Aim. To evaluate experience of using endovascular techniques for treatment of patients with cerebral aneurysms (their efficacy and safety) at the Regional Vascular Center of Petrozavodsk. Materials and methods. Results of treatment of patients who underwent surgery at the Neurosurgery Division of the Republican Hospital named after V.A. Baranov (Petrozavodsk) between May 2015 and December 31st 2022 were analyzed. Results. Endovascular techniques were used in treatment of 131 patients, 141 surgeries were performed. The most common was endovascular occlusion of the aneurysm sac with coils – 110 (78 %) surgeries; additionally, assisting techniques were used in 21 (14.9 %) surgeries, flow-redirecting devices were installed in 7 (5 %) surgeries, in 3 (2.1 %) surgeries aneurysm occlusion was attempted. In the majority of cases complete occlusion of the aneurysm was achieved (class I per the Raymond–Roy Occlusion Classification (RROC)): 70.2 % of patients; subtotal occlusion (class II per RROC) was achieved in 25 (19.1 %) patients, partial (class III per RROC) in 11 (8.4 %). Intraoperative complications developed in 11.4 % of cases. Clinically good treatment outcome (score 4–5 per the Glasgow scale) was achieved in 102 (77.8 %) patients, unsatisfactory result (score 1 per the Glasgow scale) was observed in 20 (15.3 %) patients. Conclusion. In patients with cerebral aneurysms who underwent surgery using endovascular techniques at the Regional Vascular Center of Petrozavodsk generally favorable clinical outcomes were achieved.

The first results of surgical treatment of patients with hypertensive putaminal hematomas using puncture aspiration and local fibrinolysis with Russian medication Fortelyzin are presented. Efficacy of this mediation is demonstrated. In patients with intracerebral hematomas of volume between 40 and 55 cm 3 , 87.5 to 100 % of hematoma volume were evacuated in 36-72 h. Further studies for determination of optimal dose and fibrinolysis scheme are necessary.

Aim. To investigate the gender-specific social and demographic characteristics of neurosurgical patients with drug-resistant epilepsy.Materials and methods. The study design was single-center, non-randomized, retrospective, in parallel groups. It was conducted at A.L. Polenov Neurosurgical Institute - branch of the V.A. Almazov National Medical Research Centre, in the department of functional neurosurgery in 2022-2023.The study is part of the state assignment commissioned by the Government of the Ministry of Health of Russia (topic No. 123021000127-7 “Development of a new neurorehabilitation procedure for patients after surgical treatment for drug-resistant epilepsy”).The object of the study were neurosurgical patients with drug-resistant epilepsy. The subject of the study was gender-specific socio-demographic indicators.The study is based on the results of the examination and treatment of 100 patients with drug-resistant epilepsy after neurosurgical treatment at A.L. Polenov Neurosurgical Institute. There were 2 heterogeneous groups: group 1 - male, group 2 - female. Social functioning was assessed by social activity. Indicators of social functioning were educational level, employment, and disability group. The analysis of the statistical data obtained during the study was done using SPSS 12.Results. Group 1 comprised 53 (53 %) men and Group 2 comprised 47 (47 %) women. The age of the cohort ranged from 18 to 43 years, with a mean of 29.65 ± 6.35 years. The average duration of disease before surgery was 18.79 ± 8.64 years.The educational level in the cohort was characterized by the prevalence of vocational education - 42 % versus secondary education - 25 % and higher education - 33 %. In group 1, patients with secondary and specialized secondary education predominated, while in group 2 about half of the patients had higher education. There were twice as many unemployed people in the cohort as employed - 62 % and 31 % respectively and 5 % were studying.The number of patients with disabilities was 41 %, without disabilities - 59 %, in group 1 and group 2 patients without disabilities predominated.Conclusion. No gender-specific differences in social functioning were found in the long-term course of epilepsy. The long-term course of the disease has a negative impact on the indicators of social functioning of people with epilepsy in the preoperative phase. The cohort of the neurosurgical profile with pharmacoresistant epilepsy is characterized by problems of social adaptation: two thirds of them are not employed, a quarter of patients have only a high school diploma and no special education, 40 % have a disability.It is necessary to actively inform doctors and patients about the existing possibilities of surgical treatment of epilepsy in order to achieve a wider application of modern methods of epilepsy neurosurgery and early referral to surgical care, thus improving the effectiveness of treatment.

Background . Invasive monitoring of electrical activity of the brain (invasive electroencephalography (EEG)) can have a number of advantages in diagnosis of early damage and delayed ischemia of the brain during cerebral vascular spasm due to its higher sensitivity and lower number of artifacts compared to noninvasive (scalp) monitoring. However, there are no standards of invasive electrode placement and registration of invasive recording. We present clinical experience of invasive prolonged EEG monitoring in patients during the acute period of cerebral aneurysm rupture. Aim . To develop technique of invasive EEG monitoring in patients with cerebral aneurysm rupture and to evaluate characteristics of the observed electrographic changes. Materials and methods . Series of clinical observations are presented: 6 patients who were operated on in the acute period of nontraumatic subarachnoid hemorrhage and who underwent simultaneous scalp and invasive EEG monitoring. Results . Pathologic changes observed during EEG correlated with development of areas of cerebral ischemia. Changes registered during invasive EEG were more pronounced and appeared earlier than during scalp monitoring. Conclusion . Informativity of invasive EEG monitoring in diagnosis of delayed cerebral ischemia and seizureless epileptiform activity is higher compared to scalp EEG monitoring.

Background. Destructive surgical methods for the treatment of drug-resistant trigeminal neuralgia in the Russian clinical recommendations are classified as options, but at the same time they are in demand and often found in clinical practice. One of them is glycerin rhizotomy by S. Hakanson.Aim. To evaluate the effectiveness of the treatment of trigeminal neuralgia using glycerin rhizotomy by S. Hakanson.Materials and methods. A retrospective cohort study was carried out: the results of treatment with glycerol rhizotomy were analyzed in 202 patients with trigeminal neuralgia, who were treated at the Irkutsk City Clinical Hospital No. 1 from 2009 to 2022 years. To study the follow-up, the telephone interview was carried out with 107 patients. Based on the analysis of the literature, the data were compared with the results of the treatment of other surgical methods.Results. Initial pain relief after surgery was noted in 95 % of patients. Recurrence of pain syndrome (III-V class on the Barrow Neurological Institute Pain Scale) was observed in 32.7 % of patients, while the medium pain intensity on the visual analogue scale score was 7.3 ± 0.26. Pain-free period was 27.7 ± 3.6 of months. There were no deaths.Conclusion. Glycerin rhizotomy provides immediate pain relief in patients with drug-resistant trigeminal neuralgia. This procedure is effective, minimally invasive, safe, simple and painless for patients in compliance with the algorithm.

Echinococcal brain damage is a fairly rare pathology. Hydatid cysts are an urgent problem of neurosurgery. As a rule, echinococcal cysts of the brain are detected at the stage of clinical manifestations, when the cyst already significantly compresses the brain, thereby causing neurological deficiency. Surgical treatment of hydatid cysts requires special delicacy, appropriate experience and practical skills of the operating neurosurgeon. A clinical case of successful surgical treatment of a five-year-old patient with a giant echinococcal cyst of the brain, combined with an echinococcal lesion of S3, 4 segments of the right lung is presented. The analysis of the literature is carried out. A total removal of a giant hydatid cyst of the right hemisphere of the brain was performed, without damaging its walls by hydro dissection with simultaneous mechanical compression. A complete regression of focal neurological symptoms has been achieved. Radical treatment of the hydatid cyst of the brain is only surgical and consists in its total removal without damaging its membranes. Hydro preparation in combination with gentle manual hydrodynamic compression of the brain allows to remove a hydatid cyst without damaging its walls.

Introduction. Currently diagnosis of cerebrospinal fluid (CSF) leak involves the use of instrumental and laboratory techniques. Computed tomography of the brain (CT brain) is the preferred instrumental method. However, it is not always effective for visualization of skull base defects less than 2 mm in size. Aim. To confirm nasal CSF leak primarily using laboratory diagnostic methods, rather than instrumental diagnostic methods. Materials and methods. Instrumental diagnosis of nasal CSF leak (outpatient): high-resolution CT brain with subsequent image analysis in multiplanar projections. Laboratory diagnosis: quantitative test of glucose in nasal fluid using test strips (Russia) and quantitative test using hexokinase method and biochemical analyzers (Japan, USA). Results. Diagnostic tactics and types of surgical treatment for 34 patients are presented. CT brain was performed in all patients, and no bone defect was found in 5 (14.7 %) cases. However, thinning of the bone tissue in the area of the cribriform plate of the ethmoid bone with the presence of a soft tissue inclusion (meningoencephalocele), as well as a low position of the olfactory fossa (8.16 ± 0.14 mm) was observed. Through laboratory diagnostics, admixture of CSF in nasal fluid was verified in 5 (14.7 %) patients. Reconstruction of CSF fistulas was performed in all patients through endoscopic endonasal access using multilayer closure technique with allo- and autografts. In the postoperative period, no recurrence of CSF leak was observed. Follow-up period ranged from 6 months to 3 years. Discussion. In verification of CSF in nasal fluid, CSF fistula diagnosis requires CT brain; in the absence of obvious defects of the skull base according to CT results, endoscopic examination of the nasal cavity and cribriform plate of the ethmoid bone should be performed without the use of invasive diagnostic methods. Conclusion . In the context of negative CT and positive laboratory results, the area of the cribriform plate of the ethmoid bone should be regarded as the most likely source of CFS.

Background. Large vestibular schwannomas can not only change the anatomy and structure of the facial nerve in the process of growth, but also encapsulate it over a considerable length. Despite the development of modern neurosurgical techniques and achievements in the field of microscopy, it is often impossible to avoid damage to its integrity during the separation of the facial nerve, which is associated with the development of paresis of the facial muscles in the postoperative period. The use of intraoperative neurophysiological monitoring in surgery for vestibular schwannomas pursues the following tasks: identification of neural structures, timely detection of signs of their damage, and prevention of iatrogenic neurological deficit. Aim. To analyze the results of microsurgical removal of vestibular schwannomas using intraoperative neurophysiological monitoring. Materials and methods. A series of clinical cases of patients who underwent microsurgical removal of sporadic vestibular schwannomas using suboccipital retrosigmoid transmeatal access under the control of multimodal intraoperative neurophysiological monitoring is presented. Neurological assessment of the facial nerve function was carried out in the early postoperative period and 3 months after surgical treatment using the House–Brackmann scale. Results. Postoperative results of surgical treatment were collected in 11 patients. According to the results of the neurological assessment in the early postoperative period, the result was regarded as successful in 5 cases, satisfactory in 3 cases, and poor in 3 cases (grade V on the House–Brackmann scale). The use of direct monopolar stimulation technique made it possible to identify the location and course of the facial nerve with high accuracy in all patients. In 2 cases, the tumor was resected subtotally due to the appearance of neurophysiological predictors of facial nerve dysfunction. Conclusion. The use of multimodal neurophysiological monitoring when removing large vestibular schwannomas can make surgical treatment more controllable and thus indirectly affect functional outcomes.

One of the complications of latent intracranial hypotension is a dystopia of the tonsils of the cerebellum, which can lead to an erroneous diagnosis of “Chiari malformation type 1”. The aim of the work is to pay attention to the symptoms, course and diagnosis of acquired (pseudomalformation) Chiari in intracranial hypotension syndrome. The work is based on clinical and neurological data and magnetic resonance imaging of the brain and spinal cord of a woman aged 28 years, obtained during dynamic observation over a number of years. At the acute onset of the disease with severe postural headache, minimal neurological symptoms, magnetic resonance imaging revealed a dynamic dystopia of the cerebellar tonsils from the plane of the large occipital foramen 15 mm below it and stable hydromyelia in the thoracic region, which inclined to the diagnosis of Chiari malformation type 1. However, flattening of the bridge, thickening of the dura mater, the tendency to rounding of the sagittal sinus, narrowing of subarachnoid spaces, basal cisterns, prolapse of the bottom of the 3rd ventricle into the prebridge cistern indicated the possibility of intracranial hypotension caused by latent liquorrhea, which was confirmed by magnetic resonance imaging with intravenous administration of gadolinium containing contrast agent in the mode of a strongly weighted T2-three-dimensional image with inversion and weakening of fluid – revealed hidden liquorrhea at the cervical level. A diagnosis of Chiari pseudomalformation has been established, which excludes surgical intervention – decompression of the posterior cranial pit. When diagnosing Chiari malformation type 1 and detecting cerebellar tonsillar dystopia, it is always necessary to exclude Chiari pseudomalformation associated with other primary pathology, in particular, with latent cerebrospinal liquor, the consequence of which is intracranial hypotension, which has specific signs in magnetic resonance imaging, and requires a different therapeutic tactic.

Cerebral blood vessel trauma (CBVT) is a serious condition of craniocerebral injury. According to literature data, different varieties of CBVT in penetrating gunshot craniocerebral injuries are found in 30–45 % of cases. Traumatic pseudoaneurysms are the most common finding in late evaluation and can lead to life-threatening episodes of intracranial hemorrhage.In addition, CBVT includestraumatic occlusion, dissection of vessels, rupture of cerebral arteries, formation of arteriovenous fistulas (carotid-cavernous anastomoses), venous stasis, etc. Injured persons with traumatic dissection and injury of vertebrobasilar pool have the highest risks of lethal outcome. There are no largerandomised trials and national recommendations for the treatment of CBVT, individual observations and small series of clinical cases have been published. In this connection, there is a need for a detailed analysis of all clinical cases, the development of tactics for early diagnosis and an algorithm for the treatment of wounded with CBVT.The article presents a review of the literature data that characterizes the current understanding of CBVT, and a clinical case of traumatic occlusion of the middle cerebral artery and pseudoaneurysm of the posterior communicating artery in a wounded man with a gunshot penetrating cranioorbital wound, who was treated at the neurosurgical center of the N.N. Burdenko Main Military Clinical Hospital.In the early period after the injury, the patient underwent endovasal occlusion of a traumatic aneurysm of the posterior connective artery by microspirals followed by local thrombolysis of intraventricular hematomas through a ventricular catheter. The catamnesis was 150 days, the score on the modified Rankin scale was 3, the Glasgow outcome scale extended was 5.