Objective. To estimate the timing of open open surgical treatment for patients with massive basal subarachnoid hemorrhage (SAH) (Fisher 3) because of cerebral aneurysms (CA) rupture. Material and methods. We analyzed the treatment outcomes at 101 patients with massive basal SAH (Fisher 3) because of CA rupture who admitted in hospital in compensate condition. The majority of patients suffered from developed severe angiospasm and decompensated cerebral ischemia. We operated 76 patients (1st group) in acute period of SAH (first 14 days), 23 patients (2d group) were treated until the regress of cerebral angiospasm. Results. CA were clipped at all patients in 1st group, among patients of 2d group 13 persons were operated on and 15 underwent repeated hemorrhage with lethality of 73%. The angiospasm incidence was 94% according to transcranial Doppler sonography (TCDS) with severe and critical angiospasm in 63% of clinical cases. The lethality in 1st group of patients was 41% comparing with 52% in 2d group (because of repeated ruptures and cerebral ischemia). Conclusion. The delay of operation on ruptured aneurysm at patients with massive basal SAH resulted in significant increase of unfavorable outcomes because of the high risk of repeated hemorrhage from aneurysm.

Objective: the usage of extracranial-intracranial (EC-IC) high-flow bypasses for treatment of patients with ischemic strokes because of unilateral or bilateral occlusion of internal carotid artery (ICA). Material and methods. We performed EC-IC high-flow bypass at 9 patients suffered from ischemic strokes because of ICA occlusion from 01.11.2012 till 30.06. The unilateral ICA occlusion combined with stenosis of contralateral ICA was revealed at 6 patients, bilateral ICA occlusion - 2 patients and 1 patient had occlusion of common carotid artery (CCA) and stenosis of contralateral ICA. Results. All patients suffered from maximum 3 episodes of ischemic stroke at the site of ICA occlusion. The computer tomography (CT) of brain revealed no severe cicatrical and atrophic changes. The bypass was performed between M2 segment of middle cerebral artery (MCA) and external carotid artery (ECA) or CCA. All operations were scheduled and performed by two surgical teams. The radial artery was used as autograft at 8 patients and femoral vein - at 1 patient. The patency of bypass was checked at all patients in postoperative period using Doppler ultrasound and duplex scanning of bypass. The bypass was patent at 5 patients and bypass thrombosis was determined at 4 patients. Conclusion. The usage of EC-IC high-flow bypass may be occurred the promising technique for cerebral hemodynamics improvement in case of ICA occlusion and requires further investigations.

Objective. To analyze the effectiveness of ventricular drainage at patients with massive cerebellar ischemic stroke complicated by development of acute occlusive hydrocephalus (AOH). Material and methods. We analyzed the results of examination and treatment of 10 patients with massive cerebellar ischemic stroke. All patients underwent the gradual depression of conscious level because of AOH development. All patients underwent ventricular drainage, among them 8 - external and 2 - ventriculoperitoneal shunt. Decompressive craniotomy of posterior cranial fossa was not performed at any patient. All patients had different level of conscious before operation - from deep stupor to deep coma. Results. The lethality was 40%. The gradual restoration of conscious level was seen at 8 patients during the following day after ventricular drainage, among them 2 patients died from extracranial complications. There was no restoration of conscious level after operation at 2 patients and they died from brain dislocation. Conclusion. The only ventricular drainage is enough for majority of patients with massive cerebellar ischemic stroke complicated with AOH. The decompressive craniotomy of posterior cranial fossa is indicative for patients with no improvement in neurological status during first 24 hours after ventricular drainage. The deep coma is not the contraindication for operation at such patients.

Objective: to examine the anatomical features of posterior cranial fossa which can pay a significant role in development of trigeminal neuralgia and its relapses after microvascular decompression . Material and methods: Our study includes 37 patients at the age from 22 till 83 years old and 10 healthy volunteers in control group. The anatomical parameters of trigeminal roots and pontomesencephalic cistern were assessed using the images obtained with the help of Т2 3D-CISS and FIESTA. Results: the measurement of cross-section area of pontomesencephalic cistern and intertrigeminal angle at patients were significantly differed while comparing with control group. The measurement of anteroposterior dimension of pontomesencephalic cistern and length of trigeminal root at the side of pain syndrome in case of trigeminal neuralgia were smaller comparing with “health” side. The small sizes and asymmetry of pontomesencephalic cistern as well as short intercisternal part of trigeminal root and huge intertrigeminal angle at the pathological side were revealed at patients with pain syndrome relapses. Conclusion: The following anatomical features as small sizes and asymmetry of pontomesencephalic cistern and short trigeminal root at the side of pain syndrome are the predisposing factors for development of trigeminal neuralgia and may be the prognostic factors for itsrelapses.

This article presents the analysis of cerebellar ischemic stroke (CIS) incidence, indications for surgical treatment of patients with such pathology and the estimation of disease prognosis depends on severity of CIS and its localization as well as discusses the types of surgical intervention and treatment outcomes according to surgical strategy.

Nowadays a growing number of women suffered from hydrocephalus and underwent shunt operations are achieved reproductive age. Pregnancy has a relatively high incidence of complications, such as shunt malfunction due to raised intraabdominal pressure caused by gravid uterus. This article discusses the effect of pregnancy on the ventriculoperitoneal shunt function as well as presents the main approaches to the treatment and obstetric strategy. The vaginal delivery with shorten second stage is recommended in case of proper shunt functioning. The caesarean section performed under general anesthesia is indicated for patients with shunt malfunction and intracranial hypertension. Magnetic resonance imaging is recommended as a safe and effective method for evaluating the ventricular dimensions and assessment of shunt function. The conservative treatment such as bed rest and pumping shunt can be apply in functional shunt occlusion. The shunt revision is required in case of ventricular enlargement. This shunt revision during first and second trimesters of pregnancy can be performed in such a way as in case with non-pregnant patients. During the third trimester, ventriculoatrial shunt or third ventriculostomy may be considered as an alternative method, thereby avoiding the risks of uterine trauma or induction of preterm labour.

This article describes the flexible endoscopy as the primary method for surgery of chronic subdural hematomas and symptomatic brain cysts. We performed the minimally invasive surgical treatment using flexible endoscope «Chip-on-tip» inserted via burr hole in all presented clinical cases. This article describes the equipment support of this method as well as the surgery technique with the usage of illustrations and clinical cases. We performed flexible endoscopy at patients with arachnoid cysts and chronic subdural hematomas, not requiring microsurgical treatment. The flexible intracranial endoscopy is effective and safe minimally invasive method, which may be widely used in neurosurgery.

This article discusses such complication of transnasal surgical treatment of pituitary adenomas as intraoperative bleeding from intercavernous sinuses. The MRI images of hypertrophic intercavernous sinuses (IS), technical features of surgery at such patients as well as methods of hemostasis and adenoma removal under conditions of bleeding are presented.

The knowing of skull base triangles topography is necessary for performing of transcavernous approaches to difficult accessible segments of internal carotid artery (ICA), to apex of basilar artery (BA), for removal of cavernous sinus tumors or skull base tumors with spreading into cavernous sinus as well as for proximal control and performing the intra-intracranial bypasses between loops and segment of ICA during revascularization surgery. The topography and anatomy of triangles of cavernous sinus roof (oculomotor triangle, carotid Umansky triangle, medial Hakuba triangle, clinoid Dolenc triangle) as well as the triangles of lateral cavernous sinus wall (Parkinson triangle and superior Fukushima triangle) are presented. The knowing of these triangles is necessary for performing the modern transcavernous approaches for clipping of basilar apex aneurysms and for transcavernous approaches to meningohypophyseal trunk for treatment of carotid-cavernous fistula.

This article presents the clinical case of chronic epidural hematoma with its transformation into epidural abscess at 29 years old male patient suffered from head injury 8 years before. The clinical signs of suppuration were obliterated for a long time and the disease manifested by fester spreading into soft tissue of the head. The successful surgical treatment was performed with 5-months follow-up.

This article presents the clinical case of subarchnoid hemorrhage and hematomyelia because of bleeding from spinal hemangioblastoma. The presented clinical case is of interest because of exclusive rarity of such clinical manifestation of spinal tumor.

Intermittent radiofrequency neurotomy (IRFN) of dorsal root ganglions (DRG) is a new minimally invasive method for pain syndrome treatment. The candidates for IRFN usage are the patients with strictly contraindications for routine surgical treatment because of severe somatic pathology or patients who rejected decompressive operation on spinal roots. The IRFN does not require general anesthesia and conducted under roentgenologic control. The presented clinical cases illustrate the results of IRFN at 8 patients operated on in our clinic during 2014. The usage of this new technique resulted in significant regress of pain syndrome at all operated patients.

This article presents the clinical case of bilateral and unilateral formation of cavities in vertebral bodies around the previously placed transpedicular screws because of osteoporosis that resulted in their failure and severe изнуряющим lumbar pain syndrome. The risk of open surgery at 78 years old female patient suffered from obesity and some somatic pathologies was extremely high that is why we successfully used the posterior percutaneous injection of bone cement into these cavities using robot-assisted technique, which allowed escaping open surgery and possible related complications.

This lecture discusses the main types of brain dislocation at patients with severe head injury (HI). The clinical and neurological signs, EEG data as well as expansiveness of pathomorphological changes in brain and treatment outcomes t patients with different stages of supratentorial variant of dislocation syndrome as the most often seen in case of severe HI are presented.