Objective. To examine the individual anatomical variability of superior cerebellar artery (SCA) and its branches. Material and methods. The total amounts of 100 SCA were studied using 50 anatomical specimen of brain. The features of SCA localization in relation to brain stem, cerebral peduncle and cerebellar surfaces were examined. This anatomical study was conducted using step-by-step microdissection, microphotography, modeling of surgical approaches and morphometry. Results. The localization of orifice and anterior pontomesencephalic segment of SCA in relation to clinoid plate and free edge of tentorium cerebelli correlated with angular parameters of skull base is described. It is found that branching of SCA can be divided into 3 main types. The perforating branches arising from main, caudal and rostral trunks of SCA are also described. It is confirmed that petrosal surface of cerebellum is supplied by marginal branches arising from the main (II type) or caudal (I type) trunks or marginal branch is the lower trunk of doubled SCA. The topography of SCA in relation to V nerve is described. Conclusion. The position of proximal parts of SCA is correlated with cranial parameters. SCA contacts with V nerve in half of cases as well as proximal part of SCA forms the perforating vessels of interpeduncular fossa in one-third cases. The lower doubled SCA was the main source of perforating arteries for brain stem approximately in one forth cases. It is important to take into account these described topographic features of individual variability of SCA while choosing the surgical approach to basilar artery apex, tentorial incisura, V nerve, petroclival and pineal areas.

Objective: to estimate the effectiveness of translaminar approach for surgical treatment of III ventricle floor craniopharyngiomas at adults. Methods: We presented the treatment outcomes at 13 patients with III ventricle floor craniopharyngiomas who underwent surgical treatment with the usage of subfrontal-translaminar approach. Results: The subtotal removal of the tumor was performed at 7 (54%) patients whilst total tumor resection was done at 6 (46%) patients. All patients had diabetes insipidus in postoperative period. The functional state of patients at discharge estimated as 83 scores at average by Karnovsky scale (at admission - 74 scores). This increase was connected with improvement of vision and regress of hypertensive syndrome. Conclusion: the usage of subfrontal-translaminar approach allowed achieving good functional outcomes and high resection radicality of III ventricle floor craniopharyngiomas.

Objective: to present the functional results of stereotactic thermal destruction of basal nuclei with the usage of microelectrode analysis at such patients. Material and methods: We operated on 55 patients with lateralized forms of Parkinson’s disease at the base of в Novosibirsk Federal Neurosurgical Center within 8 months in 2013. We performed 26 ventral dorsal pallidotomies and 29 ventral intermediate thalamotomies. The sequential steps of intraoperative microelectrode registration of neuronal activity of basal nuclei and clinical testing are presented. Results: The usage of the mentioned method allowed significantly improving the life quality at patients with such pathology (PDQ-39 and UPDRS scales) by 73% in general. There were no lethal outcomes, 2 (3,6%) patients had perioperative complications: temporary dysarthria and hypertensive inctracerebral hemorrhage on the 2d day after thalamotomy. Conclusion: the usage of neurophysiological navigation system allows conducting stereotactic deconstructive operations more safely at the new submillimeter accuracy level as well as achieving maximal clinical effect and decreasing the risk of complications for each patient personally, whereas only anatomical orientation is possible during neurostimulation procedures.

Objective: the development of algorithm for choice of optimal mode for spinal cord electrostimulation in treatment of indoor patients with chronic pain syndrome after implantation of epidural electrodes in area of interest corresponding to spinal segments functionally determined the localization of pain sense. Material and methods: This algorithm was developed for test device of Medtronic, USA while performing neurostimulation with the usage of 4-contact cylinder epidural electrode implantation. The base of algorithm included the following parameters: controlled choice of active contacts polarity, patient’s position, fixed values of duration and pulse repetition frequency as well as values of current amplitude. Results: the modes choice for chronic spinal cord electrostimulation was performed at 30 patients with refractory pain syndrome taking into account the developed algorithm. The sequence of operations reflected in presented algorithm allows reducing time for choice of optimal combination of chronic stimulation factors and minimizing the level of medical error while spontaneous prescription of certain stimulation mode for certain patient as well as determing the patient’s possibilities for evaluation of dynamics of pain syndrome severity and henceforth for management of implanted generator of electric pulses during conduction of chronic stimulation. Conclusion: The algorithm for determination of optimal parameters for spinal cord electrostimulation in treatment of chronic pain syndrome standardizes the procedure of test process which allows determing the «problem areas» in each clinical case and repeating the operational sequence for choice of optimal stimulation mode if it is necessary. All these mentioned factors reduce the risk of useless (without adequate therapeutic effect) implantation of generator of electric pulses.

Objective. To estimate the outcomes of repeated transsphenoidal adenomectomy (RTA) at patients with relapse and persistent course of Itsenko-Kushing disease and to optimize the limits of surgical intervention at such patients. Material and methods. The analysis of RTA results at 50 patients (42 women and 8 men at the age from 16 till 64 years old) with confirmed Itsenko-Kushing disease was conducted. The mean time of RTA performance was 36 months. All patients underwent endoscopic surgery. Results. The remission after RTA was seen at 28 (56%) patients, among them 20 (69%) suffered from developing adrenocortical insufficiency, the recovery of hormonal state was revealed at 8 (31%). The hypercorticoidism remained at 22 (44%) patient. Follow-up after RTA was 6 months with following examination at 30 patients which revealed remaining hypercorticoidism at 14 (47%) persons, complete remission - at 14 (47%) patients and disease relapse - at 2 (6%) patients. Conclusion. The repeated transsphenoidal adenomectomy is relatively safe and effective treatment method at patients with relapse and residual course of Itsenko-Kushing disease while performed under conditions of specialized department. The clear predictors for persistence development or relapse of ACTH-dependent hypercorticoidism were not revealed. The limits of repeated neurosurgical intervention are necessary to determine on a case by case basis.

Objective. To study the main criteria of ultrasound semiotics of cubital tunnel syndrome as well as to determine the time periods for revealing the connections between quantitative indexes of nerve dimensions and electroneuromyographic conductibility measurements of motor and sensor fibers and to clarify the time points for ultrasound monitoring. Material and methods. The ultrasound and electromyographic examination of ulnar nerves at 117 patients with cubital tunnel syndrome was conducted. The analysis of correlation relationships with neurophysiological measurements is performed. Results. It has been established that transverse section area of the ulnar nerve is correlated with the values of residual latency. The main postoperative time-points of ultrasound monitoring is 1st and 4-6th months after neurolisys. Conclusion. The ultrasound method is necessary used both for diagnostics and screening at patients with revealed or suspected cubital tunnel syndrome.

This article presents the review of classifications which reflect the complex problems of craniofacial injuries including the fracture of frontal sinus, trauma of nasoethmoid complex and skull base. The most intriguing classification schemes схемы and their usage for determination of volume and methods of craniofacial trauma treatment are described.

This literature review is dedicated to biochemical markers nowadays used for diagnostics as well as for estimation of treatment effectiveness and outcomes prognosis at patients with head injury (HI). The main current requirements for biochemical markers are presented. The advantages, disadvantages and application field of the most examined and clinically used biochemical markers of HI (S-100β protein, neuron-specific enolase, glial fibrillary acid protein, С-tau protein, degradation products of spectrin and markers for apaptosis - caspase-3, Fas protein and bcl-2 proteins) are described in details.

This literature review enlights the necessity and the possibility of early diagnosis of aortic aneurysms as well as peripheral arterial aneurysms at patients suffered from cerebral aneurysms. The high risk of cerebral, aortic and peripheral arterial aneurysms rupture with unfavorable outcomes argues for surgical treatment of patients with such aneurysms before their rupture. The role of connective tissue dysplasia for development of cerebral aneurysms, aortic aneurysms and peripheral arterial aneurysms as well as for pathological tortuosity of internal carotid artery is also presented. The necessity of brachiocephalic arteries examination at patients with intracranial aneurysms in all age groups is shown. This article detaches the high-risk patients with cerebral aneurysms which require the examination to reveal or exclude the aortic aneurysms and peripheral arterial aneurysms for surgical strategy planning judging from life-threatening rupture of aneurysm of any localization.

This literature review discusses the technical features of conduction of digital subtraction angiography (DSA) and computed tomography angiography (CTA) of intracranial arteries at patients with cerebral aneurysms. The effectiveness measures as well as advantages and disadvantages of various methods for both aneurysms detection as screening and in acute period of intracranial hemorrhage are also compared. This article suggests the optimal combination of X-ray examination methods for evaluation of postoperative complications to start with cerebral angiospam at patients with non-traumatic subarachnoid hemorrhage.

This article presents the surgical technique of low-flow extracranial-intracranial (EC-IC) bypass performance between superficial temporal artery (STA) and middle cerebral artery (MCA) with the usage of frameless neuronavigation system. The steps of neurovisualization preoperative data (CT, CTA) uploading into software of neuronavigation system as well as sequence of artery-donor and artery-recipient modeling and the choice of the most optimal trepanation projection for bypass performance are described.

Objective: to determine the optimal method for treatment of cerebral arachnoid cysts at children. Material and methods: This study includes 19 children at the age from 2 months till 12 years old, treated at the base of Federal Neurosurgical center in Novosibirsk (Russian Federation) within period from December 2012 till August 2013. The microsurgical cyst fenestration was chosen as primary treatment method at 5 children. Two patients underwent cystoperitoneal shunting. The endoscopic cyst fenestration was performed at 12 patients. The endoscopic treatment methods were prioritized however the microsurgical surgery was done in several cases under conditions of impossibility of safe endoscopic cyst fenestration. Results: The positive result was achieved in all cases with regress of neurological deficit in several weeks and decreased or disappearance of seizures. Postoperative brain MRI revealed the decrease of cyst dimensions at 14 (73,7%) patients. The small subdural hydroma with no indications for surgical removal was seen at one child. One patient underwent ventriculoperitoneal shunting in 2 months after microsurgical fenestration of posterior cranial fossa cyst because of hydrocephalus advance. Conclusion: The short-term results of conducted treatment allow insisting that appropriate cyst fenestration permits to avoid the implantation of ventriculoperitoneal shunt with its possible complications.

Head injury (HI) is one of the most often occurred type of damage and takes the first place among lethality and invalidization causes of working-age population of developed countries. The well-timed emergent diagnostics of brain injury and selection of optimal diagnostic method, which allows evaluating the volume, severity and exposure degree of secondary factors for brain damage, is one of the ways for quality improvement of administered medical care for patients with severe HI. The first part presents the review of routine neurovisualization methods using for HI diagnostics - computer tomography (CT) and magnetic resonance imaging (MRI). The diagnostic features are specified as well as the advantages and disadvantages of each method are clarified.