Objective: to optimize the surgical treatment strategy at patients with C2 odontoid process fractures in interim and delayed periods of trauma. Material and methods: We operated 12 patients (10 - men, 2 - women) with odontoid process fractures in interim and delayed periods of trauma from 03.05.2002 till 20.03.2011. The majority of patients (8 persons) were in active working age. According to Anderson and D’Alonzo classification (1974) 10 patients had type II of odontoid process fractures, 2 patients - type III. Results: Halo-immobilization for 1 month was performed on 37th day at one patient with type II of odontoid process fracture without dislocation. Halo-reposition with thoracocranial plaster bandage was performed at one female patient with type II of odontoid process fracture on 48th day after trauma. The posterior spondylodesis was done at 8 patients with Halo-correctable fractures, among them one patient required transoral decompression. The combined anterior-posterior surgical intervention was performed at 2 persons with Halo-noncorrectable fractures of odontoid persons. Conclusion: active surgical strategy at patients with fractures of odontoid process in interim and delayed period of trauma allows achieving the optimal clinical and orthopedic results.

Background and objective. Although surgery has traditionally been performed for patients with a single brain metastasis, an increasing number of patients with multiple brain metastases may also be treated surgically. The objective of the study was to analyse postoperative survival results and the clinical factors affecting them. Material and methods. The records of patients who underwent surgical resection of two or more lesions between January, 2005 and January, 2010 were retrospectively reviewed. Survival was calculated from the date of surgery to the last follow-up evaluation or death and different clinical factors were analyzed in regards to patient survival. Statistical analysis was performed using the SPSS and MedCalc for Windows software. Results. 36 patients underwent one or more craniotomies. Survival of entire group ranged from 16 days to 37,5 months (mean = 7,29 months). There were four death within 30 days. When divided into Radiation Therapy Group RPA classes, the survival rates were 11,75 , 8,58 and 5,31 month for Classes I, II and III, respectively. Regarding impact on survival statistically significant association with a favourable outcome was found for the following factors: number of brain metastases (2-3 vs. 4-6) p= 0,019 and radicality of metastases removal (all vs. partial) p= 0.018. Conclusions. Well-selected patients with multiple brain metastases appear to benefit from surgery.

Objective: to compare the therapeutic possibility of the posterior decompressive surgeries (microdiscectomy + stabilization) with disc hernial removal using the anterior retroperitoneal approach in patients with combination of inherent and obtaining lateral stenosis. Patients and methods. 82 patients with combined lateral stenosis were divided in two groups. At both groups we removed the herniated disc with stabilization using anterior and posterior approaches respectively. Results. Observed results were comparable at both groups. More excellent and good results were at the second group where the anterior approach was used. Index Oswestry at the remote period in these two groups made up 46±4,5; 42±5,8 respectively. Conclusion. The decompressive-stabilizing surgery with anterior interbody fusion is a pathogenetic and technically adequate treatment for combined lateral stenosis.

Objective: to improve the results of surgical treatment of patients with Trigeminal neuralgia (TN). Material and Methods: retrospective analysis of results of microvascular decompression (MVD) in 200 patients (comparison group) with classical TN varying in age from 30 to 84 years. In this group of patients the neurovascular conflict (NVC) was corrected using a coupling shaped polypropylene protector. In addition, it was studied the results of (MVD) in 33 patients (control group) with classical TN within age from 38 to 77 years, operated with considering potential factors that could cause a recurrence of TN. Correction of (NVC) in this group of patients was corrected using coupling shaped polypropylene protector, and if necessary with the use of few protectors (type garland), and a part of patients (NVC) was correctied with use of teflon gasket or the combination of coupling shaped polypropylene protector and teflon gasket. Results: studied catamnesis of operated patients (comparison group) showed recurrence of TN in 22 (11%) patients, 16 of them women. The time of occurrence of recurrence varied from a few months to 2 years. In the patients (control group) operated with considering potential factors for recurrence of TN it happened in only 1 patient. Conclusion: MVD is an effective method of surgical treatment for TN, which can completely relieve the patient from pain. The correct choice of patient category and the restoration of normal topography-anatomic relationship of the conflicting vessel and trigeminal nerve root is one of the most important highlights in preventing recurrence of TN.

The uncontrolled intracranial hypertension and acute dislocation syndrome are the leading causes for unfavorable outcomes at patients with severe head injury (HI). The routine decompressive craniotomy for reversal of brain stem compression is not enough in certain patients with intensive development of brain edema and rapidly growing dislocation syndrome accompanied by temporo-tentorial herniation. The partial or total resection of temporal lobe is the one of internal brain decompression methods which allows releasing the mediobasal parts of parahippocampal gyrus intercalated into tentorial incisure and favouring the prevention of repeated temporo-tentorial herniation whilst the intracranial hypertension is progressively increasing. This article presents the historical aspects and current literature review dedicated to usage of temporal lobe resection as a method of internal decompression at patients with severe HI complicated with development of acute dislocation syndrome.

We operated more than 100 patients with spinal diseases and spinal trauma using endoscopic technique at the base of neurosurgical department of Scientific Research Institute of Emergency Care named after N. V Sklifosovsky. Patients with spinal trauma had one- or two-staged endoscopic operations. The endoscopic anterior decompression of spinal cord combined with spondylodesis using bone autograft or cage with fixation by titanic plate was performed during one-staged endoscopic operation. The first stage while using the two-staged operations was the performance of posterior decompression and transpedicular spondylodesis with the following endoscopic ventral spondylodesis for consolidation of vertebral anterior column and performance of 360-degree fixation as the second stage of operation. The usage of endoscopic technique allowed decreasing the volume of intraoperative blood loss and time of operation as well as minimizing the duration of postoperative analgesia and achieving the good cosmetic effect.

The clipping and resection of giant fusiform aneurysms of M2-segment of middle cerebral artery is possible with the usage of additional intra-intracranial revascularization. This operative technique is useful if the performance of reconstructive operation or extra-intracranial bypass is not possible as well as in the case of necessity of ischemic complications prevention. The development of giant fusiform cerebral aneurysms at young patients is caused by defects of connective tissue in arterial walls instead of atherosclerotic changes at elderly patients.

The treatment of aneurysms of cavernous part of internal carotid artery (ICA) requires somewhat different strategy instead of supraclinoid aneurysms because of its topographical and anatomical features as well as clinical characteristics. This article presents the clinical case of successful treatment of giant aneurysm (GA) of left cavernous ICA by performance of extra-intracranial low-flow anastomosis with following extracranial ICA sacrifice because of endovascular treatment impossibility.

This article describes three clinical cases of relative unusual occurrence - subdural intra- or paracystic hemorrhage at patients with arachnoid cyst of middle cranial fossa. We examined 45 patients with arachnoid cyst of middle cranial fossa and noted such subdural intra- or paracystic hemorrhage only at 6,7% of cases. All patients were male and at relatively young age (10, 30 and 26 years old). The hemorrhage was fatal in one clinical case. The questions issued from presented clinical cases are still waiting for the answers. Some of them are the follows: 1) how asymptomatic may be some of these arachnoid cysts of middle cranial fossa?; 2) how can we «predict» the risk of hemorrhage?; 3) as far as how important to detect the source of hemorrhage and its characteristics. The detailed analysis of presented clinical cases allows extending our viewpoints about developmental mechanisms of such pathological conditions as well as about its complications and consequences.

This article presents the rare clinical case of 51 years old male patient with multiple cerebral aneurysms combined with fenestration of proximal segment of basilar artery. This patient underwent step-by-step surgical treatment with clipping of right supraclinoid aneurysm and aneurysm of proximal segment of basilar artery. The presented data of 3D-angiography allow clarifying the diagnosis. This clinical case is of concern due to rare vessel abnormality combined with multiple cerebral aneurysms and its diagnostics using the modern angiographic methods with 3D-reconstruction useful for planning of surgical treatment steps.

This article presents the continuation of lecture dedicated to radiological diagnostic methods of vertebral and spinal trauma and enlights the role of magnetic resonance imaging (MRI) and spinal sonography for diagnostics of vertebral and spinal trauma. The last one is recently used method, but it is already showed itself as the most informative in diagnostics of soft tissue pathologies and some radiolucent changes of vertebrae. This manuscript is aimed on neurosurgeons, neurologists and specialists in radiological diagnostics. We hope that in spite of rather brief descriptions of these methods MRI and spinal sonography will be more widely used in acute and delayed periods of vertebral and spinal trauma.