Objective: to estimate the surgical treatment strategy at patients with bilateral occlusive and stenotic diseases of brachiocephalic arteries because of atherosclerotic damage.

Objective: to create the patent prognostic scale of postoperative lethality at patients suffered from hypertensive intracerebral hemorrhages and to estimate the indications and the volume of surgical intervention depending on the risk degree based on developed prognostic scale. Material and methods: The retrospective analysis of postoperative lethality among 336 patients with hypertensive intracerebral hematomas treated at the base of neurosurgical department of Emergency Care Hospital in Ufa was conducted. The favorable outcome was observed at 187 patients (1st group) while 149 patients died in different postoperative periods (2d group). The analysis of surgical treatment outcomes was performed with the usage of patent scale developed at the base of using the principle of aggregate estimation (by the sum of gathered scores). The statistical examination was performed using Kul’ban method. The significance value compiled р< 0,001 and р< 0,0001. The follow-up postoperative period was 30 days. Results and discussion: The lethality rate was analyzed depending on the following parameters: age, the level of consciousness impairment, volume and localization of hemorrhage, presence of ventricular hemorrhage. The examination analysis of influence power of various parameters on the outcomes of intracranial hemorrhage revealed the following dependence: the most informative parameter was the level of consciousness with the gradual decreasing of informative value from the degree of ventricular hemorrhage, then - volume of hematoma; localization of hematoma and patient’s age. The average sum of scores in the group of survived patients was 6,45 scores comparing with 10,25 scores in the group of died patients. The lethality dynamics depending on the sum of gathered scores showed the directly proportional increase of unfavorable outcomes number with increase of estimated figures by our patent scale. We distinguished 4 degrees of surgical risk depending on the lethality rate. The relationships between every criteria group and type of operation was determined using the revelation of connection between simple comparison of scores increase and lethality rate. Conclusion: The data analysis based on patent prognostic scale of postoperative lethality allows determing the criteria for prognosis of surgical treatment outcomes. The assignment of the risk degrees based on the suggested scale will allow choosing the optimal type and volume of surgical interventions at patients with hypertension hemorrhages.

Objective. To optimize the decision algorithm of appropriate surgical approach based on topographical characteristics of approaches and features of lesions localization. Material and methods. The modeling of approaches to pterygopalatine fossa and infratemporal fossa were performed on 30 fresh specimens «head-neck». The craniometric measurements as well as examination of generally accepted and additional criteria were conducted for evaluation of surgical approaches. Results. The mathematic analysis of operative wound parameters was performed while modeling the examined surgical approaches. These examined surgical approaches were compared using the following parameters: depth of operative wound, angle of operative direction and area of operative intention. Conclusion. The transfacial approaches (in particular the group of translocation approaches) are the most usable in case of tumor localization predominantly in pterygopalatine fossa, parapharyngeal space and or with its expansion along the external surface of skull base with imperceptible intracranial growth. The craniobasal and combined approaches must be used in case of tumor localization in infratemporal fossa, while usage of only transzygomatic approach is suitable for intracranial tumor with just minor lateral extracranial expansion.

Objective: to improve the treatment outcomes at patients with degenerative-dystrophic spinal disease through the examination of the clinical features of discogenic referred pain syndromes caused by spondyloarthrosis or intervertebral discs pathology and to develop the methods for their differential diagnosis and multimodality treatment. Materials and methods: the step-by-step denervation of intervertebral discs and facet joints (FJs) on the cervical and lumbar levels was performed at 127 patients including in two main groups in order to differentiate the noncompressive signs because of spondyloarthrosis or intervertebral discs pathology. The visual analogous scale (VAS) and Macnab scale were used to evaluate the treatment outcomes. Results: The analysis of reproduced referred pain syndromes allowed including them into classification scheme and confirmed that referred pain syndromes were caused by pathologic impulses aroused from intervertebral discs and from FJs. The chemical denervation of facet joints eliminated referred pain syndromes associated with pathologic impulse radiated from facet joints, and denervation (dereception) of intervertebral discs eliminated discogenic referred pain syndromes. The follow-up examination in 6-12 months revealed the more excellent and good outcomes according to Macnab scale (81,5% and 76,2% for cervical and lumbar spine respectively) in the main group while comparing with the control group. Conclusion: The conduction of step-by-step denervation (dereception) of intervertebral discs and facet joints allows diagnosing all referred pain syndromes and achieving the good conservative treatment outcomes at patients with degenerative-dystrophic spinal disease.

Objective: to conduct the retrospective analysis of diagnostics and treatment outcomes at patients suffered from various types of vertebrogenic and vascular cervical myelopathy. Material and methods. We operated 404 patients with cervical myelopathy from 1993 till 2013. The neurological as well as neurophysiological, radiological and statistical methods of examination were used. The following types of operations were performed: decompressive and stabilization operations (250 patients), decompressive and plastic operations with autodermoplasty or functional disc prostheses (88 patients), laminoplasty at 28 patients with multilevel compression of spinal cord by osteochondral vertebral hyperplasia; stabilizing operations at 24 patients with forceps mechanism of dynamic compression of spinal cord as well as reconstructive operations of vertebral arteries (14 patients). Results. While analyzing the clinical signs and data of instrumental methods of examination the 3 types of cervical myelopathy were defined: 1) compressive myelopathy (69,3% of patients); 2) compressive-vascular myelopathy (21,8% of patients); 3) vascular myelopathy (8,9%). The spinal-cerebral vascular syndrome caused by compression or stenosis of vertebral arteries feeding the cervical enlargement was diagnosed at 36 (8,9%) patients. The excellent and good surgical treatment outcomes were reliably more often seen at patients with compressive myelopathy (34,2%) comparing with compressive-vascular myelopathy (9,4%) and vascular myelopathy (13,9%). It could be explained by development of irreversible spinal ischemic damages in the last two groups of patients.

The literature data concerning brain metastatic disease have been analyzed. The aim of this literature review is to determine the optimal surgical treatment strategy at patients with multiple brain metastases, because there are no standard treatment schemes for such patients nowadays.

The rupture of intracranial arteriovenous malformation (AVM) during pregnancy is a rare but dangerous event associated with a high perinatal mortality. This review discusses the influence of pregnancy on the AVM rupture as well as presents the main principles of treatment strategy for such pathology and the choice of anesthesia method and types of delivery. The AVM rupture during pregnancy requires immediate surgery in the most cases because of high risk of re-bleeding. The endovascular embolization followed by surgical excision of the AVM is the most effective treatment according to the available data in the literature. Concerning the unruptured AVMs revealed during pregnancy the conservative management of pregnancy is recommended to reduce the risk of intracerebral hemorrhage (arterial blood pressure control, treatment of preeclampsia).

This literature review analyzed the possibilities of ultrasound examination in spinal surgery particularly for navigation during spinal surgery as well as for intraoperative visualization and postoperative control.

The various types of complications at patients with spinal trauma are described. The data concerning etiology, pathogenesis, clinical signs of complications related to course of traumatic disease of spinal cord are presented. The pyoinflammatory and vascular complications in pre-and postoperative periods as well as the data concerning the features of microflora at patients with spinal trauma are listed. The periods of various complications development are presented in relation to severity of spinal cord trauma, presence of concomitant injury as well as to trauma periods and surgical treatment. The prevention measures for avoiding complications in pre-and postoperative periods are presented. The technical complications of operative interventions on vertebral column and spinal cord connected with surgical approaches, implants placement, performance of corporectome and/or laminectomy for all vertebral levels are described in details. The data concerning various delayed complications in postoperative period because of spondylodesis failure as well as fracture and dislocation of fixators are also described.

The rare clinical case of postoperative hyponatremia with henceforth development of diabetes insipidus followed by one-stage clipping of giant left ICA paraclinoid aneurysm and small aneurysm of right ICA bifurcation is presented. The differential diagnosis, treatment and surgical causes for such complication development are discussed.

Authors describe the clinical cases of patients operated on because of rare lumbar spine pathology (discal cysts). This article presents the experience of diagnostics and surgical treatment of 5 patients with discal cysts who were operated on at the base of neurological orthopedic department of Novosibirsk Scientific Research Institute of Traumatology and Orthopedics from 2009 till 2012. The average age was 38,2±12,9 years old (3 men, 2 women). All patients suffered from radicular pain syndrome resistant to conservative treatment and caused by discal cysts revealed by MRI. There were no relapses of pain syndrome during follow-up. The literature data describe only sporadic clinical cases concerning such pathology. The discussion about etiology and pathogenesis of discal cysts and analysis of various treatment methods based on literature data are presented in conclusion.

The clinical case of a rare localization of central nervous system tuberculoma appearing as mass lesion in pineal region is presented. The surgical treatment strategy is described taking into account the tuberculoma localization and its clinical onset.

This article presents the clinical case of successful surgical treatment of patient suffered from rare and complex cerebrovascular pathology - giant partially thrombosed ophthalmic aneurysm of left internal carotid artery, manifesting with dislocation syndrome and development of right-sided hemiparesis. The aneurysm dimensions were 49х52х49 mm (sagittal/vertical/axial) according to brain CT data, the midline shift was 17 mm to the right. The following operative treatment was performed: left-sided pterional craniotomy, performing of extracranial-to-intracranial low flow bypass between frontal branch of left superficial artery and cortical branch of left middle cerebral artery (STA-MCA bypass); the clipping of aneurismal neck, thrombectomy and resection of aneurismal sac. This presented clinical case demonstrates the defensibility of STA-MCA bypass in case of necessity of long temporary trepping while performing the reconstructive operations because of giant cerebral aneurysms.

This article summarizes our experience in usage of hyperbaric oxygenation (HBO) at patients with acute cerebral pathology received treatment in neurointensive care unit. The conducted analysis of HBO usage at 750 patients after surgical treatment because of cerebral aneurysms, hemorrhagic stroke, head injury and brain tumors showed the possibility and safety of HBO usage at such patients. The principally new strategy for HBO usage is demonstrated. Thus the effectiveness of HBO conduction at the most critically-ill patients requiring the breathing support is proven as well as the absence of angiospasm deterioration under condition of HBO is demonstrated and the activation of antioxidant body system after HBO sessions is confirmed. The technique of HBO conduction under conditions of artificial lung ventilation is developed. It was demonstrated that usage of HBO in complex treatment of patients with acute cerebral pathology promotes the faster recovery of vital functions as well as the prevention of intensive care unit complications and the acceleration of neurological deficit regress.