[Phosphorus MR spectroscopy and 18F-FDG PET/CT in the study of energy metabolism of glial tumors]. / Fosfornaya MR-spektroskopiya i PET/KT s 18F-FDG v izuchenii energeticheskogo metabolizma glial'nykh opukholei.

OBJECTIVE: To study energy metabolism in glial tumors using dynamic MR spectroscopy and 18F-FDG PET/CT. MATERIAL AND METHODS: The study included 19 patients (9 women and 10 men) with newly diagnosed supratentorial glial tumors WHO Grade I-IV (diffuse astrocytoma - 4 cases, oligodendroglioma - 4 cases, anaplastic astrocytoma - 5 cases, glioblastoma - 6 cases). All patients underwent examination and surgical treatment at the Burdenko Neurosurgery Center. Dynamic MR spectroscopy and 18F-FDG PET/CT were applied in each patient. RESULTS: We found multiple correlations between the ratio of bioorganic phosphate peaks and parameters of glucose uptake by tumor tissue. These relationships were more significant in patients with high-grade tumors: positive significant correlation between SUVtumor and PME/PCr ratio (RS=0.75, p=0.01), T/Nmix and ßATP/Pi ratio (Rs=0.76, p=0.02), SUVpeaktumor and aATP/Pi ratio (RS=0.77, p=0.008). Moreover, there were negative correlations between SUVtumor and PCr/bATP ratio (RS= -0.66, p=0.05), T/Nmix and PDE/bATP ratio (RS= -0.83, p=0.006), SUVpeaktumor and PDE/aATP ratio (RS= -0.76, p=0.009). CONCLUSION: High-grade gliomas were characterized by higher glucose consumption, ATP release (intensification of energy metabolism) and faster cell membrane synthesis. These processes indicate enhanced proliferation of tumor cells (intensification of plastic metabolism).

[3D proton MR spectroscopy of the gray and white brain matter. A study of 15 volunteers]. / Protonnaia 3D MR-spektroskopiia serogo i belogo veshchestva golovnogo mozga. Issledovanie 15 dobrovol'tsev.

One of the important problems of modern diagnostics of brain diseases is detection of early lesions, which determines the choice of patient management and the disease outcome. The introduction of magnetic resonance imaging in practice has significantly improved the quality of diagnosis. Multivoxel proton magnetic resonance spectroscopy is an additional and clarifying technique enabling non-invasive examination of changes in brain metabolism in tumors as well as simultaneous acquisition of information on metabolism in surrounding tissues and in the intact brain matter. Along with single voxel MR spectroscopy (SV MRS) and 2D MRS (CSI Chemical Shift Imaging), 3D proton MRS (MRSI) has been increasingly used in clinical practice, which enables single-run acquisition of data on the metabolite composition for the entire volume of interest. OBJECTIVE: To assess the possibility of using multivoxel 3D proton MRS in healthy volunteers without organic brain pathology. MATERIAL AND METHODS: In this study, 15 volunteers without organic brain pathology were examined using the 3D 1H-MRS. CONCLUSION: 3D proton MRS has proven to be an effective technique in studying the brain metabolism. One short-term series of examinations provided information on intact brain metabolism at different anatomical levels, which enabled their comparison both in spectral data and in parametric maps of the major metabolite distribution.

[Craniofacial tumors blood supply]. / Krovosnabzhenie kraniofatsial'nykh opukholei.

Because of the spread to different anatomical regions, craniofacial tumors (CFTs) usually receive blood supply from several arterial systems, and CFT removal is often accompanied by abundant blood loss. PURPOSE: The study purpose was to develop an algorithm of diagnostic angiography for planning surgical treatment of CFT patients. MATERIAL AND METHODS: Complex preoperative angiography was performed in 72 patients with craniofacial tumors, aged 10 to 78 years (mean age, 45.5 years), who underwent surgical treatment at the Burdenko Neurosurgical Institute in the period from 2012 to 2015. At the first stage, blood supply to tumors was quantified using SCT perfusion. Then, depending on an assessed degree of tumor vascularization, direct angiography or modern minimally invasive angiographic techniques (3D TOF HR MR angiography, SCT angiography) were applied. RESULTS: In 12 cases of hypervascular tumors, accessible afferents were preoperatively embolized through the external carotid artery, which was accompanied by an increase in the blood supply to tumors via alternative routes of the external and internal carotid arteries. The obtained data were used to plan the surgical approach. A comparative analysis of the SCT perfusion data and the expression level of endothelial markers in histological specimens revealed no significant correlation. CONCLUSION: The study demonstrated the importance of a comprehensive assessment of the blood supply to CFTs in planning of the surgical treatment and enabled the development of algorithms for preoperative angiographic diagnosis, depending on the baseline clinical and radiological data.

[A correlation between diffusion kurtosis imaging and the proliferative activity of brain glioma].

UNLABELLED: The aim of the study was to assess the capabilities of diffusion kurtosis imaging (DKI) in diagnosis of the glioma proliferative activity and to evaluate a relationship between the glioma proliferative activity index and diffusion parameters of the contralateral normal appearing white matter (CNAWM). MATERIAL AND METHODS: The study included 47 patients with newly diagnosed brain gliomas (23 low grade, 13 grade III, and 11 grade IV gliomas). We determined a relationship between absolute and normalized parameters of the diffusion tensor (mean (MD), axial (AD), and radial (RD) diffusivities; fractional (FA) and relative (RA) anisotropies) and diffusion kurtosis (mean (MK), axial (AK), and radial (RK) kurtosis; kurtosis anisotropy (KA)) and the proliferative activity index in the most malignant glioma parts (p<0.05). We also established a relationship between the tensor and kurtosis parameters of CNAWM and the glioma proliferative activity index (p<0.05). RESULTS: The correlation between all the absolute and normalized diffusion parameters and the glioma proliferative activity index, except absolute and normalized FA and RA values, was found to be statistically significant (p<0.05). Kurtosis (MK, AK, and RK) and anisotropy (KA, FA, RA) values increased, and diffusivity (MD, AD, RD) values decreased as the glioma proliferative activity index increased. A strong correlation between the proliferative activity index and absolute RK (r=0,71; p=0.000001) and normalized values of MK (r=0.8; p=0.000001), AK (r=0.71; p=0.000001), RK (r=0.81; p=0.000001), and RD (r=-0.71; p=0.000001) was found. A weak, but statistically significant correlation between the glioma proliferative activity index and diffusion values RK (r=-0.36; p=0.014), KA (r=-0.39; p=0.007), RD (r=0.35; p=0.017), FA (r=-0.42; p=0.003), and RA (r=-0.41; p=0.004) of CNAWM was found. CONCLUSION: DKI has good capabilities to detect immunohistochemical changes in gliomas. DKI demonstrated a high sensitivity in detection of microstructural changes in the contralateral normal appearing white matter in patients with brain gliomas.

[3D-TOF MR-angiography with high spatial resolution for surgical planning in insular lobe gliomas].

UNLABELLED: Despite the obvious progress in modern neurosurgery, surgery for glial tumors of the insular lobe is often associated with a high risk of postoperative neurological deficit, which is primarily caused by damage to perforating arteries of the M1 segment of the middle cerebral artery. OBJECTIVE: The work is aimed at evaluating the effectiveness of high resolution time-of-flight (3D-TOF) MR angiography in imaging of medial and lateral lenticulostriate arteries and determining their relationship to tumor edge in patients with gliomas of the insula. MATERIAL AND METHODS: 3D-TOF MR angiography data were analyzed in 20 patients with primarily diagnosed cerebral gliomas involving the insula. All patients underwent non-contrast enhanced 3D-TOF MR angiography. In 6 cases, 3D-TOF MRA was performed before and after contrast enhancement. RESULTS: 3D-TOF angiography before intravenous contrast injection was capable of visualizing the medial lenticulostriate arteries in 19 patients (95% of all cases) and lateral lenticulostriate arteries in 18 patients (90% of all cases). Contrast-enhanced 3D-TOF angiography allows for better visualization of both the proximal and distal segments of lenticulostriate arteries. Three variants of relationship between the tumor and lenticulostriate arteries were identified. Variant I: the tumor grew over the arteries without their displacement in 2 cases (10% of the total number of observations); variant II: the tumor caused medial displacement of arteries without growing over them in 11 cases (55% of the total number of observations); variant III: the tumor partially grew over and displaced arteries in 2 cases (10%). In 25% of cases (5 patients), tumor was poorly visualized on 3D-TOF MR angiograms because their signal characteristics did not differ from those of the medulla (tumor tissue was T1 isointense). As a result, it was impossible to determine the relationship between the tumor and lenticulostriate arteries. CONCLUSION: High spatial resolution time-of-flight MR angiography can be recommended for preoperative imaging of lenticulostriate arteries to plan the extent of neurosurgical resection in patients with glial tumors of the insular lobe.

[The structure of activation of the language zone in patients with intracerebral tumors according to fMRI with respect to tumor location and the functional asymmetry profile].

MATERIAL AND METHODS: A total of 50 patients were examined prior to surgical resection of intracranial tumors of the temporal and frontal lobes. Left-sided tumors were observed in 33 patients and right-sided tumors were observed in 17 patients. The functional asymmetry profile was determined using self-assessment, the Annet questionnaire, and the dichotic listening task. Twelve patients were left-handers or retrained left-handers and the remaining 38 patients were right-handers. FMRI examination was carried out on a 3.0 T SignaHDxt magnetic resonance tomograph (GE). The standard language block design paradigm was used in the study. We used the following tests: 1) recitation of months in reverse order; 2) generation of nouns according to the initial letters shown on the screen (K, M, L, N, P, C); 3) generation of verbs according to simple actions shown on the screen; 4) producing sentences using nouns shown on the screen; 5) listening to text through headphones. Data were processed using the standard BrainWave PA software (General Electric). Z-test was used in the range from 6 to 9. In all the studies, p<0.001. Statistical data processing included the nonparametric Spearman's test to determine the correlation between lateralization of the detected activation zone under speech load and tumor location (tumor is adjacent to the language zone, invades the language zone, or is located far from the language zone), as well as left- or right-handedness. RESULTS: Among 16 patients (right-handers and 2 left-handers) the activation of language zones was observed only on the left side; in one left-handed patient, Broca's area was detected only on the right side. In other patients (including right-handers with right-sided tumors), lateralization of language zones was different, including bilateral. Statistical processing revealed that bilateral activation of both Broca's and Wernicke's areas was more frequently observed in left-handers. Broca's area was more frequently detected on the left side in the presence of a distant tumor, while this trend did not apply for Wernicke's area. CONCLUSION: Localization of activation of Broca's area is more dependent on tumor location, while it depends on personal characteristics of an individual in the case of Wernicke's area.

[SCT perfusion in the diagnosis of sellar and parasellar tumors].

UNLABELLED: The study is devoted to the use of a minimally invasive method of SCT perfusion for the differential diagnosis of sellar and pаrаsellar tumors. Given a wide differential diagnostic range of tumors occurring in this area, the tumor perfusion indicators were used as an auxiliary diagnostic criterion. MATERIAL AND METHODS: The study analyzed outcomes in 115 patients with various tumors of the sellar area who underwent surgery or biopsy for histological verification of the diagnosis. RESULTS: The statistically significant differences were obtained for certain groups of tumors based on the values of hemodynamic parameters (p<0.05) that enable, with a high confidence, making a conclusion on the histologic type of most tumors. CONCLUSION: These findings demonstrated that SCT perfusion is a highly informative method of the preoperative differential diagnosis of these tumors. The sensitivity and specificity of SCT perfusion in the study were 100% and 81.2%, respectively.

[The analysis of fMRT answer's individual variability at healthy examinees when opening eyes, motor and speech tests].

This paper analyzes the variation of the functional anatomy of the brain in healthy people performing identical activities on the basis of functional magneticresonance imaging (fMRI). According to the authors, this approach allows you to showcase a variety of individual strategies to achieve the same external (behavioral) result intracerebral different means, and to identify the factors that determine this diversity. Investigated hemodynamic (fMRT) brain reactions at activization of attention to opening of eyes, motor (search of the right and left hand fingers) and speech tests (mental transfer of months or days of the week upside-down) at 21 healthy subjects (21-30 years): 14 men, 7 women. Certain variety of fMRT answers is revealed: 3-4 jet types of hemodynamic changes were allocated for test in group, and the percent of supervision of each type fluctuated from 40 to 10%. Shown marked gender differences responses which specificity is determined by the nature of the functional load. In motor and speech tests, performed with his eyes closed, fMRI response in women is characterized by greater specificity and locality than in men. At motor tests fMRT answers of men are accompanied big, than at women, inclusion in reaction of frontal areas of the cortex, providing realization of regulatory functions. When opening of eyes the women's fMRT responses, on the contrary, become more diffusion, and men's--more local.

[EEG and fMRI reactions of a healthy brain at active and passive movements by a leading hand].

Bioelectrical (EEG) and hemodynamic (fMRI) responses of cerebral reactions to active and passive movements by the right hand were analyzed in 17 right-handed healthy persons. Individual and averaged fMRI and EEG data was analyzed. The main cortex fMRI responses (sensorimotor cortex of the contralateral, left hemisphere) were topographically similar during both active and passive movements. This fact allows us to recommend the usage of the passive movement paradigm for the mapping of the motor areas in patients with movement disorders. Including in reactive process of cerebellum and subcortical structures at passive movements was more variability than active ones. FMRI-reactions at passive movements were characterized more individual variability than during active ones at the expense of diversity of cerebellum and subcortical structures answers. The EEG analysis revealed that at both passive and active movements there is a coherence increase in the high-frequency alpha-ban in left central-frontal area of the left, activated hemisphere. The power-frequency changes of the EEG parameters during active and passive movements were primarily shown in a frequency increase and the desynchronization of the beta-band. Consistency with the topography of the fMRI response was not found.

[Neuroanatomical basis for traumatic coma: clinical and magnetic resonance correlates].

In this paper, the relationship between brain lesion localization (verified by magnetic resonance imaging (MRI)) and the severity of traumatic brain injury (TBI) and its outcomes is presented. Magnetic resonance studies in different modes (T1, T2, FLAIR, DWI, DTI, T2 * GRE, SWAN) were performed in 162 patients with acute TBI. Statistical analysis was done using Statistica 6, 8 software and R programming language. A new advanced MRI-based classification of TBI was introduced implying the assessment of hemispheric and brainstem traumatic lesions level and localization. Statistically significant correlations were found between the Glasgow coma and outcome scales scores (p < 0.001), and the proposed MRI grading scale scores, which means a high prognostic value of the new classification. The knowledge of injured brain microanatomy coming from sensitive neuroimaging, in conjunction with the assessment of mechanisms, aggravating factors and clinical manifestation of brain trauma is the basis for the actual predictive model of TBI. The proposed advanced MRI classification contributes to this concept development.

[Structural and functional peculiarity of brain activity to performance and imaginary motor tasks in healthy persons (EEG and fMRI study)].

Bioelectrical (EEG) and hemodynamic (fMRI-response) cerebral reactions to performance and imaginary motor tasks by right or left hand were analyzed in 15 right-handed healthy persons (21-39 years old). During actual movement the main fMRI-response was registered in the area of central gyrus of the hemisphere contralateral to the working hand. Areas of activation were also revealed in the supplemental motor area and the ipsilateral hemisphere of the cerebellum. EEG data showed coherence increase in high frequency alpha- and beta-bands in the activated hemisphere. In imaginary motor tasks the intensity and topography of fMRI-response became the more variable; response was decreased in the motor area and in cerebellum, they increased in the subcortical structures and in the parietal association zones. EEG changes were very variable in this situation also; it was observe an increase of EEG coherence in the right hemisphere for higher frequency of alpha and beta spectral bands. Changes of power spectrum parameters were similar to performance and imaginary motor tasks. Spectrum power and middle frequency of beta band were increased. Topographically these changes did not correspond to activated hemisphere and it was more in the left hemisphere. These changes were reflected nonspecific component of reaction.

[fMRI study of the dominant hemisphere for language in patients with brain tumor].

THE AIM OF THE STUDY: Paper describes a study of language lateralization of patients with brain tumors, measured by preoperative functional magnetic resonance imaging (fMRI) and comparison results with tumor histology and profile of functional asymmetry. METHODS: During the study 21 patient underwent fMRI scan. 15 patients had a tumor in the left and 6 in the right hemisphere. Tumors were localized mainly in the frontal, temporal and fronto-temporal regions. Histological diagnosis in 8 cases was malignant Grade IV, in 13 cases--Grade I-III. fMRI study was perfomed on scanner "Signa Exite" with a field strength of 1.5 As speech test reciting the months of the year in reverse order was used. fMRI scan results were compared with the profile of functional asymmetry, which was received with the results of questionnaire Annette and dichotic listening test. RESULTS: Broca's area was found in 7 cases in the left hemisphere, 6 had a tumor Grade I-III. And one patient with glioblastoma had a tumor of the right hemisphere. Broca's area in the right hemisphere was found in 3 patients (2 patients with left sided tumor, and one with right-sided tumor). One patient with left-sided tumor had mild motor aphasia. Bilateral activation in both hemispheres of the brain was observed in 6 patients. All of them had tumor Grade II-III of the left hemisphere. Signs of left-handedness were revealed only in half of these patients. Broca's area was not found in 4 cases. All of them had large malignant tumors Grade IV. One patient couldn't handle program of the research. CONCLUSIONS: Results of fMRI scans, questionnaire Annette and dichotic listening test frequently were not the same, which is significant. Bilateral activation in speech-loads may be a reflection of brain plasticity in cases of long-growing tumors. Thus it's important to consider the full range of clinical data in studying the problem of the dominant hemisphere for language.

[Meningioma challenge: analysis of 80-year experience of Burdenko Neurosurgical institute and future perspectives].

The paper describes the history of meningioma surgery at Burdenko Neurosurgical Institute, analyses of accumulated series of patients and assesses effectiveness of different techniques for meningioma diagnosis and treatment of. We analyzed 15413 patients with meningiomas operated in Burdenko Neurosurgical Institute from 1932 to 2011. Mathematical analysis was performed using Statistica 6.0 program. Mortality rate during World War II reached a disastrous level of 45,8%, in 21st century it is below 1%. Temporary and permanent morbidity has also decreased. While in 1961 Karnofsky performance score was 71, in 2011 it became 83. The probability of postoperative tumour recurrence also diminished, from 40% in 1960-s to 29% in 1996 and presumably to 25% nowadays. Independent factors that influence the risk of recurrence are primary gross total resection, grade of anaplasia and radiation therapy. However, unreasonably aggressive surgery leads to significant increase of morbidity. Further improvement of surgical results in patients with meningiomas depends on implementation of new technologies for neurovisualization, abandoning extensive surgical approaches whenever possible, finding the "balance" between radical removal and expected functional outcome, wider application of radiosurgery and three-dimensional conformal radiation therapy.

[Working results of the electronic "on-line" version of the Spine Registry for Degenerative Lumbar Spine Diseases and study of its synchronization capacity with the electronic case history]. / Itogi raboty portal'noi versii poiasnichnogo vertebrologicheskogo registra i izuchenie voprosa ego sinkhronizatsii s élektronnoi istoriei bolezni.

AIM: To assess the results of use of lumbar spine on-line registry in 2012 (IV quarter). MATERIAL AND METHODS: The Burdenko Neurosurgery Institute of the Russian Academy of Medical Sciences (RAMS) and the System Analysis Institute of the Russian Academy of Sciences (RAS) have developed an electronic "on-line" portal of the Spine Registry for Degenerative Lumbar Spine Diseases. The data on 1295 retrospective and 145 prospective patients who underwent treatment in Burdenko Neurosurgery Institute, the "AXIS" clinic, Medical Centre of the Bank of Russia, "Marina Spine Clinic" LA, USA and in the Neurosurgery department of Research Institute of Traumatology and Orthopedics, Nizhny Novgorod were analyzed. Since May 2012 to the present time outcomes of 1295 (retrospective group) and 145 (prospective group) patients with Degenerative Lumbar Spine Diseases, which underwent treatment from 2002 to 2012 were entered into online registry and subsequently analyzed. The current study has revealed two problems that need to be discussed. First problem is that the archived information is not sufficient for data base update. The second problem is low activity of many physicians in inputting data into the register. We believe that the solution of these problems lies in the plane of synchronization of on-line registry with electronic medical records. This synchronization between registry and online records will allow studying their joint work. If found to be successful after the development of the other sections of the register they will be added to an already running version as provided by the principles of its work - scalability and extesibility. The results of this work will be profile of vertebrological version of electronic medical records. In the future it could be used in clinics dealing with spine disorders. RESULTS: Since May 2012 the outcomes of 1295 (retrospective group) and 145 (prospective group) patients with Degenerative Lumbar Spine Diseases, who were operated on in Burdenko Neurosurgery Institute (Moscow, Russia), minimally invasive spinal surgery clinic "AXIS" (Moscow, Russia), Medical Centre of The Bank of Russia (Moscow, Russia), "Marina Spine Clinic" (LA, USA) and Neurosurgery department of Research Institute of Traumatology and Orthopedics (Nizhny Novgorod, Russia) from 2002 to 2012 were analyzed. The perspective of this work is development of other parts of spine registry (for cervical and thoracic spine) and improving the outcome assessment process in Russian spinal surgery clinics.

[Modern technology in the surgical treatment of head injury sequelae].

The paper presents main types of surgically relevant posttraumatic lesions in 4136 patients with skull vault as well as skull base defects, craniofacial deformities, recurrent CSF leaks, arterio-venous fistulas, aneurysms and pseudoaneurysms etc. Classification of TBI sequelae and complications as well as its clinical course grading is presented. The use of modern neuroimaging techniques for studying pathophysiologic mechanisms and complications of TBI has been demonstrated. Special emphasis was given to minimally invasive and reconstructive surgery; computer modeling with subsequent full-copy stereolitographic laser implant setup was shown which is of great importance in cases of large and complex skull base and craniofacial deformities. Patient selection for transcranial and endonasal CSF leak closure techniques was justified. Treatment of post-traumatic vascular injuries using Serbinenko balloon-catheters as well as modern techniques such as stents, coils and embolization has been demonstrated.

[Comparison of reactive EEG changes and fMRI characteristics of brain health based on multivariate statistics].

To gain a deeper insight into the relationship between the electrogenesis and oxygenation of the brain, fMRI and EEG reactions to identical functional loads (opening of the eyes and right- and left-hand fingering) were compared in 11 young right-handed healthy subjects with statistical techniques. Changes in power, frequency and coherent EEG parameters obtained by 18-channel monopolar recording were compared with values of + BOLD-fMRI response, calculated for 18 corresponding cortical areas on the basis of application of the "virtual cap" by the original algorithm. In reactive changes of both hemodynamic and bioelectrical parameters, sets of independent factors were identified, which were regarded on the basis of their topography as specific (localized in the cortical representation ofa relevant analyzer) and nonspecific (diffuse and similar under different functional loads). Specific component dominated in the fMRI response, whereas non-specific component was characteristic of the EEG reaction. The similar topography of reactive fMRI and EEG factors under normal conditions, confirmed by the correlation analysis, reflects the multilevel character of the systemic organization of the brain activity, visualized, in particular, in the sagittal projections of the individual fMRI images. Each of the reactive EEG factors included all of the EEG quantitative characteristics. EEG coherence, which dominated among other parameters (with a local increase in the cortical representation of a relevant analyzer and a diffuse decrease in the areas of the influence of the regulatory structures) displayed the highest correlation with hemodynamic responses of the brain.

[Analysis of radiological criteria correlation and clinical manifestation of central lumbosacral spinal stenosis].

OBJECTIVE: to assess the correlation analysis of radiologic criteria referred to central degenerative spinal stenosis and intensity of clinical manifestation. MATERIALS AND METHODS: a retrospective cohort data were collected from 2010 till 2011, 27 patients who underwent surgical treatment of central spinal stenosis in Burdenko Neurosurgical Institute. 16 male and 11 female patients were included in the present study. Mean age of the patients at the time of surgery was 57.9 years. All patients had spinal canal decompression and transpedicular or oblique transcorporal fusion. Stabilization included different types of pedicle screws, including transcutaneous stabilization systems. Interbody fusion was achieved by posterolateral transforaminal approach (TLIF --transforaminal lumbar interbody fusion). 13 cases included combination of interbody fusion and guided oblique lumbar interbody fusion "GO-LIF", which could not be managed without robotic assistance. All patients underwent full preoperative examination. MR image evaluation included: antero-posterior diameter of the spinal canal (mm), interfacet interval (mm), and cross-section area of the spinal canal (mm2). Patients were evaluated by outcome analysis scales: Degenerative Disease Intensity Level (DDIL) and Swiss Spinal Stenosis Score (Zurich Claudication Questionnaire, Brigham spinal stenosis questionnaire). Surgical outcomes were evaluated according to modified classes of Kawabata et al. RESULTS AND DISCUSSION: analysis of our patients group demonstrated absence of correlation between intensity level of degenerative central spinal stenosis based on neurovisualization methods and intensity of its clinical manifestation. Pearson's coefficient of correlation and Spearmen rank correlation for variable which evaluates clinical signs (DDIL in %) and neurovisualization data (antero-posterior diameter of the spinal canal (mm), interfacet interval (mm), and cross-section area of the spinal canal (mm2)) are not significant to zero (p > 0.2).

[Evidence-based medicine methods and critical reading of the paper devoted to degenerative lumbar and sacral spinal stenosis (comment to the article)].

The paper provides critical analysis of the article "Correlated analysis of radiologic criteria's referred to central degenerative spinal canal stenosis and intensity of clinical implications". Critical analysis was carried out by the 5-step evidence cycle. First step is supposed to formulate primary goal of the research and identify its type. This investigation belongs to prognostic studying of certain patient's characteristics and their impact on the state of disease and the treatment outcome. According to Oxford evidence based center of medicine gradation, this study is attributed to level IV (clinical series). Analysis performed allowed to state that investigation sampling might be considered as representative, but nonhomogeneous. Absence of blind evaluation of the treatment results could alter treatment outcomes when compared by two different scales. Multifactor analysis was not held in the present study. Analyzed investigation has low methodological level, however, it has no major disadvantages. Statistical significance between various factors and clinical effect can be achieved when study is based upon database analysis of many patients, which however cannot be managed by efforts of a single medical institution. Organizing investigations by registration treatment outcomes with follow up evaluation nationwide could be a problem solution. In particular, vertebrological register might be a very useful tool for development prognostic risk scales and predictive models in degenerative spine disease surgery.

[Application of robotized radiosurgical system CyberKnife for the treatment of neurosurgical patients].

Robotized system for radiosurgery CyberKnife (Accuray Inc., USA) is the first device dedicated and optimized for advanced irradiation during 1-7 fractions (i.e. radiosurgery and hypofractionation). CyberKnife is characterized by elaborate guidance system, high precision of dose delivery, possibility of conformal dose distributions with high gradient of target borderline dose which is most important in proximity of critical structures. The first CyberKnife system in Russia was installed in Burdenko Neurosurgery Institute. The paper presents 2-year experience of treating patients using CyberKnife. From April 2009 till October 2011 896 patients were treated using CyberKnife. Mean age was 48 years. Overall number of sessions was 2626. Radiosurgical procedures were performed in 21.8% of patients. 91% of cases were treated for intracranial lesions. Limited follow-up period in all kinds of pathology demonstrated results consistent with standard fractionation or radiosurgery. The rates of observed complications were also comparable with accepted techniques. CyberKnife system plays significant role in everyday activity of department of radiation therapy. In careful and thorough selection of patients it allows efficient and high-quality treatment of patients with neurosurgical diseases.

[Neuroradiological diagnostics of atherosclerotic lesions and kinking of the carotid arteries in determination of indications to surgical treatment].

Range of methods for diagnostics of extracranial arterial stenosis includes both untrasonic techniques (transcranial Doppler study, duplex sonography, which are not only screening methods, but also used in surgery as well) and high-tech imaging methods--spiral CT scans and MR angiography with visualization of structural changes in vascular wall, quantitative and functional assessment of blood flow in vessels. Aim of this study was to determine the effective of non-invasive diagnostic techniques--MR angiography (MRA), including phase-contrast MRA (PCMRA), and spiral CT angiography (SCTA) in identification and comprehensive assessment of stenosis of internal carotid artery and comparison of capabilities of these methods with gold standard--direct angiography.