Aim. To evaluate experience of using endovascular techniques for treatment of patients with cerebral aneurysms (their efficacy and safety) at the Regional Vascular Center of Petrozavodsk.

Materials and methods. Results of treatment of patients who underwent surgery at the Neurosurgery Division of the Republican Hospital named after V.A. Baranov (Petrozavodsk) between May 2015 and December 31st 2022 were analyzed.

Results. Endovascular techniques were used in treatment of 131 patients, 141 surgeries were performed. The most common was endovascular occlusion of the aneurysm sac with coils – 110 (78 %) surgeries; additionally, assisting techniques were used in 21 (14.9 %) surgeries, flow-redirecting devices were installed in 7 (5 %) surgeries, in 3 (2.1 %) surgeries aneurysm occlusion was attempted. In the majority of cases complete occlusion of the aneurysm was achieved (class I per the Raymond–Roy Occlusion Classification (RROC)): 70.2 % of patients; subtotal occlusion (class II per RROC) was achieved in 25 (19.1 %) patients, partial (class III per RROC) in 11 (8.4 %). Intraoperative complications developed in 11.4 % of cases. Clinically good treatment outcome (score 4–5 per the Glasgow scale) was achieved in 102 (77.8 %) patients, unsatisfactory result (score 1 per the Glasgow scale) was observed in 20 (15.3 %) patients.

Conclusion. In patients with cerebral aneurysms who underwent surgery using endovascular techniques at the Regional Vascular Center of Petrozavodsk generally favorable clinical outcomes were achieved.

Aim. To determine major changes of postgraduate training in neurosurgery at Central Institute for Advanced Medical Training (CIAMT) from establishment of a Chair of Neurosurgery (1935) to evacuation from Moscow (October 15, 1941).

Materials and methods. Collection, generalization, and analysis of archival materials from the Russian State Archive of Scientific and Engineering Documentation, the archives of Russian Medical Academy of Continuous Professional Education and N.N. Burdenko National Research Center of Neurosurgery were carried out.

Results. CIAMT’s activity in training of neurosurgeons from 1935 to 1941 was analyzed. All events are viewed from the perspective of CIAMT formation as leading institution for postgraduate medical training in the Soviet Union, which is reflected annual reports, staff lists, protocols and transcripts of meetings, etc. The Chair of Neurosurgery of CIAMT was established in 1935. However, its activity began several years later, when first trainees specializing in neurosurgery emerged. The Chair worked in Moscow until October 15, 1941 when CIAMT was evacuated to Novosibirsk. The Chair was based at the Central Neurosurgery Institute. Staff members of Central Neurosurgery Institute were employed at the Chair on a part-time basis.

Conclusion. The Chair of Neurosurgery began functioning in 1937, when courses of specialization in neurosurgery (mainly for general surgeons) started. Wartime events forced to restructure the work of CIAMT for intensive training of specialists during short-term courses.

Background. The growth zone of tentorial and transverse sinus meningiomas (TTSM) are located on the wall of the transverse sinus and tentorium cerebelli, and tumors often extend into the lumen of the sinus, causing its complete or partial occlusion.

Aim. To evaluate the clinical manifestations, relationships with venous sinuses, and results of surgical treatment of TTSM.

Materials and methods. The study includes 46 patients with TTSM who underwent surgical treatment (7 men and 39 women aged 37 to 75 years old). In 35 cases a subtentorial approach was performed, and in 11 cases a supratentorial approach was used. In 16 cases, a paramedian suboccipital craniotomy was performed for medial tumor location, and a median suboccipital craniotomy was used in 7 cases. A retrosigmoid craniotomy was done in 13 cases for lateral tumor location, and an occipital craniotomy was performed in 9 patients for isolated supratentorial growth (5 cases) and for sub- and supratentorial growth (4 cases). In 1 case, a posterior temporal craniotomy was used for supra- and subtentorial tumor spread. Tentoriotomy was performed in 15 cases to resect the growth zone on the tentorium cerebelli.

Results. The average tumor size was 37.6 (11–79) mm, and occlusive hydrocephalus was detected in 5 patients. In 27 cases, the tumor extended subtentorially, in 7 cases – supratentorially, and in 12 cases – both supra- and subtentorially. The typical neurological manifestation was ataxic syndrome, observed in 36 cases. The cranial nerve involvement was noted in 4 cases, which were represented by impaired function of the V nerve (hypoesthesia) in 1 patient and dysfunction of the VIII nerve in 3 patients. Homonymous hemianopsia was observed in 1 patient, and decreased visual acuity was detected in 7 cases. Total resection, corresponding to the Simpson grade II, was performed in 42 patients, and in 4 cases the tumor was subtotally removed (the Simpson grade III). The onset or increase of ataxic disorders was detected in 6 patients, and 1 patient with pronounced supratentorial growth experienced transient homonymous hemianopsia, which regressed after 2–3 weeks. Two patients developed venous infarction of the cerebellar hemisphere.

Conclusion. The goal of surgical interventions for TTSM is maximal resection of tumor tissue while preserving venous outflow through the sinuses and collateral veins, which ensures the preservation of cerebral structures and minimizes the risk of neurological complications.

Background. The population characteristics of comorbidities in patients with subarachnoid hemorrhage (SAH) are insufficiently underlined in the literature.

Aim. To test the method of complex network analysis (NA) in studying sex differences in comorbidities among patients with SAH at the population level.

Materials and methods. CN analysis was conducted on a population-based «big data» sample, including 628,831 patients. Statistical networks of comorbidities were created for 873 patients with SAH caused by cerebral aneurysms rupture of various localizations. Comorbidities were defined as any additional diagnoses presenting in patients with a ruptured cerebral aneurysm both before and after the SAH event. At the final stage of the CN analysis, all associations of comorbidities with the index diagnosis and with each other were examined for statistical significance.

Results. The CN analysis revealed 336 statistically significant associations between diagnostic codes. The number of comorbidities in women was 1.7 times higher than in men. In cases of vertebrobasilar aneurysms, the difference reached 10 times. Arterial hypertension was statistically correlated with the development of SAH only in women.

Conclusion. The CN method is applicable for analyzing clinical data at the population level. The analysis revealed that women with SAH have a higher number of comorbidities, particularly in cases of vertebrobasilar aneurysms. Interpretation of the results should consider the limitations and advantages of the method.

Background. Treatment of patients with combined injury and unstable sacral fractures is a complex interdisciplinary problem due to high risks of mortality and neurological complications, and long rehabilitation. The study is important because of the absence of a consensus on the optimal time and technique of surgical stabilization, as well as on further treatment of patients with unstable sacral fractures.

Aim. To analyze results of treatment of patients with unstable sacral fractures (type С per the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification).

Materials and methods. The retrospective study included 67 patients aged 18 to 65 years with diagnosis of unstable sacral fracture (2014–2023). Depending on treatment tactics, 2 groups were identified: group 1 received surgical treatment (n = 54) with subgroup 1А undergoing sacroiliac fixation (n = 26), group 1B – triangular fixation (n = 25), group 1В – sacral canal decompression (n = 3); group 2 received conservative treatment (n = 13). Assessment of treatment efficacy included analysis of the following parameters: time to mobilization, complications, functional outcomes (Majeed scale), neurological status (Gibbons scale).

Results. Time to mobilization in the group 1 (surgical treatment) was 6.2 ± 3.8 days (subgroup 1А), in the group 2 (conservative treatment) – 31.4 ± 8.3 days (p <0.01). Complication rate in the conservative treatment group reached 100 %, with the most common complications being deep vein thrombosis (100 %), pneumonia (84.6 %), and bedsores (76.9 %). In the surgical treatment group, general complications were reported in 61.1 % of patients, and in the triangular fixation group complication rate was higher (60.0 %) than in the isolated sacroiliac fixation group (46.1 %). In the surgical treatment group, excellent and good functional results per the Majeed scale were observed in 84.0 % of patients, while in the conservative treatment group only in 46.2 % of patients.

Conclusion. The maximal efficacy in treatment of type C3 per AO classification complicated sacral fractures was achieved using triangular fixation technique which allowed to achieve the best neurological outcomes. For uncomplicated fractures, isolated sacroiliac fixation showed excellent results. Conservative treatment is associated with high risk of complications and is the last choice.

Pharmacoresistance (drug-resistance) occurs in 40 % of cases of structural epilepsy associated with cavernous malformations. The surgical strategy in the treatment of such patients aims, on one hand, to eliminate the epileptogenic focus and achieve seizure control; on the other hand, to remove the cavernoma and eliminate the risk of recurrent hemorrhage. The following surgical options are identified: 1) removal of only the cavernous malformation; 2) microsurgical removal of the cavernoma with a perifocal area of hemosiderin and a zone of gliosis; 3) stereotactic radiosurgery method. In cases of temporal cavernoma, anterior medial temporal lobectomy is highlighted as an additional method of surgical treatment. This localization requires a special approach to the choice of surgical strategy depending on the location of the cavernoma in relation to the structures of the hippocampal complex, the presence of secondary epileptogenic foci and the duration of epilepsy.

Aim of the work – to analyze the current data on the examined topic, aspects of surgical treatment of patients with structural focal epilepsy associated with cavernomas, using the example of three clinical cases.

Clinical examples are presented based on data from three patients operated on at the Federal Center of Brain Research and Neurotechnologies of the Federal Medical Biological Agency (FMBA) of Russia between 2022 and 2023. A literature review was conducted on treatment options for this category of patients. Articles were searched on the scientific platforms PubMed, Cochrane Library, eLIBRARY. RU, and the Journal of Neurosurgery, using the following search terms: cavernous malformation, structural epilepsy, temporal focal epilepsy.

Acoustic neuroma is a benign tumor of the shelf of vestibulocochlear nerve. More often, the disease is diagnosed on working age. Tumors are subject surgical treatment or stereotaxic radiosurgery both have approximately the same efficiency. Principal conditions for radiosurgery are absence of the cysts and brainstem compression, hydrocephalus and tonsils herniation. Hydrocephalus and tonsils herniation are subject to surgical treatment be shunt-surgery and decompression craniovertebral junction before radiological treatment. Combination small acoustic neuroma and non-tumor caused hydrocephalus is allowed to use mini-invasive surgery. The article presents successful endoscopic surgery of the patient with multiple cerebrospinal fluid obstruction before stereotaxic radiosurgery of acoustic neuroma.

Eosinophilic granuloma represents a subtype of histiocytosis, a benign tumor-like condition characterized by aberrant proliferation of antigenpresenting Langerhans cells derived from dendritic cells. This article presents a clinical case of a patient admitted with complaints of left upper eyelid edema and pain in the periorbital and temporal regions. Imaging studies revealed an intraosseous soft tissue lesion on the left side of the orbital roof. Surgical excision of the tumor was performed, and histological analysis of the biopsy specimen confirmed the diagnosis of eosinophilic granuloma.

The treatment of patients with multiple cerebral aneurysms in the acute period of subarachnoid hemorrhage may be associated with strategy difficulties, since it is not always obvious which of the aneurysms is responsible for intracranial hemorrhage. This aspect is of paramount importance, since it is the ruptured aneurysm should be first treated. The combination treatment of all multiple aneurysms during one surgical intervention using all possible facilities (microsurgery, endovascular surgey or hybrid technologies) is the ideal. However, in the acute period of hemorrhage, this is not always possible. Currently, the criteria for revealing the ruptured aneurysms among the multiple ones are well known and they are helpful in the most cases.

However the sequential rupture of two aneurysms is described in few papers, and it must be taken into account, even with a low probability. There are no more than a dozen such cases described in the literature.

This article demonstrates a clinical case of a 58 year old woman with subarachnoid-parenchymal hemorrhage, in whom, according to brain computed tomography and intraoperative situation, it is highly likely that two cerebral aneurysms rupture can be assumed.

Aim. To evaluate efficacy and clinical prospects of using transposition and rotation scalp flaps with a pedicle in regional neurosurgical practice for reconstruction of postoperative defects of the soft tissues of the skull roof.

Materials and methods. Results of surgical treatment of 4 patients with defects of the skin on the head of different etiology (after radiosurgery, of traumatic and postoperative origin) are presented. In 2 patients flap transposition technique was used, in 2 – flap rotation.

Results. In all of the presented clinical cases successful primary healing was achieved. Cosmetic results are satisfactory, the patients report significant improvement of psycho-emotional status and quality of life.

Conclusion. Techniques of transposition and rotation of skin flaps proved their efficacy and safety for reconstruction of small and intermediatesized defects of the soft tissues of the head. Recommendations on preoperative planning are presented.

The prevalence of pathological tortuosity of the internal carotid arteries (ICA) in the general population is 10–40 %. Currently, the effectiveness of surgical treatment of patients with pathological tortuosity of the ICA has been proven. When choosing a method of surgical treatment, the severity of deformation and the degree of elongation of the internal carotid artery is important. Of the methods proposed in practice for surgical treatment of pathological deformities of the ICA with pronounced deformities, the most optimal is the method of ICA redressation with transposition into the common carotid artery and replantation into a new orifice. The tortuosity index used and described in the literature characterizes the severity of tortuosity, but has no practical surgical significance.

A parameter is proposed for determining the degree of elongation of the extracranial part of the ICA, taking into account its practical significance in vascular surgery, the excess length of the ICA is determined to determine the degree of ICA redressation and the level of transposition into the common carotid artery at the preoperative stage. The term of the tortuosity Delta is proposed, defined by the formula: the actual length of the extracranial part of the ICA minus the direct length of the ICA. The presented clinical observation describes the method of measuring of tortuosity Delta and its practical significance in preoperative analysis in determining the optimal surgical method.

The prevalence of intracranial arterial aneurysms associated with мoyamoya angiopathy (AA-MMA) is five times higher than in the general population. The rupture risk of AA-MMA can reach 90 %. The application of standard surgical methods for aneurysm treatment without considering the features of мoyamoya angiopathy may lead to adverse consequences for patients. Therefore, the development of a surgical strategy algorithm for AA-MMA treatment is highly relevant.

The aim of this work is to analyze the experience of treating AA-MMA as presented in the global scientific literature, to evaluate the advantages and disadvantages of various treatment methods.

The paper also discusses key aspects, including current data on prevalence, etiopathogenetic theories of AA-MMA formation and classification. A search for scientific sources was conducted in journals reviewed by the Higher Attestation Commission and included in the international database Scopus, as well as in information systems and databases such as PubMed, Scopus, MEDLINE, Cochrane Library, and eLIBRARY.RU. Publications in both english and russian were included in the analysis. There was no limitation on the age of sources.

We proposed a surgical treatment algorithm for AA-MMA based on data from scientific literature. Additionally, the article presents an improved topographic classification according to the most common anatomical locations, taking into account the high predisposition to rupture. The surgical strategy algorithm presented in this study may serve as a guide for treating patients with AA-MMA.

Surgical treatment of tumors and micromalformations in the brainstem carries significant risks of aggravating neurological symptoms postsurgery. This is primarily due to the high concentration of critical nerve structures within the brainstem. To enhance safety during these procedures, intraoperative neurophysiological monitoring is employed. Currently, various neurophysiological modalities, including mapping techniques and continuous monitoring methods, are utilized in these neurosurgical interventions. In this review, we discuss the potential applications of intraoperative neurophysiological monitoring during brainstem surgeries, highlight the limitations of these methods, and explore the prospects for the development of intraoperative diagnostic techniques. This work may be useful for clinical neurophysiologists and neurosurgeons who perform surgical treatment of patients with tumors and micromalformations of the brainstem.

This paper explores the rapidly growing field of preventive neurosurgery, a promising area in modern clinical practice. With the help of advanced neuroimaging technologies, this approach is already widely used to treat cerebral aneurysms, arteriovenous malformations, and stenotic processes in major arteries supplying the brain, as well as in pediatric neuro-oncology. However, its application to tumors of the central nervous system in adults remains limited and less systematic. Drawing on the experience of the N. N. Burdenko National Medical Research Center for Neurosurgery, the paper examines key aspects of preventive neurosurgery, including ethical considerations, guidelines for decision-making, and criteria for when surgery is appropriate or not. A special focus is placed on the principle of «non nócere» (do no harm), particularly when dealing with individuals who are otherwise healthy. The authors highlight the urgent need to develop a robust framework for this field, encompassing its philosophy, methodology, and legal aspects, to address the unique challenges of preventive neurosurgery.

«If you treat not a disease, but a patient, you first need to reach an understanding with him», these words belong to the great clinician surgeon, neurosurgeon, a man who perfectly mastered the technique of the most complex operations, Professor Semyon Yulianovich Minkin. This is a truly brilliant man who was distinguished by unconditional love and conscientiousness in science, a sense of duty to the people who entrusted him with the most precious thing they have – life. One of the main directions of his practical and scientific activity was neurosurgery, but he, distinguished by his curiosity, did not ignore other areas of medicine. He has written more than 100 scientific papers, which have been and are currently universally recognized. Semyon Yulianovich Minkin was a participant in military operations on the Ukrainian and Leningrad fronts, had extensive practical experience in brain surgery, tried to bring any work to perfection. For twenty-three years he headed the Department of Hospital Surgery of the Perm Medical Institute. During this time, he has produced more than one generation of outstanding doctors and scientists, including Lyudmila Fedorovna Palatova, Yakov Kononovich Ass and others.