Objective: to study the changes of blood streams and main hemodynamic parameters with the help of mathematical modeling of blood flow through cerebral arteries and in cerebral aneurysm when the vessel lumen is constant and in the case of various variants of angiospasm. Material and methods: the computer design method was used in our study to determine the changes of hemodynamic parameters in aneurysm, occurring because of angiospasm of afferent vessels by the example of the model of cerebral aneurysm created with the usage of computer design as well as by the example of 2 models of basilar aneurysm and anterior communicating aneurysm based on the data of computed tomography angiography. We examined the influence of changed blood flow velocity and shaped of blood flow profiles on to shear stress especially under conditions of blood flow changes because of various variants of afferent vessels angiospasm. Results: the analysis of hemodynamic characteristics of aneurysm models under condition of various variants of angiospasm revealed that the narrowing of the lumen of afferent vessel leads to significantly increase of the blood flow velocity both in the spastic area and in aneurysm itself, the profile of blood flow is significantly changed especially in the case of consequential spastic areas of afferent vessel or aneurysm localization at the junction of several vessels. The shear stress is increased at the area of shock blood wave hit in aneurysm that leads to increase the risk of repeated aneurysm rupture. Conclusion: the mathematical modeling allows assaying, understanding and visual presenting the processes occurring during blood flow through the vessels and in aneurysm as well as their changes because of angiospasm. The creating of mathematical models of hemodynamic changes under condition of angiospasm will allow understanding and predicting the character of complications which can be occur in acute period of hemorrhage (e.g. repeated rupture of aneurysm), that is of great importance for selection of surgical strategy.

Objective. To reveal the prognostic significant factors, influencing on selection of radiotherapy strategy for treatment of high-grade gliomas. Material and methods. We treated 475 patients with confirmed high-grade gliomas (grade 3-4) in our Russian Scientific Center of Roentgenoradiology (RSCRR) from 01.01.2005 till 31.12.2012. The grade 3 gliomas were diagnosed at 130 (27,4%) patients, grade 4 gliomas - at 345 (72,6%) patients. The main criteria for development of specific treatment program were pathology report data, functional condition of patients (Karnofsky index) and patient’s age - those factors in the base of RPA model and it modified adapted analog developed in Russian Scientific Center of Roentgenoradiology (RSCRR model). Results. The usage of ordinary fractionation mode was the most effective in the group of patients with I-IV grade levels based on modified RSCRR model, while the usage of moderate fractionation mode (3 Gy) is possible at patients of V grade level. The radiotherapy at patients of V grade level according RSCRR model must be conducted within 4-6 weeks after surgical removal of tumor. The radical total boost dose directly influences on patients’ overall survival according to our investigations. The combined chemoradiation therapy in this group of patients doesn’t improve this effectiveness measure of specific treatment. Conclusion. The more accurate criteria for selection of optimal modes of radiation dose fractionation will be defined taking into account the further development and improvement of methodological aspects in realization of radiotherapy for high-grade gliomas treatment.

Objective: to analyze the results of multidisciplinary treatment of patients with combined injuries of nasoethmoid complex. Material and methods. The retrospective analysis of data 527 patients with combined injuries of nasoethmoid complex treated from 1998 till 2012 years in the center for combined craniofacial trauma in Alexandrovsky hospital in Saint-Petersburg was conducted. Results: The correlation between the number of complications as well as trauma sequellae and severity of trauma as well as time of operative treatment was revealed. Conclusion: The early multidisciplinary surgical treatment and complete reconstruction of combined injuries of facial central parts allow restoring the pre-trauma facial forms and improving the social rehabilitation of patients.

Objective. To reveal the correlation between the cerebral oxygenation level and the values of cerebral perfusion at patients with head injury (HI). Material and methods. The perfusion computer tomography (CT) of brain and simultaneous registration of SctO2 level using cerebral near-infrared oxymeter were performed at 20 patients suffered from HI. The average age was 34,5±15,6 years old (from 15 till 65 years old). There were 9 men and 11 women. Results. The severity of patients’ state according to ISS (Injury Severity Score) scale was 54,7±14,6 scores (from 25 till 81 scores). The level of consciousness according to GCS (Glasgow Coma Score) was 10,4±2,5 scores (from 5 till 13 scores) at the beginning of trial. The mean value of SctO2 was 63±8,2% (from 53 till 87%). The mean value of CBV was 2,1±0,67 ml/100 g (min - 1,1; max - 4,3 ml/100 g). The mean value of CBF was 31,99±13,6 ml/100 g х min (from 11,6 till 80,8 ml/100 g х min). The mean value of MTT was 5,7±4,5 sec (min - 2,8; max - 34,3 sec). The mean value of TTP was 22,2±3,1 sec. Conclusion. The level of cerebral oxygenation at patients with HI is definitely correlated to the values of cerebral blood volume (CBV) (p<0,000001). There was no significant correlation between the oxygenation level of brain tissue and other measures of cerebral perfusion.

Objective: to compare the surgical effectiveness of ventral and dorsal decompressive-stabilizing operations for treatment of lumbar radicular compressive syndrome because of combination of spondylarthrosis and diskal hernia. Material and methods. We performed 170 decompressive-stabilizing operations on lumbar spine in Kemerovo Regional Clinical Hospital (Kemerovo, RF) from September 2008 till March 2012. All patients were divided into two groups: the first group included 83 patients underwent dorsal approach for diskal hernia removal with following stabilization of vertebral movement segment with the usage of transpedicular fixation and interbody cages; the second group consists of 87 patients underwent decompression and vertebral stabilization via ventral (anterolateral retroperitoneal) approach with the usage of implants from porous titanium nickelide (Ni-Ti). Results. The good and excellent treatment outcomes were comparable in both groups. We analyzed the treatment outcomes at 51 (61,4%) patients in the first group and at 69 (83,1%) patients in the second group. The good and excellent treatment outcomes were 86,1% and 84,0% consequently. Conclusion. Thus the ventral decompressive-stabilizing operations with the usage of porous Ni-Ti are not only as effective as posterior decompressive-stabilizing operations for surgical treatment of compressive spondylarthrosis combined with diskal hernias, but also have some advantages due to less expensive.

Objective: to describe and analyze the character, causes and frequency of various complications during endovascular occlusions (EVO)of cerebral aneurysms in acute and delayed periods of subarachnoid hemorrhage (SAH). Materials and methods: We performed EVO at 180 patients with ruptured cerebral aneurysms from 01.12.2007 till 31.07.2012; among them 74 patients were operated on in acute period of SAH (AP of SAH) (within 2 weeks from aneurysm rupture) and 106 patients - in delayed period of SAH (DP of SAH). Results: Aneurysm rupture during endovascular procedure was seen at 8 (10,8%) patients, operated on in AP of SAH and at 4 (3,7%) patients operated on in DP of SAH. The thromboembolic complications were seen at 11 (14,8%) patients in AP of SAH and at 6 (5,6%) patients in DP of SAH. The postoperative lethality was 9,45% in AP of SAH and 0,94% - in DP of SAH. Conclusion. The risk for development of hemorrhagic and thromboembolic complications is higher during EVO of ruptured aneurysms at patients in AP of SAH comparing with the those in DP of SAH. The risk factors for aneurysms rupture during EVO were aneurysm localization on anterior cerebral-anterior communicating arteries (ACA-ACoA) and on middle cerebral artery as well as the aneurysm size less than 4 mm. The thromboembolic complications were more often seen at patients with ACA-ACoA aneurysms and aneurysm size within 5-10 mm.

The persistent increase of intracranial pressure (ICP) because of severe head injury (HI) leads to impairment of cerebra perfusion and brain ischemia accompanied by severe decrease of cerebral oxygenation and metabolism as well as brain edema and dislocation syndrome. The persistent intracranial hypertension significantly worsens the severity of patients’ condition suffered from severe HI and increase in several times the risk for unfavorable outcome. Therefore the prevention, detection and well-timed correction of intracranial hypertension are the ones of the most important aims in treatment of patients with severe HI. Nowadays the surgical methods for treatment of intracranial hypertension include the controlled shunting of cerebrospinal fluid (CSF) from cerebral ventricles and decompressive trepanation. This article presents the literature review dedicated to the current state of problem of surgical treatment for intracranial hypertension at patients suffered from severe HI. The advantages and disadvantages of controlled shunting of CSF from cerebral ventricles as well as the possible complications of this method are described. The current role of decompressive trepanation (DCT) in the treatment of intracranial hypertension, the influence of DCT on ICP, cerebral perfusion pressure (CPP) as well as on cerebral oxygenation, cerebral metabolism and outcomes at patients with severe HI are presented in details.

One of the most severe types of head injury (HI) is brain contusion, representing itself as focus of morphologically destroyed brain tissue accompanied by hemorrhages, perifocal edema and cerebral ischemia. The important features of brain contusion foci are the changing of their sizes and structure over time. There are two possible types of such changes: regression of contusion focus or its progression (evolution). This article presents in details two current concepts, explaining the evolution of traumatic brain contusion foci as well as describes the risk factors for progression of brain contusion foci.

The important multicenter trials concerning the problem of neurogenic dysfunction of urinary bladder have being conducting over the last 20 years worldwide. The modern algorithms of early diagnostics and effective treatment of this pathology were developed and suggested. However there are some problems requiring the cooperative study and discussion among physicians of various specializations - urologists, neurologists and neurosurgeons. These are interdisciplinary aspects of realization of lower urinary tract functions. The one of such frontier problems is the role of vegetative nervous system in the providing of physiological functions of urinary bladder and the influence of mentioned nervous system on forming of neurogenic impairments of urination.

There are so called “complex” cerebral aneurysms with various morphological features concerning whom the possibilities of reconstructive open or endovascular methods are significantly limited. The main goal of combined (revascularization) surgery is to completely exclusion of aneurysm from cerebral blood flow and preventing the ischemic complications in the blood supply territory of compromised arteries. The usage of intracranial - to-intracranial (IC-IC) bypasses (or anastomosis) - the third stage of cerebral revascularization surgery development- is suitable for treatment of such complex brain aneurysms. This article presents the clinical case of successful treatment of patient with complex aneurysm of right callosomarginal artery using IC-IC bypass performed in our neurosurgical department for the first time as well as describes the current status of cerebrorevascularization surgery.

This article presents the clinical case of successful treatment of patient with giant aneurysm of middle cerebral artery. This patient underwent multiple but inefficient endovascular embolizations of giant aneurysm of middle cerebral artery that is why he was operated on with aneurysm clipping and the removal of aneurysm body with coils was performed.

The effectiveness and safe of ordinary surgical methods (carotid endarterectomy and carotid angioplasty) in acute period of ischemic stroke remain controversial and unproved question till nowadays. The current recommendations restrict the recanalization therapy with the usage of systematic and local thrombolysis as well as thromboembolectomy. However the active usage of ordinary surgical interventions allows significantly improving the treatment effectiveness for ischemic stroke in first hours after disease onset. We present our experience at the base of Local Vascular Center of Regional Clinical Hospital № 1 (Krasnodar, RF) concerning the usage of carotid endarterectomy and carotid angioplasty for reconstruction of brachiocephalic arteries in acute period of ischemic stroke.

Nowadays one of the main directions for spinal surgery development is minimization of operative trauma and maximal preservation of functionally significant structures. This article presents the clinical cases of totally removed spinal and cauda equina tumors via one-sided interlaminectomy approach, describes the operative technique in details as well as discusses the advantages and possibilities of suggested surgical approach and enlights the current concepts in surgical treatment for mass lesions of vertebral canal.

The paper presents the key points of respiratory support in patients with acute cerebral failure. The separate section is devoted to the modern approaches of mechanical ventilation to improve gas exchange in the development of acute lung injury and / or acute respiratory distress syndrome.