[Genetic factors in degenerative disc disease]. / Rol' geneticheskikh faktorov v razvitii degenerativno-distroficheskogo porazheniya mezhpozvonkovykh diskov.

OBJECTIVE: To analyze available literature data on the role of genetic factors in degenerative disc disease. METHODOLOGY: We reviewed the PubMed, MEDLINE, Cohrane Library, e-Library databases using the following keywords: degenerative spine lesions, intervertebral disc herniation, pathogenesis, genetic regulation. RESULTS: Searching depth was 2002-2022. We reviewed 84 references. Exclusion criteria: duplicate publications, reviews without detailed description of results, opinions. Finally, we included 43 the most significant studies. CONCLUSION: There are literature data on proinflammatory cytokines, growth factors and osteodestructive processes in pathogenesis of degenerative disc disease. However, there is only fragmentary information about the role of genetic regulation of these processes. Some factors, such as microRNA, TGF-b, VEGF, MMP are still poorly understood.

[Etiopathogenetic substantiation of surgical treatment of neurogenic pain syndromes]. / Etiopatogeneticheskoe obosnovanie khirurgicheskogo lecheniya neirogennykh bolevykh sindromov.

The purpose of the study was to improve classification of neurogenic (neuropathic) pain syndromes. This will make it possible to define the indications for appropriate analgesic surgery for each type of drug-resistant neurogenic pain syndrome. Incorrect management of neurogenic pain syndromes is usually associated with underestimation of pathogenetic prerequisites for its occurrence. Differentiation of compression, deafferentation and mixed neurogenic pain syndromes makes it possible to determine appropriate surgery and avoid tactical errors. Moreover, this approach allows you to save patients from unreasonable long-standing suffering. Patients with chronic pain syndromes often become disabled, sometimes in the prime of life, and isolated from society and family. Therefore, treatment of chronic pain is currently an urgent problem.

[Questionnaire of the Ryzhikh National Medical Research Centre for Coloproctology is a new tool for assessing chronic pelvic pain and pelvic organ dysfunction]. / Oprosnik NMITs koloproktologii imeni A.N. Ryzhikh ­ novyi instrument otsenki khronicheskoi tazovoi boli i narusheniya funktsii tazovykh organov.

The article presents the work of a multidisciplinary team of experts from various fields of medicine to optimize the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology¼ for use in clinical practice. The survey of respondents was conducted from June 28 to September 28, 2021. As a result of this survey, by repeatedly making edits and clarifications during communication with respondents, the final version was obtained, which allows assessing the patient's subjective sensations by the nature and localization of pelvic pain, sensitivity disorders and pelvic organ function. The main objective of this Questionnaire is to differentiate patients with neurogenic pain from a huge number of patients with chronic pelvic pain. This aspect will allow a more targeted approach to the diagnosis and pathogenetically justified treatment of patients, including after appropriate instrumental examinations. The work of a multidisciplinary team implies a higher degree of objectification and terminological accuracy of the Questionnaire under discussion. The presented version of the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology¼ will be primarily used in coloproctological patients with pelvic pain problems and anal incontinence and obstructive defecation. Further studies will be directed to the clinical evaluation of the results of the work carried out.

[Successful microsurgical resection of a large brainstem abscess: case report and literature review]. / Uspeshnoe mikrokhirurgicheskoe udalenie abstsessa stvola golovnogo mozga: sluchai iz praktiki i obzor literatury.

OBJECTIVE: To present a patient with brainstem abscess treated by microsurgical resection. CASE PRESENTATION: A 53-years-old female patient admitted to the neurosurgical department in a severe condition with symptoms of intracranial hypertension, hyperthermia, general infectious signs and laboratory manifestations of infectious process. Contrast-enhanced MRI revealed a large brainstem lesion (abscess). Retrosigmoid craniotomy with total microsurgical resection of the abscess was performed. External ventricular drainage was incerted on the second postoperative day due to progressive hydrocephalus with clinical deterioration, it was removed in 8 days. Slow positive dynamics was observed in postoperative period. The patient was discharged in 2 weeks after surgery. CONCLUSION: There are no established algorithm for the treatment of brainstem abscesses. Therapeutic approach is advisable for small abscesses. There are 2 neurosurgical options for this lesion: stereotactic drainage and microsurgical resection with or without external ventricular drainage. Treatment strategy depends on location and size of abscess, as well as clinical state of the patient.

[Surgical treatment of thoracic spine fracture in a patient with ankylosing spondylitis: case report and literature review]. / Khirurgicheskoe lechenie pereloma grudnogo otdela pozvonochnika na fone ankiloziruyushchego spondilita: klinicheskii sluchai i obzor literatury.

OBJECTIVE: To describe the features of diagnosis and surgical treatment of thoracic spine fracture in a patient with ankylosing spondylitis. MATERIAL AND METHODS: We present a patient with ankylosing spondylitis, blunt thoracic spine trauma and Th10-Th11 fracture, spinal cord compression and contusion and moderate lower extremity paresis. Preoperative and postoperative CT and MRI (after 8 months) were performed for control of decompression. RESULTS: The authors identified the main factors affecting the quality of life of patients with spine fractures following ankylosing spondylitis and formulated treatment algorithm. CONCLUSION: Active strategy is advisable for spine fractures following ankylosing spondylitis: spinal cord decompression, creation of anatomical compliance in the damaged vertebral segment and its fixation by transpedicular system. A similar surgical treatment of spine fractures following ankylosing spondylitis makes it possible to achieve early activation of patients and reduce rehabilitation period.

[Stimulating electroneuromyography in the diagnosis of neurogenic disorders of the pelvic floor muscles]. / Stimulyatsionnaya elektroneiromiografiya v diagnostike neirogennykh narushenii funktsii myshts tazovogo dna.

The article describes the technology for detecting and studying late phenomenon in stimulating electroneuromyography in order to objectively assess the state of innervation. The standard study of the motor response (M-response), Pudendal nerve terminal motor latency testing (PNTML), using the St. Mark's electrode from the external sphincter and pelvic floor muscles provides information only about efferent innervation at the distal part of the n. pudendus. At the same time, there are sparse reports in the literature on the study of the state of the mixed-fiber pudendal nerve along its entire length from its exit from the intervertebral foramen to the distal part using the St. Mark's electrode, the method is not clearly described, which, accordingly, causes the lack of application of the technique in clinical practice. The authors of this article cite the methodology for studying the late phenomenon in the form of a mixed feedback-reflex in stimulating electroneuromyography, describing the need to consistently use both methods of its registration.

[Efficiency and safety of minimally invasive approaches for microsurgical treatment of brain aneurysms]. / Effektivnost' i bezopasnost' ispol'zovaniya minimal'no invazivnykh dostupov v mikrokhirurgicheskom lechenii tserebral'nykh anevrizm.

Background. Brain aneurysms are found in 1-2% of population and cause subarachnoid hemorrhage (SAH) in 80-85% of cases. In recent decades, the incidence of unruptured aneurysms has increased due to widespread availability of CT and MRI. Microsurgery is still essential in the treatment of cerebral aneurysms. OBJECTIVE: To assess the effectiveness and safety of minimally invasive approaches in microsurgical treatment of brain aneurysms in comparison with traditional approaches, to clarify the indications and contraindications for minimally invasive approaches. MATERIAL AND METHODS: There were 394 patients with cerebral aneurysms for the period 2014-2019. All patients were divided into 2 groups depending on surgical approach: traditional approach (TrA) (n=171, 43.4%) and minimally invasive approach (MiniAp) (n=223, 56.6%). In the TrA group, pterional (n=85), orbitozygomatic (n=23) and lateral supraorbital approaches (n=63) were used. In the MiniAp group, transbrow supraorbital (n=88), mini-pterional (n=62), transbrow transorbital (n=37) and transpalpebral transorbital approaches (n=36) were used. Treatment outcomes were compared in both groups for patients with ruptured and unruptured aneurysms. We evaluated intra- and postoperative complications, surgery time and postoperative hospital-stay. Neurological outcomes were assessed using the Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRs). Cosmetic outcomes were compared using the visual analogue cosmetic scale. Unilateral hypesthesia and eyebrow movement were assessed separately after 3, 6 and 12 months. RESULTS: In acute period of SAH, surgery time was significantly less in the MiniAp group (p=0.001). There were no significant between-group differences in the incidence of intraoperative rupture, surgical and neurological complications (p>0.05). Postoperative hospital-stay was significantly less in the MiniAp group (p=0.006). In this group, neurological outcomes were slightly better (p<0.001), there was no mortality, adverse outcomes occurred in 5.3% of cases (n=5). In the TrA group, 1 patient died from postoperative hematoma, adverse outcomes were noted in 9 (8.7%) patients. Cosmetic outcomes were significantly better in the MiniAp group (p<0.001). In delayed period of SAH and unruptured aneurysms, surgery time was less in the MiniAp group (p=0.051). Incidence of intra- and postoperative complications was similar in both groups (p>0.05). Hospital-stay was significantly shorter in the MiniAp group (p<0.001). Functional outcomes were comparable in both groups. Cosmetic outcomes were significantly better in the MiniAp group (p<0.05). CONCLUSION: MiniAp and TrA are characterized by similar efficacy in microsurgical treatment of cerebral aneurysms. MiniAp is recommended only for experienced neurosurgeons in a specialized hospital. Safety and effectiveness of MiniAp are achieved by careful selection of patients, individual neuroimaging and preoperative planning.

[Cavernous malformation of the optic nerve: clinical case and literature review]. / Kavernoznaia mal'formatsiia zritel'nogo nerva: sluchai iz praktiki i obzor literatury.

INTRODUCTION: Cavernous malformation (cm) of the optic nerve is a rare condition It is clinically presented by the so-called chiasmal apoplexy. Microsurgical removal of cavernous malformation is the method of choice. MATERIAL AND METHODS: Authors present a clinical case of the removal of cavernous malformation of the left optic nerve. RESULTS: The presented case demonstrates the successful removal of the CM of the left optic nerve from the lateral supraorbital access. In the postoperative period, visual disorders did not worsen. Control MRI of the brain showed total removal of cavernoma. CONCLUSION: Presented clinical case demonstrates the radical removal of CM of the optic nerve. Early and correct diagnosis makes it possible to adequately treat the patient and preserve his/her visual functions.

[Bilateral supraorbital keyhole approach in surgery of multiple cerebral aneurysms: a case report and literature review]. / Bilateral'nyi supraorbital'nyi keyhole-dostup v khirurgii mnozhestvennykh anevrizm sosudov golovnogo mozga: sluchai iz praktiki i obzor literatury.

The choice of an approach in surgery of bilateral multiple aneurysms is a complex and topical issue. According to the literature data, the occurrence rate of multiple aneurysms varies between 6.5 and 33%. Many authors have proposed various modern microsurgical approaches to reduce the risk of adverse surgical outcomes. The need for surgery in several vascular territories requires a detailed assessment of the topographo-anatomical relationships upon choosing a surgical approach. An important issue is preliminary planning and personalization of an approach for a particular patient. MATERIAL AND METHODS: We report a case of clipping of mirror middle cerebral artery aneurysms using a minimally invasive bilateral approach. RESULTS: The presented case demonstrates successful clipping of middle cerebral artery aneurysms in different vascular territories using the bilateral supraorbital approach: a skin incision along the eyebrow followed by supraorbital keyhole craniotomy. Follow-up CT angiography in the postoperative period demonstrated elimination of aneurysms from the bloodstream. The cosmetic effect after the intervention was evaluated as excellent. CONCLUSION: The bilateral supraorbital approach in surgery of multiple mirror aneurysms may be recommended as an alternative to the contralateral or bilateral pterional approach. The bilateral supraorbital approach avoids additional traction of the frontal lobes, provides a focused personalized approach, and is a safe and effective approach with excellent cosmetic results.

[Treatment of uncomplicated vertebral compression fractures]. / Lechenie neoslozhnennykh kompressionnykh perelomov pozvonochnika.

According to statistical studies in different countries, the annual incidence of spine and spinal cord injuries is 15-50 cases per 1 million people. In Russia, the incidence of this condition is 5% of the total number of all nonpenetrating traumatic injuries (Neurosurgery: Guidelines for Physicians, ed. by Prof. ON Dreval', 2013). According to the WHO reports, approximately 500,000 people annually experience spine injuries worldwide. Acute spine injuries make up 23.7% of all spinal traumas and include contusions (2.67%), injuries to the capsular ligamentous apparatus (3.88%), fractures and dislocations (7.63%), and muscle injury (9.52%). In males, the risk of experiencing a spine injury is the highest at the age of 20-29 and above 70 years, while in women this risk is the highest at an age of 15-19 and above 60 years. According to the studies, this risk is characterized by an at least 2:1 ratio between adult males and females. OBJECTIVE: To compare the outcomes of surgical (vertebroplasty) and conservative treatment in management of pain syndrome in patients with uncomplicated spine injury. MATERIAL AND METHODS: The study involved 60 patients with stable uncomplicated compression fractures of vertebral bodies in the thoracic and lumbosacral spine. These patients were subdivided into two groups. Group 1 consisted of 30 patients who had undergone unilateral transpedicular percutaneous vertebroplasty; Group 2 involved 30 patients who had undergone a course of conservative treatment. The medical records and the catamnestic follow-up data of patients treated at the Neurosurgery Department of the Research Clinical Center of JSC Russian Railways in 2015-2017 were analyzed for this purpose. RESULTS: No statistically significant differences in sex, age, and level of injury were revealed between the study groups. A comparative analysis of treatment outcomes demonstrated that pain intensity assessed using the VAS scale was significantly reduced after one-year follow-up in both groups as compared to the baseline. A statistically significant decrease in pain intensity in the group of patients who had undergone vertebroplasty was observed as early as one month after the injury. No significant intergroup differences were observed in the long-term follow-up period (3 and 6 months) for this parameter. In five out of 60 patients, examination 12 months after the injury revealed that vertebral body height decreased by up to 10%. No statistically significant correlation with the treatment method was observed. CONCLUSION: Vertebroplasty provides a statistically better pain relief during the first month after spine injury as compared to conservative treatment. For patients, this means earlier activization and quicker return to daily routines and work.

[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.

[Endoscope-assisted keyhole approach in cerebral aneurysm surgery]. / Éndoskopicheskaia assistentsiia pri keyhole-dostupakh v khirurgii tserebral'nykh anevrizm.

The last decades in neurosurgery have been marked by the rapid development of minimally invasive techniques, including the use of the concept of keyhole/burrhole surgery and active introduction of endoscopic techniques. These alternatives to traditional approaches have minimized concomitant injury to tissues and the brain and improved functional and cosmetic outcomes. Endoscopic assistance in keyhole approaches, along with its use in traditional approaches, seems even more reasonable because the field of microscopic view is considerably limited in the case of a mini-approach. AIM: We present our experience of using endoscopic assistance (EA) in aneurysm surgery through supraorbital and transorbital keyhole approaches. MATERIAL AND METHODS: We describe the surgical technique, indications for EA, and possible complications. In the period between 2014 and 2107, we used EA in the surgical treatment of 40 patients with cerebral aneurysms of the internal carotid (37 patients) and basilar (3) arteries. In all cases, 0 and 30° rigid endoscopes were used. The EA technique involved standard stages: assessment of anatomy before clipping and assessment after clipping. In 5 (12.5%) patients, clipping was performed under endoscopic visualization. The follow-up period was 6-12 months, on average. RESULTS: All patients underwent successful clipping of aneurysms without neurological complications. There was no death, disability, or serious permanent approach-associated complications in the study group. CONCLUSION: EA is a safe and effective technique providing additional visualization in keyhole surgery of aneurysms.

[The transpalpebral keyhole approach in surgery of orbital cavernomas: a case report and literature review]. / Transpal'pebral'nyi keyhole-dostup v khirurgii kavernom orbity: sluchai iz praktiki i obzor literatury.

AIM: Currently, there are many different surgical approaches to orbital pathology. This pathology rarely occurs in neurosurgical practice, and neurosurgeons have often used approaches that can be accompanied by negative cosmetic and functional outcomes. MATERIAL AND METHODS: We present a case report of orbital cavernoma removal via a minimally invasive approach. RESULTS: The presented case demonstrates successful removal of orbital cavernoma using the transpalpebral approach: a skin incision along a natural fold of the upper eyelid and orbitofrontal keyhole craniotomy. In the postoperative period, existing symptoms regressed; the patient assessed the cosmetic effect as excellent. CONCLUSION: The transpalpebral keyhole approach can be an excellent alternative to traditional approaches to orbital cavernomas. This approach demonstrated its efficacy and safety in skull base surgery and provided excellent functional and cosmetic outcomes.

[Transpalpebral craniotomy in skull base surgery]. / Transpal'pebral'naia kraniotomiia v khirurgii osnovaniia cherepa.

The concept of minimally invasive neurosurgery has significantly evolved in recent years, which is associated with improvements in diagnostics, microneurosurgical techniques, anesthesiology, and intraoperative imaging. MATERIAL AND METHODS: We present the preliminary results of using transpalpebral craniotomy in surgery of supratentorial aneurysms and anterior cranial fossa tumors. In the period between 2015 and 2107, we used this approach in surgical treatment of 30 aneurysms (10 aneurysms in the 'cold' period of hemorrhage and 20 unruptured aneurysms) and 10 anterior cranial fossa base tumors. The approach included a superior eyelid incision and a fronto-orbital craniotomy. We retrospectively evaluated outcomes, postoperative complications, and cosmetic results after these operations. The mean follow-up period was 6 months. RESULTS: There were no deaths, disabilities, or serious permanent approach-associated complications. All patients had expected periorbital edema that was not considered as a complication. CONCLUSION: Transpalpebral craniotomy is a safe and effective approach to anterior cranial fossa neoplasms and anterior circle of Willis aneurysms. This approach avoids injury to the frontal and temporal muscles as well as to the facial and trigeminal nerve branches. Patients assessed the postoperative cosmetic result as excellent.

[An acute subdural hematoma caused by rupture of a middle cerebral artery aneurysm]. / Ostraia subdural'naia gematoma na fone razryva anevrizmy sredneĭ mozgovoĭ arterii.

Acute subdural hematoma caused by cerebral aneurysm rupture is rare. We describe a clinical case of an acute subdural hematoma developed due to rupture of an aneurysm at the M1 segment bifurcation of the middle cerebral artery (MCA). The acute subdural hematoma associated with intracranial hypertension and transtentorial herniation resulted in a comatose condition. The patient underwent decompressive craniectomy, hematoma removal, and clipping of the aneurysm. A significant improvement was observed in the postoperative period. The patient was discharged with mild hemiparesis and moderate paresis of the oculomotor nerve. This case demonstrates the need for an urgent surgical intervention in the form of decompressive craniectomy and aneurysm clipping as life-saving surgery, even in patients with transtentorial herniation syndrome in a serious condition.

[Supraorbital keyhole craniotomy in surgery of anterior circle of willis aneurysms]. / Supraorbital'naya «keyhole¼ kraniotomiya v khirurgii anevrizm perednego otdela villizieva kruga.

The progress in surgical treatment of intracranial aneurysms is based on the introduction of modern minimally invasive techniques. Among the variety of keyhole approaches, supraorbital craniotomy is most often used in surgical treatment of anterior circle of willis aneurysms. The authors present the preliminary results of application of supraorbital keyhole craniotomy for anterior circle of willis aneurysms in 27 patients. Most of the patients had unruptured aneurysms (18 patients). Nine patients had SAH, and 4 of them were operated on in the acute period. The patients' condition was assessed as a grade 1-2 (Hunt-Hess scale) and grade 1-3 (Fisher scale). There were no intraoperative aneurysm ruptures, other serious complications, and deaths. Postoperative complications were assessed at 2 weeks and 6 months. The postoperative cosmetic outcome was assessed by patients as excellent.

[Mini-orbitozygomatic craniotomy in surgery for supratentorial aneurysms and tumors of the anterior and middle cranial fossae]. / Minimal'naya orbitozigomaticheskaya kraniotomiya v khirurgii supratentorial'nykh anevrizm i obrazovanii perednei i srednei cherepnykh yamok.

UNLABELLED: Progress in microneurosurgical techniques, neuroanesthesiology, and intraoperative imaging enables surgery using small incisions and craniotomy, in accordance with the keyhole surgery concept. Supraorbital craniotomy is the most widespread minimally invasive approach. There are a number of supraorbital craniotomy modifications, regarding different soft tissue incisions and the extent of craniotomy. We present the first results of using mini-orbitozygomatic craniotomy for aneurysms of the anterior circle of Willis and space-occupying lesions of the anterior and middle cranial fossae performed through an eyebrow incision. MATERIAL AND METHODS: Forty five patients were operated on using mini-orbitozygomatic (MOZ) craniotomy in the period between March 2014 and December 2015. Fifteen supratentorial aneurysms were clipped, and 30 space-occupying lesions were resected. Most patients had unruptured aneurysms (10 patients). Five patients had a history of SAH. The aneurysm localization was as follows: 8 anterior communicating artery aneurysms, 4 aneurysms of the internal carotid artery in the area of the posterior communicating artery orifice, and 3 ophthalmic aneurysms. The Hunt-Hess scale was used to evaluate the patients' condition, and the Fisher scale was used to quantify SAH volume. Surgery was performed 14 days after SAH, on average. Contrast-enhanced MRI of the brain was the diagnostic method of choice in a group of patients with space-occupying lesions within the anterior and middle cranial fossae. In some cases, patients underwent CT with reconstruction for assessment of the skull base bone structures. The mean age of patients was 58.3 years. RESULTS: All aneurysms were completely excluded from the cerebral blood flow. No serious complications and deaths in a group of aneurysm patients occurred. Complete tumor removal was performed in 28 patients. Two patients having pituitary macroadenomas with supra- and parasellar spread underwent subtotal resection due to adenoma invasion into the cavernous sinus. Mortality in this group was 3.3% (1 patient). Postoperative complications were evaluated after 2 weeks and 6 months. The postoperative cosmetic result after 3 and 6 months after surgery was assessed by patients as excellent. CONCLUSION: Mini-orbitozygomatic craniotomy is an alternative to classic approaches and can be assistive in surgery for skull base aneurysms and tumors. Selection of candidates for this keyhole surgery should be based on their critical assessment.

Kidney cancer with brain metastases. Prognostic factors and treatment outcome.

The aim of this study was to study the effectiveness of stereotactic radiosurgery by Gamma Knife in kidney cancer with brain metastases. There were analyzed results in 112 patients with such spread of the disease who received treatment in the Gamma Knife Center, Moscow. The median age of patients was 58 years (range, 33-77 years). Total number of metastatic lesions was 444, and the average number of brain metastases in one patient 4 (from 1 to 30). A single brain metastasis had 28 patients (25 %). Median of total volume of brain metastasis for each patient was 5. 9 cm3 (from 0. 1 to 29,1sm3). Mean marginal dose for metastatic lesion was 22 Gy (from 12 Gy to 26 Gy) and the average value of isodose, on which planning was performed - 64% (from 39% to 99%). The overall survival after radiosurgery was 37,7%, 16,4% and 9,3% for 12, 24 and 36 months, respectively, with a median overall survival of 9,1 months (95% CI = 7,1-11,8). New brain metastases after radiosurgical treatment occurred in 44 (54,3%) patients with a median of 10,1 months. (95% CI = 7-18). Local recurrences after radiosurgical treatment were detected in 19 (17%) patients with a median of 6,6 months (95% CI = 4,0-9,6). The Karnovsky index was >80. Local control was achieved in 96% of metastatic lesions in 87% of patients. Side effects of radiosurgical treatment occurred in 33. 8% of patients (6% radionecrosis and 23. 8% an increase of perifocal edema). Thus stereotactic radiosurgery by Gamma Knife is an effective treatment option for brain metastases in kidney cancer providing a high level of local control of metastatic lesions with minimal neurotoxicity. In a case of distant recurrence reuse of such treatment provides good local control and improves overall survival compared with other methods of treatment.

[Minipterional craniotomy in surgery for anterior circle of Willis aneurysms]. / Minipterional'naya kraniotomiya v khirurgii anevrizm perednego otdela villizieva kruga.

One of the significant events in aneurysm surgery was promotion of a microneurosurgical technique by G. Yasargil. Despite its versatility, pterional craniotomy is associated with extensive osteotomy and a significant incision of the skin and temporal muscle, which may lead to the adverse cosmetic effects, risk of temporomandibular joint dysfunction, injury to the frontal branch of the facial nerve, and facial and scalp numbness. We present our experience with minipterional craniotomy in surgery for anterior circle of Willis aneurysms in 40 patients. There were no serious complications or deaths. Also, there were no intraoperative aneurysm ruptures. All patients had expected transient hypesthesia in the temporal region, which was not considered as a complication. This region was significantly smaller compared to that in classical pterional craniotomy. Patients assessed the postoperative cosmetic outcome as excellent.