistency, size, and closeness to important anatomical structures. Preoperative prognosis of meningioma density plays an important role in selection of surgical access and operative inventory, general radicality of tumor resection, and neurological outcome after surgery.

Aim. To determine predictors of intracranial meningioma consistency using magnetic resonance imaging and T1, T2‑mapping technique.

Materials and methods. The study included 96 patients with primary meningiomas who underwent surgery at the Federal Neurosurgical Center (Novosibirsk) between 2018 and 2021. Magnetic resonance images were analyzed using calculation of the ratio between signal intensity on T1‑weighted and T2‑weighted images with subsequent group and correlation statistical analysis for comparison of T1, T2‑mapping results with clinical, histological and intraoperative data.

Results. Statistically significant increase in the signal intensity and standard deviation from the mean intensity on T1, T2‑maps of psammomatous meningiomas compared to all other subtypes was observed. Additionally, positive correlation between signal intensity form meningiomas on T1, T2‑maps and intraoperative data on tumor consistency was found.

Conclusion. Images obtained using T, T2‑mapping technique are as informative as traditional T2‑weighted images for evaluation of intracranial meningioma consistency. Additionally, they allow to obtain absolute intensity values. Further prospective studies are necessary for confirmation of the obtained results.

Background. Currently, the “gold standard” of differential diagnosis of Cushing’s disease is inferior petrosal sinus sampling and measurement of the adenocorticotropic hormone (ACTH) level. The studied literature data indicate a wide variability in the sensitivity and specificity of inferior petrosal sinus sampling in the range of 85–100 and 67–100 %, respectively, which can lead to an erroneous diagnosis of the source of ACTH hyperproduction and, as a consequence, to incorrect and untimely treatment.

Aim.To improve the results of differential diagnosis of Cushing»s disease by using bilateral simultaneous sampling of the cavernous and inferior petrosal sinuses.

Materials and methods. Cohort single-center retro/prospective study of 70 patients with confirmed ACTH-dependent Cushing’s syndrome. For the purpose of differential diagnosis, a number of indicators were calculated: central-peripheral ratio, prolactin-normalized ACTH ratio, successful catheterization. Sampling results were evaluated in comparison with contrast-enhanced pituitary magnetic resonance imaging data and intraoperative data.

Results. The study of the central-peripheral ratio showed the need to assess it simultaneously at the level of the cavernous and inferior petrosal sinuses. This approach makes it possible to significantly increase the sensitivity and specificity of the applied gradient to 93.1 and 85.7 %, respectively. Prolactin-normalized ACTH ratio is a second line predictor in the differential diagnosis of Cushing’s disease with sensitivity and specificity reaching 94.7 and 28.6 %, respectively. The gradient of successful catheterization is a reflection of possible hemodynamic features of a particular sinus, does not serve as an indicator of the correct positioning of microcatheters in the vascular bed.

Conclusion. Bilateral simultaneous sampling of the cavernous and inferior petrosal sinuses is an effective method of differential diagnosis of Cushing’s disease and ectopic ACTH-dependent syndrome.

Background. The anterior interosseus nerve (AIN) syndrome is a rare pathology, with cause is discussed. The findings in isolated AIN patients are in the main trunk of median nerve. It is confirmed by neuroimaging data and intraoperative picture in the form of the construction of fascicles in the nerve.

Aim. To describe the clinical and instrumental characteristics of patients with isolated non-traumatic lesion of AIN.

Materials and methods. The clinical, electrophysiological and neuroimaging data of 7 patients with isolated nontraumatic lesion of AIN were retrospectively analyzed, three of whom underwent surgical treatment.

Results. All patients complained of neuropathic pain in the affected upper limb, with an average intensity of 8 points according to visual analog scale and a duration of 1.5 to 4 weeks. Weakness of the flexor pollicis longus from 1 to 3 points on the MRC (Medical Research Council Weakness) scale was observed in all cases, weakness of flexion of the distal phalanx of the index finger in 6 patients from 1 to 3 points, which indicated an isolated lesion of the anterior interosseous nerve.

Needle electromyogram revealed denervation in c in all cases, 5 patients – in the pronator teres.

The fascicular constriction from 1 or 2 sections of the median nerve were detected at the shoulder level on the affected side by ultrasound in 6 patients. An increase in the cross-sectional area of the median nerve at the shoulder level in 2 cases we observed, in one case the changes were o bilateral and asymmetric. In 2 cases, an increase in cross-sectional area of С₅ root was noted on the affected side by no more than 23 % of the normal value. A change in echogenicity and size decrease of the pronator quadratus, when compared with the opposite side, was noted in all cases.

Conclusion. Patients with isolated AIN syndrome needs intensive evaluation to identify the localization of the level of damage to the median nerve.

Background. In patients with skull bone tumors, it was demonstrated that not only the oncological but also the cosmetic result has a significant influence on the long-term outcome. The traditional approach to the surgical treatment of tumor lesions of the skull bones is removal of the tumor and intraoperative modeling an artificial bone flap without a template. Recently, the technology of simultaneous resection and computer-aided design/computer-aided manufacturing (CAD/CAM) cranioplasty has received more and more attention.

Aim. To compare the results of surgical treatment of patients with tumors of the cranial bones using the traditional approach (intraoperative formation of a plate to close the defect) and simultaneous resection followed by plastic surgery of the defect with a personalized implant made using preoperative virtual modeling.

Materials and methods. The study included 24 patients with tumors of the skull or meningiomas with extracranial growth. Depending on the surgical procedure, patients were divided into 2 groups: group 1 (n = 13) – the technology of simultaneous resection and CAD/CAM cranioplasty; group 2 (n = 11) – where surgery was performed using a traditional approach based on intraoperative modeling an artificial bone flap without a template.

Results. There were no statistically significant differences between groups in gender, age, time of surgery, blood loss, or time in hospital. The use of simultaneous resection and CAD/CAM cranioplasty did not demonstrate a statistically significant better result in terms of maintaining skull symmetry compared to the traditional approach. All patients had a good cosmetic result and there were no complications.

Conclusion. The technology of simultaneous resection and CAD/CAM cranioplasty is an effective method of treating patients with neoplasmas of the skull bones. Despite the absence of statistically significant differences in the results of treatment of cranial bone tumors between this method and the traditional approach based on intraoperative modeling an artificial bone flap without a template this method seems to be a more precise providing the best cosmetic effect in patients with lesion in fronto-orbital region.

Background. A vast ischemic lesion in cases of malignant middle cerebral artery infarction causes a massive edema of the affected cerebral hemisphere, which leads to development of the dislocation syndrome and, in most cases, death. Decompressive hemicraniectomy is a more effective method for treatment of malignant ischemic infarction, than conservative therapy.

Aim. Evaluation of the effectiveness of treatment of malignant middle cerebral artery infarction.

Materials and methods. Analysis was carried out of the case histories of 57 patients with malignant middle cerebral artery infarction, out of which number 64.9 % were women and 35.1 % were men. The patients’ ages varied from 49 to 90 years, with the average of 72.7 year. All patients were divided into two groups: Group 1 patients (n = 47, 82.5 %) received only conservative therapy, while Group 2 patients (n = 10, 17.5 %) were subjected to surgical treatment.

Results. The in-hospital stay of Group 1 patients varied from 2 to 73 days (the mean stay being 14.4 ± 1.8 days). Lethality in the conservative therapy patients was 46.8 % during the in-hospital stay varying from 2 to 21 days, with the average of 7.7 ± 1.7 days. Based on the postmortem examination, dislocation syndrome and its consequences were the cause of death in 90.9 % of the patients, who received in-hospital conservative therapy.

The in-hospital stay of Group 2 patients varied from 22 to 33 days, with the average of 19.6 ± 4.3 days. The postoperative mortality was 40 %. The postmortem examination showed that the cause of the deaths was exacerbation of the dislocation syndrome and its consequences.

Conclusion. Malignant ischemic syndrome in the territory supplied by the middle cerebral artery is the most severe form of ischemic infarction accompanied by constant disability of patients. Despite decompressive hemicraniectomy, lethality for the patients with malignant ischemic syndrome remains high, the principal cause being development of the dislocation syndrome.

The aim of the study is to present rare clinical cases of isolated cerebral varices, summarize scientific literature data on their diagnosis and treatment.

The article describes 2 clinical observations of isolated cerebral varix, presents a literature review of this topic, as well as treatment tactics for patients with this pathology.

In the first clinical observation, in a male 72‑year-old patient isolated cerebral varix was interpreted as distal saccular aneurysm of the right middle cerebral artery per computed angiography data. Surgical treatment was performed: from subtemporal approach in the area of the floor of the middle cranial fossa, cerebral varix, inflow and outflow veins were visualized. The inflow and outflow veins were clipped, aneurysm was resected and sent to histological examination. The patient was discharged on day 8 after surgery. Histological examination of the cerebral varix wall showed typical components for a venous wall, in particular, individual smooth muscle fibers, absence of elastic membrane.

In the second clinical observation, in a female 59‑year-old patient magnetic resonance (MR) imaging, MR angiography and MR venography in the projection of anterior basal parts of the left temporal area showed an aneurysmal malformation transitioning into the superficial middle cerebral vein. Taking into consideration venous pathogenesis of the vascular lesion, dynamic observation of the patient was chosen.

Isolated cerebral varix is a rare vascular pathology without a specific clinical and instrumental picture. To avoid erroneous diagnosis and determine further treatment tactics, additional examinations are recommended: MR imaging, MR angiography and MR venography.

Traumatic vertebral artery injury (TVAI) is a rare but severe pathology which can be associated both with penetrating injury of the neck and blunt or unclassified injury. Injury of the vertebral artery, especially due to gunshot or knife wounds, causes severe condition of the patients, development of a wide spectrum of complications including life-threatening, high rates of disabilities and mortality.

There is no consensus on the treatment tactics for this pathology. Open surgery as the first stage of surgical intervention can be used in a limited number of cases. X-ray endovascular techniques of TVAI treatment are considered to be preferable.

We present a clinical case of a 27‑year-old patient with TVAI caused by a penetrating gunshot wound of the neck and complicated by formation of a giant pseudoaneurysm of the V3 segment of the vertebral artery. Two-stage combination treatment of TVAI was performed using endovascular and open surgical techniques.

Descriptions of TVAI cases are rare, and further accumulation and analysis of corresponding data and proposals on treatment of the patients with TVAI will help to formulate precise algorithms of doctors’ actions and optimize treatment tactics.

Aim. To present a technique for continuous monitoring of corticospinal tract integrity using an electrode with a dynamic balloon, examine the advantages and disadvantages of the selected and alternative monitoring techniques.

Materials and methods. At the 1^st stage, an electrode combined with a dynamic balloon was prepared. At the 2^nd stage, continuous monitoring of the corticospinal tract using direct stimulation of the cortex using ballon grid during the main stage of cerebral surgery was performed. At the 3^rd stage, interpretation of the obtained neurophysiological responses was performed.

Results. The presented technique of continuous monitoring of the integrity of the corticospinal tract through direct cortical stimulation using the developed device prevents false response decreases which significantly helps with the interpretation of the obtained results and increases information value of the technique. The described technique is based on the presented clinical observations of intracerebral tumor resection, as well as microsurgical aneurysm clipping using the technique. During surgery, no false decrease of the neurophysiological signal amplitude was observed due to dynamic ballon inflation and maintenance of close contact between the electrode and the surface of the brain. A surgery performed using this technique allowed to achieve a favorable neurological outcome in a patient in the postoperative period.

Conclusion. The presented device allows to perform continuous neuromonitoring using direct cortical electrostimulation with a strip electrode at any level of brain retraction. The technique decreases the risk of primary and secondary injury of the corticospinal and corticobulbar tracts which increases safety of neurosurgical intervention and decreases risks of neurological complications.

Trauma of the spinal cord is a severe injury of the structure of the central nervous system leading to deep and enduring disability in most patients. Treatment and rehabilitation of such patients are associated with high costs to the state. Disability imposes even greater financial burden: loss of ability to work, expenses for financial assistance, yearly reha‑ bilitation, etc. Currently, methods of regenerative medicine are being actively developed and they are promising from the clinical point of view. However, effective treatment of spinal cord injury and recovery of even partial ability to work in patients should also have positive results from the financial standpoint. In 2018, we have completed the first part of a clinical trial confirming safety and high effectiveness of systemic use of umbilical-placental blood in the acute period of spinal cord injury. Based on the trial results, we have calculated potential financial benefit for the state from development of new methods of regenerative therapy for treatment of spinal cord injuries. In this article, we present financial and economic rationale for using such trials in current conditions.

Complications of operations are negative, but inevitable companions of surgery and determine dissatisfaction with the outcome of treatment for both the doctor and the patient. In this regard, the improvement of the results of surgical treatment is associated not only with the improvement of the technique and skill of the surgeon, but also with the prevention and control of complications. On this path, it is necessary to analyze complications from your own practice and share negative experiences in scientific publications, at conferences, in the educational process. Despite the significance of the problem, there is still no single approved definition of “complication of surgery” in the surgical literature, and experts’ opinions on this matter differ. It is quite difficult to analyze scientific publications on this topic when different indicators of the frequency and structure of complications can be determined by different understanding of the term “complication” by specialists. This review presents the main approaches to the definition of “complication of surgery”, as well as other definitions proposed by some authors (“consequence of surgery”, “undesirable perioperative events”). Based on the conducted review, a variant of the use of terms is proposed.

The article discusses the epidemiology, types and features of the pathogenesis of early complications of decompressive craniectomy in patients with severe traumatic brain injury.

To reduce patient’s discomfort during awake surgery convenient patient’s position on operation table is applied, comfort temperature and close contact to psychologist are supported. Anesthesiologic features of awake surgery include regional and conduction anesthesia of scalp nerves, light sedation, attentive control over air ways and dural infiltration with anesthetics. Keeping patient’s consciousness during surgical approach increases reliability of intraoperative tests but demands more thorough anesthesia and control over patient’s condition.

Neuromonitoring in awake patient increases extent of gliomas’ resection and decreases risk of permanent neurological disorders.

Risks of awake surgery are devided into respiratory, neurological, cardiological and psychological. Intraoperative seizures arise in 3–12 % of cases.

Most of the patients rate awake surgery positively and agree to repeated similar operations.

In 2022, 315 years have passed since the founding of N.N. Burdenko Main Military Clinical Hospital and 70 years of the formation of the Neurosurgical Department of the Hospital. The history of the hospital allows us to talk about the provision of neurosurgical care from the day of its foundation, which is confirmed by numerous documents and facts. The article presents the historical milestones in the development of neurosurgical care in the hospital for more than 300 years – from the Petrine era to the present. The main trends in the development of neurosurgical care at the present stage are outlined.