Objective: to develop the procedure of subacute and chronic intracerebral hematomas microsurgical removal using the burr hole approach. Material and methods: we analyzed the results of surgical treatment at 31 patients with hypertensive hemorrhages which underwent microsurgical removal of hematoma through the burr hole approach in period from 3 till 34 days after disease onset. The studied group included 20 men and 11 women at the age from 39 till 76 years old. 24 patients had putamen hematomas, 3 - thalamic, 2 - intracerebellar hemorrhage and 2 patients - subcortical hematoma. The volume of hematomas varied from 15 till 135 cm. Results: we developed the procedure of intracerebral hematomas microsurgical removal using the burr hole approach. The neurological deficit was fully recovered at 4 patients (13%) after operation, 8 (26%) patients remained moderate disabled, 17 (54,5%) had severe disability, and 2 patients (6,5%) died. Risk factors for unfavorable outcomes of surgical treatment at patients with hemorrhagic stroke are the follows: depression of consciousness and deep location of intracerebral hematoma. Conclusion: the microsurgical removal of intracerebral hematome via the burr hole approach is the effective minimally invasive method for the treatment of patients with hypertensive intracranial hemorrhages.

Objective. To conduct the comparative efficacy analysis of conservative and surgical treatment of patients with malignant course of massive ischemic stroke Material and methods. The analysis of examination and treatment results of 63 patients with malignant course of massive ischemic stroke was performed. All patients had midline shift more than 7 mm in first 48 hours from disease beginning. All patients were divided into two groups: 1st group - conservative treatment (42 patients) and 2d group - patients with decompressive craniotomy (12 patients - intracranial pressure (ICP) monitoring). Results. The lethality among patients of 1st group was 100% comparing with 48% among patients of 2d group (p<0,05). The 3 types of ICP hemodynamics at operated patients (with ICP monitoring) were determined: 1. Normal ICP without any requirements for correction - 1 type; 2. Progressive increase of ICP up to 20 mmHg and more, which is manageable by conservative therapy - 2 type; 3. Progressive increase of ICP up to 20 mmHg and more with development of refractory intracranial hypertension - 3 type. Conclusion. The surgical treatment (decompressive trepanation) at patients with malignant course of massive ischemic stroke with midline shift more than 7 mm during first 48 hours since disease beginning is accompanied by more than 2-fold lethality decrease. The ICP monitoring at such patients after decompressive craniotomy performing allows diagnosing intracranial hypertension and determing of its treatment strategy.

Objective: to study the treatment outcomes at patients underwent carotid endarterectomy (CEAE) because of minor stenosis of carotid arteries, performed in acute period of ischemic stroke. Material and methods. We performed reconstructive operations on carotid arteries at 158 patients within 1 year, among them 108 persons suffered from acute ischemic stroke and 15 patients had transitory ischaemic attacks. The neurological outcomes at 18 patients with symptomatic minor stenosis of carotid arteries (less than 60%) underwent CAEA in acute period (within 4 weeks after disease beginning) of ischemic stroke were analyzed. The neurological outcomes were estimated according to NIHSS, modified Rankin scale (mRs) and Rivermead scale. Among these 18 patient 12 (66,7%) were men, 6 (33,3%) - women, average age - 63,1±1,5 years old, the average percentage of ICA stenosis - 58,5%, mean Charlson comorbidity index - 3,5±1,3 scores. The duration of ward treatment - 23,4±5,1 days. All patients were divided into two groups depending on severity of neurological deficit: mild stroke - less than 4 scores by NIHHS (4 patients), moderate stroke - 4-8 scores by NIHHS (10 patients), severe stroke - 8-12 scores by NIHHS (4 patients). This paper discusses the time of CEAE performance after acute stroke. Results. The full recovery was seen at 8 (44,5%) patients during discharge from hospital, partial recovery - 6 (33,3%) patients, absence of dynamics in patient’s state or decrease of NIHSS by less than 4 scores - 4 (22,2%) patients. There were no complications of surgical treatment as well as lethal outcomes. Conclusion. The complex rehabilitation including early surgical treatment for brain reperfusion leads to significant regress of neurological deficit.

Objective: to estimate of frequency and severity of restenosis after «classical» carotid endarterectomy (CEE) depending on type of arteriotomy closure. Material and methods: we estimated the surgical treatment outcomes at 128 patients underwent «classical» CEE during period from 2 till 9 years, mean follow-up period was 4,2 years. The type of arteriotomy closure was chosen according to geometrical parameters of carotid artery bifurcation. The simple closure by running suture was performed at 70 patients (1st group), the closure with the usage of synthetical patch (polytetrafluorethylene, 0,6-0,8 mm thick) - 58 patients (2d group). Results: The thickness of intima-media complex because of intima hyperplasia at the area of operation was significantly greater at patients underwent plasty of carotid artery by synthetical patch whilst the diameter of artery lumen was significantly narrow at patients in 2d group comparing with 1st group. The volume of blood flow didn’t significantly differ in studied groups. The thrombosis of ICA was seen twice oftener among patients of 2d group comparing with 1st group during more than 5-years follow-up period (6,9% vs. 2,8%). Conclusion: the usage of primary artery suture doesn’t lead to increase of restenosis rate and stroke occurrence in postoperative period in case of ICA diameter more than 5 mm, whereas it allows avoiding the excessive enlargement of ICA ampulla and forming of mural thrombotic masses which may promote the development of restenosis. The usage of expanding patch is necessary if the ICA diameter is less than 5 mm. The UCA stenosis more than 90% or expansion of atherosclerosis plaque into ICA more than 1,5 cm are the unfavorable factors for restenosis occurrence.

Objective: to perform the morphological examination of arterial wall in case of pathological tortuosity of internal carotid artery (ICA) in order to chose the best way for its reconstruction. Material and methods: We examined and operated 146 (men:women=1:2) patients with pathological tortuosity of ICA at the age from 22 till 78 years old which underwent 164 reconstructive operations. All patients were divided into 5 groups depending on clinical signs of cerebro-vascular insufficiency (CVI) and types of tortuosity. There were 5 methods of ICA reconstruction. Results: The perioperative lethality was 1,8%. The complications of early postoperative period were the follows: transient ischaemic attack - 8 (4,9%) patients, thrombosis of restored ICA - 2 (1,2%) patients, trauma of peripheral nerves - 36 (22%) patients, hematomas of operative wound - 7 (0,6%) patients. The morphological examination of ICA walls fragment collected from areas of its kinking and its proximal part as well as fragment of common carotid artery (CCA) walls from area of ampulla, taken from cadavers. The severe degenerative and sclerotic changes in all layers of arterial wall were seen at the area of ICA tortuosity whereas the minimally expressed morphological changes were revealed at the areas of ICA and CCA orifices. Conclusion: The optimal method for IVA reconstruction in case of its pathological tortuosity according to morphological examinations data is редрессации without resection of artery redundancy. The localization of neoformed anastomosis is depend on the length of tortuos ICA redundancy.

Objective. To estimate the clinical outcomes of using the transcutaneous puncture facet joint plasty with endoprosthesis replacement of facet joints by prosthetics of joint synovial fluid ViscoPlus® at patients with lumbar spondyloarthrosis. Material and methods. The comparative analysis of 120 patients treatment (age from 24 till 68 years old, men - 44, women - 76) was conducted. There were 3 analyzed groups of patients: 1st group - conservative treatment (50 clinical cases), 2d group - underwent facet joint plasty (20 clinical cases), 3d group - combination of facet joint plasty and following conservative treatment (50 clinical cases). The endoprosthesis of joint synovial fluid ViscoPlus® was injected via transcutaneous puncture into cavities of facet joints for improving the lubricating and dampening characteristics of joints. Results. The efficacy of conservative treatment achieved 61,6% comparing with 78,2% in case of facet joint plasty. The efficacy of combined therapy (conservative treatment+ facet joint plasty) was the highest and amounted to 86,5%. Conclusion. The transcutaneous puncture facet joint plasty with endoprosthesis replacement of facet joints by prosthetics of joint synovial fluid ViscoPlus® is effective method for treatment of facet syndrome. The clinical effect is multiplying while adding the conservative treatment.

The main problems of cerebral angiopasm (CA) modeling because of non-traumatic subarachnoid hemorrhage at various biological animals (primates, dogs, rats) are presented. The main methods of CA modeling as well as features of its assessment in experiment and compatibility of experimental and clinical data are discussed. The potential opportunity for examination of various prophylaxis methods and CA treatment on certain biological models are considered. The special attention is paid for features of CA at «small» laboratory animals, rats in particular.

This article presents the analysis of literature data concerning surgical interventions because of symptomatic occlusion of internal carotid artery (ICA). The data of the most significant modern trials concerning examination of cerebral hemodynamics at such patients as well as the results of 3 randomized trials dedicated to efficacy estimation of low-flow extracranial-intracranial (EC-IC) bypasses are presented. The various types of operations performed in case of symptomatic ICA occlusion are described.

This article presents the possibilities and indications for usage of Ommaya reservoirs for treatment of cystic mass lesions of chiasmatic region.

This article describes our experience for usage of high-speed drill for bone cut. The suggested method may be recommended for performance of such complex trepanations as bifrontal approach or trepanation above dural venous sinuses as well as for drilling of bones with expressed thickness. The obtained results allow recommending this technique as safety method under condition of its maximally accurate usage.

The bilateral ventriculoperitoneal shunting should be done in some cases of non-operable tumors of chiasmatic region, occupying the III ventricle and causing the occlusion of both Monro foramens (craniopharyngiomas, gliomas, pituitary adenomas, meningiomas and others). The drainage of posterior horns of both lateral ventricles is seems to be the logic and correct solution to solve this problem. The main advantage of such operation is the possibility to perform the tumor removal in future via different approaches (pterional, subfrontal, transcallosal) because of absent of shunting system components in front of the coronal suture. The expectancy of correct placement of ventricular catheter into posterior horn of lateral ventricle varies from 42 till 89%. This article presents our first experience (5 clinical cases) of ventriculoperitoneal shunting with joining of posterior horns of lateral ventricles, during which the semi-sitting position of patient was used for facilitating the puncture of posterior horns of lateral ventricles. The authors haven’t found such operations in literature. This described semi-sitting position of patient facilitates the unmistakable placement of catheter into posterior horn of lateral ventricle and don’t embarrass the «peritoneal» step of operation.

Head injury (HI) is one of the most frequent types of damage and occupies the first place among morbidity and mortality causes at working-age population of developed countries. The well-time emergent diagnostics of brain injuries as well as selection of correct diagnostic methods which allows estimating the volume and severity of trauma as well as evaluating the severity of exposure to secondary brain damage factors are the courses for improving the quality of administered medical aid for patients with severe HI. The second part of this article presents the review of special methods of computer tomography and magnetic resonance imaging (CT and MRI), applied for HI diagnostics (CT-angiography, CT-perfusion and MRI-perfusion, diffusion-weighted MRI and diffusion-tensor MRI) as well as radionuclide methods (positron emission computer tomography and single-photon emission computed tomography (SPECT)). The diagnostic possibilities as well as advantages and disadvantages of each method are described.