Introduction. Minimally invasive techniques in brain tumor surgery are the priority tasks for preserving the function of the structures of the central nervous system adjacent to tumors. The approaches through the natural arachnoid spaces avoiding additional trauma to the intact brain with dissection of the falx, can be an alternative to conventional direct approaches to the interhemispheric fissure tumors.

Results. This paper presents the results of surgical treatment of 18 patients with tumors of the interhemispheric fissure of various histological structures, which underwent removal of the lesions through the contralateral transfalx approach. Radicality was achieved in 100 %. there was no increase in neurological deficit in the postoperative period, and the regression of neurological symptoms was noted in 67 % of cases.

Conclusion. The contralateral transfalx approach can be recommended as an alternative option for the treatment of a number of patients with tumors of the interhemispheric fissure, as minimally invasive, less traumatic and effective.

Introduction. Idiopathic obstruction of the foramen of Monroe is an extremely rare pathology in adults and accounts for 1 % of all forms of occlusive hydrocephalus. The largest described series of patients with such pathology includes 4 adult patients. Four types of the foramen of Monro obstruction have been distinguished: type A – atresia, or stenosis, type B – morphological obstruction (membrane), type C – functional obstruction, type D – patent foramen. These patients usually undergo endoscopic or shunting surgery. Currently no algorithm exists for the treatment of such patients.

Materials and methods. From 2004 to 2019 year 251 adult patients with idiopathic hydrocephalus were treated at the N. N. Burdenko National Medical Research Center of Neurosurgery. Of these, 11 people (4.4 %) had signs of obstruction at the level of the foramen of Monro. The average age of the patients was 41.9 years (25–67 years). The condition was more prevalent among women (8 female, 3 male patients). The most common symptoms were headaches and nausea. None of the patients showed signs of intracranial hypertension upon examination of the fundus. Magnetic resonance imaging of the brain demonstrated expansion of one or both of the lateral ventricles, stenosis of foramina of Monro, or their occlusion by membranes.

Results. Patients were divided into 3 groups depending on the type of foramen of Monro obstruction. Type A obstruction was observed in 8 patients: in patients with unilateral obstruction (3 patients), only septostomy was performed, while among the patients with bilateral obstruction, 3 patients underwent septostomy followed by reconstruction and stenting of the right foramen of Monro (1 of these patients later required a shunting procedure), and in 2 patients, a shunting procedure was performed at initial presentation. Type B obstruction was observed in 2 patients: a patient with unilateral obstruction underwent septostomy and dissection of the membrane, and 1 patient with bilateral obstruction underwent septostomy, dissection of the membrane, and foraminal stenting. In a patient with type C obstruction, a septostomy and stenting of the right foramen of Monro were performed. Based on postoperative MRI data, the dimensions of the ventricles of the brain decreased or did not change. Most patients showed a complete regression of symptoms or their significant reduction, while one patient’s condition stabilized after surgery. There were no fatal outcomes or persistent complications. The follow-up period ranged from 4 to 60 months (29.4 months on average).

Conclusion. In cases of idiopathic obstruction of the foramen of Monro, endoscopic surgery can be used as the treatment of choice.

Introduction. Spinal cord injury is a debilitating traumatic event in central nervous system resulting in tissue destruction and severe neurological deficit development. Preclinical assessment of quantitative lesion area parameters (e. g. structure and volume) is critical for subsequent evaluation of neuroprotective and / or neuroregenerative therapy efficiency. Current methods for parameter calculation require manual limitation of the interested area (region of interest, RoI). This process is tedious and often not precise enough.

Study objective is to develop and implement software for automated assessment of volume and structure of posttraumatic spinal cord lesion using extra-high-field MRI 7.0 Tesla and to compare methods preciseness with the current manual techniques.

Study design. Ten rat models of acute severe spinal cord contusion injury were used including female Sprague–Dawley animals weighting 250–350 gr. MRI imaging was performed in 1 day postoperative and then 4 times with interval (1 week). Study was prospective open-label uncontrolled comparative.

Materials and methods. Standard spinal cord contusion injury model was used. Anesthetized animals underwent laminectomy at level Th9–Th10 vertebrae followed by “weight drop” injury technique application: 10 g weight with 2 mm pin diameter dropped from 25 mm height. Software was developed using Microsoft Visual Studio 2017 environment and programming language C#. Statistical analysis was performed using IBM SPSS Statistics 21.0 software.

Results. We developed and patented specialized software Spinal cavity Searcher realizing the algorithm of T2‑weighted images (T2‑WI) analysis based on image bynarization and Freeman chain code. This algorithm supports calculation of spinal cord posttraumatic lesion parameters in a half-automatic manner. Results of this algorithm application were comparable to results of manual calculation: no statistical difference were observed between two values.

Conclusion. Current method of spinal cord injury volume and structure quantitative assessment simplifies the calculation procedure due to automatization of RoI limitation comparing to manual technique. The level of preciseness is comparable in both methods.

Clinical relevance. The developed algorithm optimizes the process of non-invasive control of the performed treatment efficiency according to 7.0 Tesla MRI data.

The research has been based on surgical experience of multiple decades and on retrospect study of more that 4000 clinical cases, among them 3500 surgical invasion due to different types of traumas. Since it relies on the latter, it shows the evolution of our approaches towards severe cerebral cranial traumon includes different matters regarding diagnostics and surgical treatment with neuropathogenetic approach. We have shown the advantages of certain surgical procedures in cases of cerebral cranial trauma and also the way approaches were changing after introduction of high medical technology and taking into consideration bio mechanisms and pathological data.

Computer diagnostics changed several surgical procedures and opportunities. In cases of traumas impacted in immobilized condition method of choice used to be plastic craniotomy, when in cases of cerebral congestion would cause decompression, placing bone fragment under the skin. 902 surgeries were performed among 1990. In 894 cases surgeries were performed using plastic trepanation, 217 among them was performed with improved modified method. In cases of negligible brain congestion, bone fragment were left in its place without suture fixation and after the congestion resolution fragment would return to its anatomical location. In several times it would be ligated in two – three points.

This method was the most efficient in bifrontal low craniotomy. The need of removing bone fragment was observed in zero cases.

In cases of acceleration traumas, which is characterized by diffuse damage, multifocal hemorrhages and bruises, in 157 cases double decompression method was used, in some case with falcostomy, effective in 49 cases. Trafination and resection trepanation were removed from practice.

Trafination method was sometimes use in cases of chronic hematomas and acute hydromas. In Recurrent and chronic hydromas method was less effective, in such conditions plastic trepanation method was used in order to create extra space for fluid. In singular cases of collapsed brain and for resolving tunica arachnoidea broken surface, we used to infuse 25–35 ml oxygen or 20–25 ml distillate in spinal chord. This method was proved effective in 70 cases.

Therefore, taking into consideration patho-mechanisms and pathology data, using differential pathogenetic methods of surgical invasion and computer monitoring of post-operative period we managed to decrease mortality in severecerebro- cranial traumas to 29–30 % comparing to pre computer periods 36–38 %.

Study objective. To determine the role of transcranial duplex sonography measurements in prognosing the risk of adverse outcome in patients with nontraumatic subarachnoid haemorrhage.

Materials and Methods. In 2010–2020 413 patients admitted to N. V. Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare Department with aneurysmatic subarachnoid haemorrhage were enrolled into the study, including 201 males (48.7 %) and 212 females (51.3 %). Mean age was 51 ± 12 years. All patients were treated surgically (aneurysm clipping). Patients’ status on admission and before surgery was evaluated according to Hunt and Hess scoring system. Transcranial duplex sonography was conducted in all patients on admission, before surgical treatment and on a daily basis after aneurysm clipping (up to the 10th day after aneurysm rupture, 2,612 examinations in total). The degree of angiospasm in middle cerebral artery, Lindegaard ratio and the presence of diffuse angiospasm in all arteries of Willis circle were assessed according to a previously described classification system. Brain computed tomography scans were used to determine the extent of subarachnoid haemorrhage according to C. M. Fisher scale and volume of ischemic lesions in areas supplied by middle cerebral artery. Outcomes were rated according to Glasgow Outcome Scale. Study sample was divided into two groups according to outcome. Group 1: adverse outcome (Glasgow Outcome Scale 1–3). Group 2: favorable outcome (Glasgow Outcome Scale 4–5). Binary logistic regression was applied to reveal risk factors for adverse outcome. To define long-term treatment outcome 104 patients (68 females, 36 males) were examined using neurologic scoring systems: Modified Rankin Scale, Barthel Index, Mini-Mental State Exam, Hospital Anxiety and Depression Scale.

Results. Favorable outcome (group 2) was ascertained in 221 (53.5 %), unfavorable outcome (group 1) – in 192 (46.5 %) patients. The following independent risk factors for unfavorable outcome were detected: angiospasm in middle cerebral artery before surgery, severe angiospasm in middle cerebral artery and diffuse angiospasm. According to univariate analysis, daily increase in middle cerebral artery peak systolic velocity by 51.6 cm / s was associated with adverse outcome either. Binary logistic regression model was able to predict unfavorable outcome with sensitivity 88.5 %, specificity 76.0 %. Daily increase in middle cerebral artery peak systolic velocity by 58.7 cm / s was associated with Modified Rankin Scale increase by 1 point. Angiospasm proved to be strongly connected with cognitive and self-care ability impairment on follow-up.

Conclusion. Ultrasonic signs of angiospasm in patients with aneurysmatic subarachnoid haemorrhage are independent predictors of adverse outcome and long-term results worsening.

The study objective – to present a clinical case of axillary nerve neurolysis performed through arthroscopic transcapsular access.

Clinical case. Patient Ch., 38 years old, received a fracture of the head of the left humerus as a result of a fall 5 months ago. Immediately after the injury, symptoms of axillary nerve damage appeared. Conservative therapy was carried out without positive dynamics. According to ultrasound and electroneuromyography, signs of compression of the axillary nerve were noted without violating its anatomical integrity. The pathological substrate was located in the neck of the humerus, in the “blind” zone of the nerve. The situation was complicated by the progression of the phenomena of arthrosis of the joint with the formation of pain. Performed acroscopic transcapsular neurolysis of the axillary nerve with sanitation of the cavity of the shoulder joint. After 2 months, a visual increase in deltoid muscle volume and range of motion in the shoulder joint was noted.

Conclusion. Arthroscopic transcapsular axillary neurolysis is, from our point of view, a promising minimally invasive intervention with the ability to perform simultaneous surgery by a multidisciplinary team. It is necessary to compare the results of the operation with arthroscopic and open access.

Carotid cavernous fistula is commonly caused by head trauma. Carotid cavernous fistula may be associated with intracavernous aneurysm of internal carotid artery, but occurrence of aneurysm at other site is rare. Management becomes complicated when carotid cavernous fistula is associated with aneurysm. Carotid cavernous fistula and aneurysm are managed by endovascular coiling with or without stenting. The management is more complicated if aneurysm is in cervical internal carotid artery along with carotid cavernous fistula. The decision to first obliterate what varies according to patient and doctor. We are reporting one of the rarest case of post-traumatic cervical internal carotid artery pseudo-aneurysms with carotid cavernous fistula following blunt head-neck injury and evidence based management strategies in such cases.

Introduction. In recent years, Enhanced recovery after surgery (ERAS), or Fast-track, has been actively developed and introduced into clinical practice in many industry of surgery in Europe and the USA. However, the ERAS® Society has not yet approved a unified protocol in spinal neurosurgery, and most of the publications on the topic have appeared only in the last few years.

The purpose of the study is to present a systematic review of the literature to identify the key elements of the ERAS program and the effect of their use, as well as the impact on complications in the following areas of spinal neurosurgery: deformities, trauma, degenerative, infectious and oncology diseases.

Materials and methods. The authors analyzed and systematically reviewed all published literature on ERAS in spine and spinal cord surgery up to October 10, 2020 using the main databases of medical literature and search resources PubMed and eLibrary according to the PICOS inclusion and exclusion criteria, as well as the recommendations of the protocol for writing systematic reviews. and PRISMA meta-analyses.

Results. We analyzed 13 articles considering the use of ERAS technology in surgery for deformities (n = 3), degenerative (n = 8) and tumor (n = 2) lesions of the spine. The level of evidence of the study is 2a. The publications contain information on the treatment of 2,777 patients, whose average age was 50.5 years (from 14.0 to 72.4 years). The ERAS protocol has been implemented in clinics in the USA (46 %), China (30 %), France (8 %), Russia (8 %) and Great Britain (8 %). The average number of key elements of the ERAS program was 13.7 (range 5 to 24). The most popular are: preoperative patient counseling and education, minimally invasive surgery, multimodal analgesia, early mobilization and enteral loading, as well as active follow-up and care. The introduction of the ERAS protocol in spinal surgery made it possible, compared with the control group, to reduce the duration of hospitalization by 1.8 days (from 0.17 to 3.2 days), the cost of treatment by $ 1,443.75 (from 146 to $ 3,444), the severity of pain syndrome and the use of opioids in 38 % of cases, the consumption of antiemetics after surgery, as well as the time of surgery and blood loss at 29 minutes and 188 ml, respectively. For ERAS-groups, cardiovascular and respiratory complications are more typical, and for control groups – urinary, infectious, thromboembolic complications and liquorrhea. In general, there is a decrease in the total number of complications by 8.5 % (from 2.3 to 9.6 %).

Conclusions. Enhanced recovery after surgery is a promising technology for improving the quality of care for patients in spine surgery.

The purpose of the study – to present an analysis of clinical trials to study the clinical efficacy and safety of the technique of percutaneous laser decompression of intervertebral discs based on a review of Russian and foreign studies.

The review article presents modern literature data covering the issues of indications, contraindications, technique, efficacy and safety of percutaneous laser disc decompression in patients with degenerative disease of the lumbar intervertebral discs. The publication present modern data on the choice of the most rational tactics for surgical treatment of patients with this pathology. Relevant, unresolved issues are indicated, which dictates the need for large randomized placebo-controlled clinical trials, with the inclusion of the latter’s results in systematic reviews and meta-analyzes.

Introduction. The first surgical operations on the nervous system in Russia began to be carried out at the end of the 19th century. The first neurosurgical clinic in Soviet Russia was opened in Petrograd on the basis of the trauma institute in 1921. In the late 1920s the Department of Neurology and Neurosurgery began to function at the Faculty of Medicine of North Caucasian Medical State University in Rostov-on-Don. During the Great Patriotic War, neurosurgery took shape as an independent scientific and clinical discipline.

Aim – to present the biography of the famous Dagestan neurosurgeon, doctor of medical sciences, professor Rashidbek Umakhanovich Umakhanov (1925–2003).

Materials and methods. On the basis of archival materials from the funds of the State Archives of the Russian Federation, the Central State Archives of the Republic of Dagestan, the archive of the Dagestan State Medical University, which are for the first time introduced into scientific circulation, the main milestones in the life of R. U. Umakhanov and his multifaceted activities in Dagestan.

Results. During the period of active work of R. U. Umakhanov, the formation of the neurosurgical service of the republic, the beginning of the systematic teaching of the discipline at the Dagestan Medical University and the folding of the system of rendering neurosurgical care to patients took place. A special place is given to the role of R. U. Umakhanov in the development of the clinic of neurology and neurosurgery, the main directions of scientific research of the scientist are considered.

Conclusions. The neurosurgical service in Dagestan began to develop at a time when doctors did not have diagnostic methods that are considered commonplace today. А neurosurgeon was armed exclusively with his own knowledge and could rely only on professional instinct. And at the origins of the provision of specialized care was Rashidbek Umahanovich Umahanov was a man who embodied the faithful to the chosen path, the scientific vision and aspirations for the future.