Background. Combined traumatic brain injury and spinal cord injury (TBI/SCI) is one of the most challenging cases in emergency neurosurgery. The severity of systemic injury, frequent extracranial lesions, impaired consciousness, and the necessity of stepwise treatment complicate timely diagnosis and worsen surgical outcomes.

Aim. To assess clinical features, diagnostic aspects, and surgical treatment outcomes in patients with combined TBI/SCI.

Materials and methods. A retrospective analysis of 1,772 patients with traumatic brain injury (TBI), spinal cord injury (SCI), and their combination (TBI/SCI) who were admitted and surgically treated between 2016 and 2022 at the Sklifosovsky Research Institute for Emergency Medicine, City Clinical Hospital No. 3 named after S.M. Kirov, and Alexander-Mariinsky Regional Clinical Hospital was performed. The study group included 63 patients with combined TBI/SCI, while the comparison groups were comprised of 1,519 patients with isolated TBI and 190 patients with isolated SCI. The mechanism of injury, time to admission and diagnosis, Injury Severity Score (ISS), Glasgow Coma Scale score, neurological deficit according to the American Spinal Injury Association (ASIA) scale, timing and extent of surgery, and treatment outcomes were evaluated. Statistical analysis included non-parametric tests, χ² and Fisher’s exact tests, and Spearman correlation analysis.

Results. Combined TBI/SCI was diagnosed in 3.6 % of patients and was associated with the highest injury severity, with median ISS of 34.0 [25; 40.5]. High-energy trauma mechanisms predominated, including road traffic accidents (46.0 %) and falls from height (44.4 %). This group was characterized by a high rate of multiple associated injuries (42.9 %), predominance of cervical spine fractures (33.3 %) and multilevel injuries (30.2 %), and impaired consciousness on admission in 69.8 % of cases. Severe spinal cord injury (ASIA A–B) was observed in 19.0 % of patients. Delayed verification of spinal injury for more than 6 hours occurred in 42.9 % of cases. The median time from admission to surgery was 72 [7; 312] hours, exceeding that in isolated TBI and isolated SCI. Early spinal surgery (≤24 h) was associated with a higher rate of neurological improvement on the ASIA scale than delayed surgery performed after 72 hours (21.4 % vs 6.5 %).

Conclusion. Combined TBI/SCI should be considered a distinct severe trauma type associated with high frequency of cervical and multilevel spinal injuries, impaired consciousness, and diagnostic delays. Improved outcomes require early whole-spine CT assessment in patients with decreased consciousness, multidisciplinary treatment strategy, and the earliest possible spinal decompression and stabilization once life-threatening conditions are under control. 

Background. Currently, there is no common algorithm for the surgical treatment of patients with nonspecific spondylitis and spondylodiscitis.

Aim. To evaluate the surgical treatment results in patients with nonspecific spondylitis and spondylodiscitis and to identify the risk factors for an unfavorable outcome at patients’ discharge.

Materials and methods. Our study included 80 patients operated on between February 1, 2018, and August 31, 2024, in the neurosurgical and purulent surgery departments of City Clinical Hospital No. 13 (now – V.P. Demikhov City Clinical Hospital) because of spondylodiscitis and spondylitis of various etiologies.

Results. The excellent results (patients are fully active – 80–100 points according to Karnofsky performance status (KPS) scale) were achieved in 38 (48 %) patients, moderate disability (patients are able to care for themselves – 50–70 points according to KPS scale) was observed in 21 (26 %) patients, and severe disability (patients are unable to care for themselves, requiring care – 10–40 points according to KPS scale) was observed in 12 (15 %) patients. Postoperative mortality was 11 % (9 patients). The significant correlation between treatment outcome and leukocyte and C-reactive protein levels was observed only before surgery and on the sixth postoperative day.

Conclusion. The significant risk factors influencing the treatment outcome in patients with nonspecific spondylitis and spondylodiscitis include the following: leukocyte level, C-reactive protein level before surgery and on the sixth postoperative day, primary spinal fixation (if indicated), and neurological deficit. 

Background. Tubular retractors are successfully used in brain surgery as an alternative to classical retraction methods. Modern tubular retractors reduce brain retraction injury while maintaining the surgeon's ability to perform bimanual surgery.

Aim. To analyze the results of surgical treatment of intracerebral mass lesions using the tubular retractor.

Material and methods. The study included 204 patients who underwent surgery for deep-seated brain tumors between 2015 and 2023 using tubular retractors. Patient demographics, pre- and post-operative clinical data, and neuroimaging data were reviewed. 

Results. Cerebral mass lesions were mainly, located intraventricularly (39 %), with a lower incidence in subcortical structures and the basal ganglia (20.5 %). Total resection was achieved in 81.9 % of cases. The median postoperative Karnofsky performance state was 80.

Conclusion. The use of neuroendoportal technologies in surgery for deep-seated intracerebral and intraventricular mass lesions can be recommended as an alternative to routine microsurgical approaches, allowing to protect the patient from additional brain trauma during the surgical approach as well as to reduce the operative time, and to eliminate the additional surgical complications. 

Background. Endoscopic endonasal surgery is currently the approach of choice for the resection of greater than 95 % of pituitary adenomas. In transnasal transsphenoidal surgery, one of the most common complications is nosocomial meningitis.

Aim. Аnalysis of the structure and causes of meningitis in patients after transnasal adenomyotomy.

Materials and methods. The study included 3497 patients with pituitary adenomas who underwent endoscopic transsphenoidal tumor resection. Surgical treatment of all patients was carried out at the N.N. Burdenko National Medical Research Center of Neurosurgery. Patients who were diagnosed with meningitis during the in-hospital the postoperative period were analyzed.

Results. Postoperative meningitis was diagnosed in 39 (1.12 %) patients. Among patients with meningitis, 6 (15 %) patients died. The causative pathogenic agent was identified in 20 (51 %) of 39 patients. Statistically significant risk factors for the development of postoperative meningitis in patients who underwent surgery included the usage of the lumbar drain, intra- and postoperative cerebrospinal fluid leakage, and the presence of mental disorders (dementia and psychosis). Among re-operated patients, meningitis was statistically more likely to occur in patients with intraoperative and postoperative cerebrospinal fluid leakage, as well as in patients older than 60 years old. A statistically significant relationship was observed between postoperative meningitis and death.

Conclusion. Nosocomial meningitis is one of the most serious and potentially fatal complications in transsphenoidal surgery. Intraand postoperative nasal cerebrospinal fluid, along with the presence of lumbar drainage, the duration of the operation of more than 2 hours remain the main factors affecting the incidence of meningitis. 

Background. In modern armed conflicts, gunshot wounds to the head remain a relevant problem. Gunshot midline traumatic brain injury (GMTBI) account for approximately 5 % of all traumatic brain injury (TBI) and characterized by high mortality.

Aim. To determine the anatomical and topographical features of GMTBI, evaluate surgical treatment outcomes, and develop optimal treatment strategy. 

Materials and methods. Single-center retrospective clinical case series was analyzed, including surgical treatment outcomes of 14 patients with GMTBI admitted to City Hospital No. 2, Belgorod, in 2024–2025. All patients underwent clinical and laboratory examinations as well as CT and CT angiography were performed.

Results. Six types of GMTBI were identified based on the location of the entry wound. All patients had fractures of the skull vault and base as well as contusion foci of the brain. Intracerebral hematomas were observed in 77 % of cases. Mortality was 7 %.

Conclusion. GMTBI are a complex group of injuries requiring specialized neurosurgical care. Modern technologies and the refine of surgical techniques can improve treatment outcomes. 

Background. Modern neuro-oncology requires morphological and molecular genetic verification of central nervous system tumors to determine the optimal treatment strategy. Despite the high information yield of neuroimaging methods, a definitive diagnosis in most cases can only be established based on histological tissue examination. Stereotactic biopsy (STB) is a minimally invasive method for obtaining diagnostic material; however, the problem of uninformative results remains clinically significant.

Aim. To assess the diagnostic effectiveness and identify the main causes of non-diagnostic results of STB in patients with brain tumors.

Materials and methods. A retrospective analysis of 172 STB performed at the National Medical Research Center of Neurosurgery named after Academician N.N. Burdenko in 2023–2024 was conducted. All patients underwent comprehensive neuroimaging (computed tomography and magnetic resonance imaging) as well as histological and molecular genetic examination of the biopsy specimens.

Results. The diagnostic yield of STB was 92.4 % (n = 159) and increased to 95.9 % (n = 165) after repeat histological review. The main cause of non-diagnostic biopsies (n = 7) was technical planning errors, primarily incorrect target selection. The presence of diagnostically significant tumor tissue at intraoperative (frozen-section) examination was statistically significantly associated with the final diagnostic yield of the procedure.

Conclusion. STB remains a highly effective and relatively safe method for obtaining diagnostic material in patients with brain tumors. In the era of modern neuro-oncology, it plays a key role in morphological and molecular verification, which determines treatment strategy. The implementation of intraoperative histological control and the standardization of STB protocols may further improve diagnostic accuracy and procedural reproducibility. 

Complications of hemorrhagic stroke of the brain in the form of suppuration of the putaminal hematoma on the left is a rare situation in neurosurgical practice. The article presents a clinical observation of surgical treatment of a patient with an abscess: pus-filled intracranial hematoma of the frontotemporal area. Microsurgical resection and drain of the abscess using neuronavigation, antibacterial therapy in accordance with the clinical guidelines and the drug’s sensitivity to the microflora allowed to achieve a good result, mobilize the patient early, and shorten the duration of medical and social rehabilitation. 

Endoscopic endonasal approach is an effective method for pituitary adenomas removing, including tumors with significant intracranial extension. However, with complex growth variants, it becomes impossible to use onle this approach. The modern development of endoscopic technologies in neurosurgery and achievements in neuroanesthesiology allow performing the simultaneous combined (transcranial-transnasal) interventions for pituitary adenomas with complex tumor extension.

This article presents a clinical case demonstrating the treatment of a patient with a hormone-active pituitary adenoma (somatotropinoma) characterized by expressed supra- and laterosellar growth patterns. The possibility of simultaneous removal of large pituitary adenomas using a combined one-stage (transcranial and transnasal approaches) intervention with a good outcome has been demonstrated. 

Objectives. To evaluate the evidence of timing of surgery in Brachial plexus injury and neurological outcome.

Data sources. The search included PubMed (until November 2022); Scopus (until March 2023); Central Cochrane Registry of Controlled Trials (The Cochrane Library) (until March 2023); MEDLINE (Ovid) until 2023; November EMBASE (Ovid); CINAHL (until March 2023). Study selection. All articles that reported assessment timing of surgery in Brachial Plexus Injury (BPI), poor neurological and functional outcome.

Data extraction. Study type, publication year, number of patients, level of lesion, preoperatory assessment, delayed of operation, operative management, follow up. We performed a meta-analysis for each variable which there was important data to estimate the importance of surgical time in the management of BPI.

Data synthesis. 21 studies were included in the studies, which included collected data on 878 patients from retrospective and prospective observational studies. The analysis combined odds ratios, showing an overall effect of 3.1 (95 % confidence intervals 2.2–4.3), indicating that early surgery significantly improves neurological outcomes. The low heterogeneity suggests overall consistency across studies. Although studies such as Goubier et al. (2011) and Socolovsky et al. (2011) showed stronger effects, the results indicate that surgery timing plays a crucial role in neurological recovery, with early interventions being more favorable.

Conclusion. There is a solid foundation to support that early surgical intervention in patients with brachial plexus lesions is a more beneficial treatment than late stage interventions. 

Chronic occlusion of the internal carotid artery may be a cause of hemodynamic ischemic stroke and may also manifest itself by progressive decline in cognitive function. Large multicenter studies have failed to demonstrate the benefits of surgical cerebral revascularization both in the prevention of ischemic stroke on the ipsilateral side and in the treatment of cognitive deficits. Reports in recent years indicate high efficacy and safety of double-barrel EC–IC bypass in the treatment of patients with chronic internal carotid artery occlusion; however, such publications are few and contain mostly single cases of treatment. The aim of this work is to analyze the available literature data on safety, efficacy and technique of performing cerebral revascularization by formation of a double-barrel EC–IC bypass. 

Dysresorptive hydrocephalus is one of the formidable complications that occur in the long-term period of non-traumatic subarachnoid hemorrhage due to rupture of an arterial aneurysms of the brain. The development of this complication significantly affects the functional outcomes in this category of patients. The review highlights the epidemiology, risk factors and current methods of preventing this complication, in particular, special attention is paid to the method of inthrathecal fibrinolysis, which, in combination with cerebrospinal fluid drainage can affect the incidence of dysresorptive hydrocephalus and secondary cerebral ischemia. 

Spider silk is an unusually strong, flexible, biocompatible natural biomaterial that is becoming attractive for scientific research with the possibility of translation into clinical practice. Female orb-weaving spiders of the genus Nephila clavipes produce up to seven different types of silk, using various silk glands and spinning organs located at the posterior end of the spider’s abdomen. The main proteins are the main ampulla spidroins MaSp1 and MaSp2, which can be used to create recombinant spider silk due to the limitation of web collection in vivo. The review highlights studies dedicated to the use of spider silk-based materials in the field of tissue engineering in vitro. In particular, data on the use of two-dimensional and three-dimensional models and scaffolds for tissue engineering with the possibility of using modern technologies such as bioprinting are summarized. 

Scientific interest in craniotomy arose only in the second half of the 19th century after a pre-Columbian trepanned skull brought from the expedition by E.D. Squier. The subsequent study of this find by the French surgeon P.P. Broca, taking into account his anthropological and medical knowledge, helped create an exciting atmosphere in which scientists reflected on what Neolithic and primitive people actually knew about the brain and surgery. V.A. Horsley postulated that trepanation originated as a way to treat pain and epilepsy caused by depressed cranial fractures. Like P.P. Brock before him, V.A. Horsley aroused scientific interest, prompting others in the late 1800s to research and write about ancient trepanations.