[Trigeminal nerve lipoma presenting with trigeminal neuralgia: case report and literature review]. / Lipoma koreshka troinichnogo nerva, proyavlyayushchayasya trigeminal'noi nevralgiei: opisanie klinicheskogo nablyudeniya i obzor literatury.

Cerebellopontine angle lipomas are benign mass lesions and rarely result trigeminal neuralgia. A 61-year-old male with right-sided trigeminal neuralgia in V2 and V3 divisions without sensory disturbances is reported in the article. MRI revealed mass lesion 11´11´4 mm on the lateral pontine surface spreading to the right trigeminal nerve root entry zone. No signs of neurovascular compression were found. Microsurgical exploration of the cerebellopontine angle showed a fatty mass adherent to the brainstem with incorporation of inferior part of trigeminal nerve root. Fatty tissue resection was followed by partial sensory trigeminal rhizotomy. Histological examination identified lipoma. Postoperative MRI showed small residual tissue with minimal ischemic area near trigeminal nerve root entry zone. Mild hypoesthesia within V2 and V3 trigeminal branches occurred after surgery. Trigeminal neuralgia completely resolved, and medications were discontinued. This clinical case and literature review clearly demonstrated successful elimination of trigeminal neuralgia in patients with cerebellopontine angle lipoma after resection of mass lesion and partial trigeminal rhizotomy.

[Trigeminal radiculopathy in vestibular schwannomas]. / Trigeminal'naya radikulopatiya pri vestibulyarnykh shvannomakh.

OBJECTIVE: To evaluate the correlation of trigeminal radiculopathy with anatomical relationships of trigeminal nerve root, brainstem, tumors and vessels in patients with vestibular schwannomas. MATERIAL AND METHODS: A retrospective analysis included 153 patients (106 females and 47 males aged 22-82 years) with vestibular schwannomas who underwent surgery via retromastoid approach. Preoperative trigeminal radiculopathy (facial pain and sensory disturbances) was examined after microsurgical resection. Brainstem compression was analyzed by comparison of transverse size of contralateral to vestibular schwannoma half of brainstem and ipsilateral side. RESULTS: Tumor-induced brainstem and trigeminal nerve compression was found in 115 cases. Sixty-four of these patients had trigeminal radiculopathy symptoms. Degree of brainstem compression was significantly higher in trigeminal radiculopathy group. Facial hypoesthesia was found in 61patients, trigeminal neuralgia - in 5 cases, neuropathic pain - in 3 patients. Thirty-seven patients without brainstem compression had no trigeminal nerve involvement. One patient had trigeminal neuralgia following compression by superior cerebellar artery. Total resection with brainstem and trigeminal nerve decompression were performed in all cases. Isolated or combined compression of trigeminal nerve root was noted in 9 patients with trigeminal neuralgia and neuropathic pain, in 2 with facial numbness and in 2 patients without trigeminal symptoms. In case of trigeminal neuralgia following compression by superior cerebellar artery, vascular decompression was performed only in patients with facial pain and numbness. Facial pain completely resolved in all patients. Complete or partial sensory restoration was noted in 25 cases. No facial sensory disorders were noted in 26 cases, transient sensory deterioration - in 10 patients. CONCLUSION: Trigeminal radiculopathy is caused by severe brainstem compression following vestibular schwannomas and usually results sensory disturbances and rarely facial pain. The impact of tumor on trigeminal nerve root and brainstem trigeminal pathways can be accompanied by vascular compression by superior cerebellar artery. Regression of trigeminal radiculopathy symptoms after resection of vestibular schwannoma is caused by decompression of trigeminal nerve root and brainstem. In case of concomitant neurovascular syndrome, vascular decompression is indicated.

[Organizing the medical care for the COVID-19 patients in non-infectious Moscow hospital: reassignment experience].

AIM: To present the results of work of National Medical Research Center of Treatment and Rehabilitation, reassigned for COVID-19 patients treatment during pandemic. Run-up methodology, procedures and working process organization are detailed. MATERIALS AND METHODS: 354 COVID-19 patients were treated from 13.04.2020 to 10.06.2020 [age 59 (470) years, 56% women, body mass index 28.5 (24.932.2) kg/m2]. Patients were admitted at 8 (611) day of sickness. In-hospital stay was 16 (1420) days. RESULTS: NEWS scale at the day of admittance was 2 (14); 2 (13) in patients discharged alive and 6 (47) in died patients, p=0.0001. So prognostic accuracy of NEWS scale was confirmed as very well (area under ROC-curve = 0.819). 69 patients (19.5%) were treated at intensive care department for 7 (413) days. 13 patients died, 11 of them had COVID-19 as direct or indirect cause of death. Total in-hospital mortality was 3.67%, in-hospital mortality of COVID-19 patients 3.1%. 17 healthcare workers (HCW), contacted with COVID-19 patients were infected (2.67%). 4 HCW, who had no direct contact with patients were also infected and 7 HCW were infected before the first patient was admitted. No one of them died. CONCLUSION: Complex tasks of healthcare organization during COVID-19 pandemic can be solved quickly with acceptable quality, characterized by low levels of patients; mortality and HCW infection.

[Anatomical rationale for surgical treatment of trigeminal neuralgia combined with cerebellopontine angle tumors]. / Anatomicheskoe obosnovanie khirurgicheskogo lecheniia trigeminal'noi nevralgii, sochetaiushcheisia s opukholiami mostomozzhechkovogo ugla.

Trigeminal neuralgia (TN) can be combined with tumors of the cerebellopontine angle (CPA). The optimal surgical management in these cases depends on the anatomical relationship of the trigeminal nerve root (TNR) with tumors and vessels. The purpose of this study is to evaluate variants of the anatomical relationship between the TNR and the surrounding structures as well as to analyze the results of using various surgical techniques for treatment of TN in CPA tumors. MATERIAL AND METHODS: We performed a retrospective analysis of 51 patients (38 females and 13 males aged 22 to 77 years) with TN and ipsilateral CPA tumors. Space-occupying lesions were represented by 29 meningiomas of the petrous apex, 11 epidermoids, 9 vestibular schwannomas, 1 hemangioma, and 1 cavernoma. RESULTS: Intraoperatively, we identified 6 types of the anatomical relationships among the TNR, tumors, and CPA vessels: type I - the TNR is completely surrounded by the tumor (4 epidermoids); type II - the tumor compresses and displaces the TNR (21 meningiomas, 4 schwannomas, and 6 epidermoids); type III - the tumor occurs inside the TNR (1 cavernoma); type IV - the tumor together with the vessel compresses the TNR (3 meningiomas and 1 epidermoid); type V - the tumor displaces the TNR towards the vessel (5 meningiomas and 5 schwannomas); type VI - the tumor does not contact the TNR that is compressed by the vessel (1 hemangioma). Preoperative MRI and intraoperative findings revealed compression and deformity of the brain stem at the TNR entry level in all but two patients. Vascular compression of the TNR (usually by the superior cerebellar artery) was found in 15 of 51 patients. Microvascular decompression (MVD) was performed using various techniques: interposition of implants between vessels and the TNR, transposition of the compressing vessels from the TNR, or transposition of the nerve root. In all patients, except 1, pain syndrome regressed immediately after tumor removal and MVD. In 1 case, the pain syndrome did not regress after total removal of epidermoid and MVD, and TN was resolved by percutaneous radiofrequency rhizotomy. Long-term postoperative follow-up results showed complete elimination of TN in all cases; there were no persistent neurological complications and postoperative mortality. CONCLUSION: TN may result from direct compression and deformation of the TNR and brain stem by CPA tumors. In some cases, the cause of TN is combined compression of the TNR by the tumor and vessels. Assessment of the neurovascular relationships requires detailed examination of the entire TNR after tumor removal. In the case of vascular compression of the TNR, various MVD techniques can be used for treatment of TN.

[Intraoperative mapping of long association fibers in surgery of gliomas of the speech-dominant frontal lobe]. / Intraoperatsionnoe kartirovanie dlinnykh assotsiativnykh traktov v khirurgii gliom dominantnoi po rechi lobnoi doli.

Surgery of intracerebral tumors involving long association fibers is a challenge. In this study, we analyze the results of intraoperative mapping of the superior longitudinal, arcuate, and frontal aslant tracts in surgery of brain gliomas. PURPOSE: The study purpose was to compare the results of intraoperative mapping and the postoperative speech function in patients with gliomas of the premotor area of the speech-dominant frontal lobe, which involved the superior longitudinal, arcuate, and frontal aslant tracts, who were operated on using awake craniotomy. MATERIAL AND METHODS: Twelve patients with left frontal lobe gliomas were operated on: 11 patients were right-handed, and one patient was a left-hander retrained at an early age. Histological types of tumors were represented by Grade II diffuse astrocytomas (6 patients), Grade III anaplastic astrocytomas (1 patient), Grade IV glioblastoma (1 patient), Grade II oligodendroglioma (1 patient), and Grade III anaplastic oligodendrogliomas (3 patients). The mean age of patients was 45 (29-67) years; there were 6 males and 6 females. All patients underwent preoperative and postoperative MRI with reconstruction of the long association fibers and determination of the topographic anatomical relationships between the fibers and the tumor. Surgery was performed using the asleep-awake-asleep protocol with intraoperative awakening of patients. All patients underwent cortical and subcortical electrophysiological stimulation to control the localization of eloquent structures and to clarify the safe limits of resection. For intraoperative speech monitoring, a computerized naming test was used with naming of nouns or verbs, and automatic speech was evaluated (counting from 1 to 10, enumeration of months and days of the week), which was complemented by a talk with the patient. Speech disorders before, during, and after surgery were evaluated by a neuropsychologist. The mean current strength during direct electrical stimulation was 3 (1.9-6.5) mA. RESULTS: The association fibers were intraoperatively identified in all patients (SLF/AF in 11 patients; FAT in one patient). In 4 patients, the cortical motor speech area was intraoperatively mapped; in three cases, tumor resection was accompanied by speech disturbances outside the stimulation. During direct electrical stimulation, speech disturbances developed in 7 of 12 cases. All patients underwent control MRI within the first 48-72 h: total resection (more than 90% of the tumor) was performed in 7 cases; subtotal resection was achieved in two patients; partial resection was performed in two cases. According to postoperative MR tractography, the resected tumor bed was adjacent to the SLF/AF complex in 7 cases, located near the SLF/AF complex in three cases, and adjacent to the FAT in two cases. Postoperatively, 11 out of 12 patients had worsening of neurological symptoms in the form of various speech disturbances. In one patient, speech disturbances developed 2 days after surgery, which was associated with an increase in edema. On examination 3 months after surgery, severe speech disturbances remained in 1 patient. CONCLUSION: Resection of frontal lobe tumors in the speech-dominant hemisphere using early postoperative awakening is associated with a high rate of complex speech disorders due to injury to the SLF/AF complex and FAT. In these cases, intraoperative speech mapping with allowance for the course of long association fibers is an essential procedure. Preoperative tractography in combination with intraoperative speech mapping enables identification of association fibers of the SLF/AF complex and FAT, which may help to avoid severe conduction aphasia with poor speech recovery after tumor resection.

Bilateral stereotactic lesions and chronic stimulation of the anterior thalamic nuclei for treatment of pharmacoresistant epilepsy.

BACKGROUND: The use of the anterior nucleus of thalamus (ANT) as a target for treatment of pharmacoresistant epilepsy is based on its crucial role in seizure propagation. We describe results of chronic bilateral ANT stimulation and bilateral ANT lesions in 31 patients with refractory epilepsy. METHODS: ANT DBS was performed in 12 patients (group I) and bilateral stereotactic radiofrequency lesions of ANT were performed in 19 patients (group II). Targeting was based on stereotactic atlas information with correction of the final coordinates according to the location of anatomical landmarks and intraoperative microelectrode recording data. RESULTS: Both groups were similar in age, gender, seizures frequency, and duration of disease. The median x, y, and z coordinates of ANT were found to be 2.9, 5, and 11 mm anterior, lateral, and superior to the mid-commissural point, respectively. Mean seizures reduction reached 80.3% in group of patients with ANT DBS with two nonresponders and 91.2% in group of patients with lesions. Five patients from group I and three patients from group II became seizure-free. The morbidity rate was low in both groups. CONCLUSIONS: Stereotactic anterior thalamotomy and chronic ANT stimulation are both effective for seizure control in epilepsy originated from frontal and temporal lobes. ANT lesions and stimulation were more effective for secondary-generalized seizures compared to simple partial seizures.

[Surgical treatment of epilepsy in patients with mediobasal temporal cavernous malformations]. / Khirurgicheskoe lechenie épilepsii u patsientov s mediobazal'nymi visochnymi kavernoznymi mal'formatsiiami.

OBJECTIVE: Epilepsy is a frequent clinical manifestation of cavernous malformations (CMs) of the mediobasal temporal region (MBTR). Surgical removal of CMs is an excellent technique for treating associated epilepsy and may range from pure lesionectomy to tailored resection of the temporal lobe. PURPOSE: The study purpose was to determine the optimal surgical management for epilepsy in patients with CMs of the MBTR. MATERIAL AND METHODS: We retrospectively analyzed the clinical data, neuroimaging findings, surgical techniques, and surgical outcomes in 11 patients with epilepsy and CMs of the MBTR. All patients underwent video-electroencephalography, magnetic resonance imaging, and computed tomography in the pre- and postoperative periods. Nine patients underwent preoperative implantation of foramen ovale electrodes. In all cases, surgery was accompanied by electrocorticography (ECoG). RESULTS: CMs were located in the anterior MBTR in 7 cases, anterior and middle thirds of the MBTR in 1 case, middle third in 2 cases, and middle and posterior thirds in 1 case. In 8 patients, preoperative monitoring revealed a seizure onset area in the MBTR. These patients underwent cavernomectomy with ECoG-guided resection of the hemosiderin ring and adjacent tissue using the pterional (4 cases) or supracerebellar transtentorial approach (4). In 3 cases, anterior temporal lobectomy with cavernomectomy was additionally used due to spreading of pathological activity to the lateral temporal neocortex. Seizure control after surgery was excellent in 7 patients (class 1 ILAE) and good in 4 (class 2 ILAE). CONCLUSION: Surgery in patients with epilepsy caused by CMs of the MBTR should be performed based on non-invasive and invasive presurgical evaluation. If the seizure onset area is located in the MBTR, lesionectomy with ECoG-guided resection of the adjacent temporal cortical areas can be performed using the pterional or supracerebellar transtentorial approach. Lateral spread of epileptic activity requires cavernomectomy and anterior temporal lobectomy.

[An aneurysm of the medial posterior choroidal artery: a case report and a literature review]. / Anevrizma medial'noi zadnei vorsinchatoi arterii: opisanie klinicheskogo nabliudeniia i obzor literatury.

INTRODUCTION: Aneurysms of the medial posterior choroidal artery are very rare. To date, only 5 cases have been reported. The article presents a case of successful surgical treatment of an aneurysm of the medial posterior choroidal artery and a literature review. CLINICAL CASE: A 57-year-old male was admitted to the Center 1 month after a massive subarachnoid hemorrhage. CT angiography revealed an aneurysm of the right posterior medial choroidal artery in the perimesencephalic cistern and resolved hemorrhage. TREATMENT: The paramedian supracerebellar transtentorial approach to the lateral surface of the midbrain was used. The posterior cerebral artery was identified in the perimesencephalic cistern, and the medial posterior choroidal artery aneurysm was isolated and successfully clipped, with the parent artery being preserved. Postoperative CT and MRI scans revealed a small asymptomatic ischemic lesion in the tectal region on the right. The patient was discharged without any neurological symptoms 10 days after surgery. CONCLUSION: Medial posterior choroidal artery aneurysms can be clipped using the paramedian supracerebellar transtentorial approach.

[The paramedian supracerebellar transtentorial approach to the mediobasal temporal region]. / Paramediannyi supratserebellyarnyi transtentorial'nyi dostup k mediobazal'nomu otdelu visochnoi doli.

UNLABELLED: The mediobasal temporal region (MTR) is located near the brain stem and surrounded by the eloquent neurovascular structures. The supracerebellar transtentorial approach (STA) is safe access to the posterior MTR structures, however its use for resection of anterior MTR lesions still remains controversial. The article describes the technique and outcome of surgery for different MTR structures using STA. MATERIAL AND METHODS: The paramedian STA was used in 18 patients (13 females and 5 males) for 7 years. Ten patients presented with glial MTR tumors, 3 patients with cavernomas, 2 patients with arteriovenous malformations (AVMs), 2 patients with intraventricular meningiomas, and 1 patient with mesial temporal sclerosis. The patient age ranged from 19 to 57 years. In 10 cases, lesions were localized on the left. Epilepsy was the leading symptom in 14 cases. Patients underwent preoperative high-resolution MRI, electroencephalography video monitoring before and after surgery, intraoperative corticography (if necessary), and postoperative CT and MRI. RESULTS: Lesions were located in the anterior third of MTR in 5 patients, in the anterior and middle thirds in 2 patients, in the middle third in 5 patients, in the middle and posterior thirds in 2 patients, in the posterior third in 1 patient, in the anterior, middle, and posterior thirds in 1 patient, and in the ventricular triangle area in 2 patients. In all patients with intraventricular tumors, AVMs, and cavernous malformations and in 8 patients with glial MTR tumors, the lesions were totally resected. Two patients with intracerebral tumors underwent subtotal resection. A patient with intractable epilepsy and mesial temporal sclerosis underwent resection of the anterior two-thirds of the hippocampus and parahippocampal gyrus and, partially, amygdala using intraoperative corticography. There was no surgical mortality; 2 patients developed a transient neurological deficit, and 1 patient had a cerebellar hematoma that was successfully removed during surgery. CONCLUSION: STA enables resection of lesions localized in all parts of the MTR, without damage to the surrounding nerve and vascular structures.

[Bilateral radiofrequency anterior thalamotomy in intractable epilepsy patients]. / Dvustoronnyaya radiochastotnaya perednyaya talamotomiya u patsientov s farmakorezistentnoi epilepsiei.

BACKGROUND: Identification of the crucial role of the anterior thalamic nuclei (ATN) in the generalization of seizures led to increased interest in surgical interventions in this particular area in intractable epilepsy patients. Simulation of ATN destruction in animals demonstrated its high efficacy for both preventing the seizure development and reducing the seizure rate. However, bilateral radiofrequency destruction of the anterior thalamic nuclei in humans has not yet bee described. AIM: The study objective was to perform bilateral radiofrequency anterior thalamotomy in intractable epilepsy patients and to evaluate its MATERIAL AND METHODS: We performed for the first time bilateral stereotactic radiofrequency thermocoagulation of ATN in 13 patients with long-term intractable epilepsy. Before surgery, we assessed the disease duration, age of seizure onset, localization of pathological activity sources, and types of seizures, morphological damages, and ongoing pharmacotherapy. All interventions were performed under local anesthesia and were accompanied by intraoperative microelectrode monitoring of the neuronal activity and by EEG. RESULTS: Seven males and 6 females, aged 22 to 48 years, were operated on. All patients had epileptogenic foci in the frontal and/or temporal lobes. MRI revealed epileptogenic structural abnormalities in 3 patients. There were no postoperative complications. According to a postoperative examination, 5 patients were seizure-free; a decrease in the seizure rate was 70% in 6 patients and 50% in 1 patient; 1 patient had no response to the surgery. The resulting effect was manifested not only in a reduction in the frequency and severity of seizures but also in a decrease in the dose of administered anticonvulsants. EEG also showed a significant improvement in the majority of patients. CONCLUSION: Our experience demonstrates that bilateral radiofrequency anterior thalamotomy is a safe and effective technique to control seizures in humans. Further research will clarify, based on the clinical and EEG data, the patient selection criteria for surgical treatment.

[Trigeminal neuralgia and hemifacial spasm associated with vertebrobasilar artery tortuosity].

BACKGROUND: The tortuous vertebrobasilar artery (TVBA) often causes neurovascular conflicts in patients with trigeminal neuralgia (TN) and hemifacial spasm (HFS). Implementation of microvascular decompression (MVD) in these circumstances is hindered due to stiffness of the enlarged and dilated arteries and is often accompanied by poor outcomes. The surgical strategy in cases of trigeminal neuralgia and hemifacial spasm associated with the TVBA should be clarified in order to achieve good outcomes. MATERIAL AND METHODS: MVD was performed in 268 TN patients and 71 HFS patients. The TVBA as a compressing vessel was identified in 30 cases (11 cases of TN, 18 cases of HFS, and 1 patient with painful tic convulsif). All patients underwent MVD and a retrospective analysis of clinical outcomes. RESULTS: Compression caused by the vertebral artery was found in all HFS patients and 4 TN patients, and compression caused by the basilar artery was observed in 7 TN cases. Additional compression of the cranial nerve root entry/exit zone by cerebellar vessels was observed in 21 cases. The TVBA was mobilized by dissection of arachnoid adhesions between the vessel and the brainstem and retracted laterally. Then, the TVBA was retracted from the brainstem to the caudorostral direction. These manipulations resulted is "spontaneous" decompression of the cranial nerves without placing prostheses between the artery and the nerve root entry/exit zone. In all cases (except two), the displaced TVBA was fixed between the enlarged artery and brainstem using pieces of the patient's muscle and adipose tissues, followed by application of fibrin glue. A cylindrical silicone prosthesis was used in 1 case. In another case, the TVBA was retracted using a fascial loop fixed to the dura mater of the petrous pyramid by means of a suture. After application of MVD, TN and HFS symptoms completely regressed. There were several transient complications and 2 cases of permanent hearing loss. No clinical symptom recurrence was observed. CONCLUSION: MVD is the most effective surgical treatment of TN and HFS caused by the TVBA. The TVBA should be retracted from the brainstem without placing prostheses in the nerve root entry/exit zone.

[Giant partially thrombosed aneurysm of the vertebral artery: a case report and literature review]. / Gigantskaia chastichno trombirovannaia anevrizma pozvonochnoi arterii: opisanie klinicheskogo nabliudeniia i obzor literatury.

INTRODUCTION: Giant partially thrombosed aneurysms of the vertebral artery are recalcitrant to treatment by microsurgical trapping and thrombectomy. Application of endovascular interventions is limited due to substantial brainstem compression and cranial nerve neuropathy. Combined endovascular exclusion and microsurgical excision provides an approach to treatment of these lesions. CLINICAL CASE: A 48-year-old female patient presented with progressive complaints of ataxia, diplopia in left lateral gaze, and dysphagia. Imaging studies (CT, MRI, angiography) revealed a giant partially thrombosed aneurysm of the right vertebral artery and pronounced brainstem compression. TREATMENT: The initial phase of treatment involved endovascular occlusion of the vertebral artery and aneurysm trapping that did not lead to changes in the postoperative patient's neurological status. MRI demonstrated complete aneurysm thrombosis and a weak TOF signal in the vertebral artery near the proximal aneurysm neck region. Because of persistent brainstem compression, the patient underwent right suboccipital craniectomy and hemilaminectomy of the CI arch for aneurysm excision one week after endovascular occlusion. After isolating the aneurysmal sac, the vertebral artery was transected, and two small branches extending from the aneurysm neck to the brainstem were also coagulated and transected, followed by aneurysm excision. Numerous vasa vasorum in the wall of the proximal vertebral artery and aneurysm neck were coagulated to stop bleeding. After surgery, the patient developed neurological symptoms (right leg ataxia and dysphagia worsening) due to lateral medullary infarction (confirmed by MRI) that presumably resulted from coagulation of two small perforating branches coming from the aneurysm neck to the brainstem. Recovery of the patient's neurological functions was observed during conservative treatment. The patient was discharged with mild right leg ataxia and preoperative left-sided abducens paresis. CONCLUSION: Medulla oblongata compression associated with a giant thrombosed aneurysm of the vertebral artery can be eliminated by endovascular trapping followed by surgical excision of the aneurysm. Preserving the vasa vasorum feeding the brainstem is crucial for prevention of ischemic complications.

[Light optical and ultrastructural characteristics of human focal cortical dysplasias].

Focal cortical dysplasias (FCD) are one of the most common causes of drug-resistant epilepsy. Morphological changes in the focal cortical dysplasia tissues obtained from epileptic patients during surgical interventions were analyzed. Eleven specimens of the cerebral cortex with FCD areas were explored. There were a variety of light optical and ultrastructural abnormalities affecting different portions of the cortical arrangement, as well as a considerable heterogeneity in these changes. Special emphasis was placed on morphological correlations between excitation and inhibition processes when possible mechanisms responsible for the epileptogenicity of dysplasia cells were assessed. The findings suggest that there is a preponderance of FCD tissue excitation processes along with depressed inhibition processes.

[Neurovascular interactions in hemifacial spasm].

The article describes our results of surgical treatment of 37 patients with hemifacial spasm (HS) as well as results of morphological studies of facial nerve root exit zone (REZ). Morphological studies demonstrated that extension of central myelinated zone differed between 0.9 and 3.6 mm (mean 2.24 mm). This zone did not exceed 1.1 diameter of facial nerve. Intraoperative findings included 27 cases of compression by a single vessel and 9 cases of compression by multiple vessels. In cases of compression by a single vessel the offending artery was AICA in 11 cases, PICA in 12 cases and VA in 4 cases. In 35 patients complete decompression of facial nerve REZ was achieved. In one case complete decompression was not possible due to penetration o vestibular nerve by AICA which prevented safe manipulations of the artery and nerves. Excellent results of surgical treatment were achieved in 33 patients. In 1 described case the outcome was unsatisfactory. We observed no serious postoperative complications. Vascular decompression is highly effective and relatively safe procedure for treatment o HS. HS results from compression of central myelinated zone of facial nerve thus surgical decompression should be preformed close to REZ at the brainstem.

[Intrachiasmal hematoma].

This case report describes 41-year-old female who suffered from progressive visual loss due to chiasmal apoplexy. Her neurological examination revealed bitemporal hemianopia without any pathological changes of optic disks. MRI showed round-shape, hyperintensive on T1WI and T2WI lesion inside the chiasm without enhancement after IV contrast administration. The lesion was suspicious of acute or subacute hemorrhage. MRI and CT scans revealed characteristic signs that supported the diagnosis of intrachiasmal hemorrhage. Surgery was performed via a pterional approach. Minimally invasive surgical intervention to chiasm allowed us to minimize the risk of further visual deterioration in postoperative period. Meta-analysis of publications highlights the various aspects of diagnosis and management of intrachiasmal hemorrhages.

Clinical case of the late diagnosis of type-II schizencephaly.

The management of patients with epilepsy in rural areas is often hampered by the lack of diagnostic facilities and neuro-radiologists. There are many congenital abnormalities which can present with seizures only, or in combination with other neurological symptoms. This case report examines the occurrence of the rare brain abnormality schizencephaly in a 14 year old boy, following a chain of management errors and incorrect treatments.