[Tractography in functional neuronavigation]. / Traktografiya v funktsional'noi neironavigatsii.

The review addresses the combined use of tractography and neuronavigation. Fundamentals of diffusion tensor imaging are given, technical aspects of fiber tracking in general and in depicting separate subcortical tracts are described. Main advantages of the method and possible causes of errors are highlighted. Precision assessment of this technology is given by comparing with results of subcortical neurostimulation. Surgical tactics is described depending on distance between the tumor and subcortical pathways.

The routing of medical evacuation of patients with ruptures of cerebral aneurysms from remote out-of-the-way rural area.

The patients with aneurysm subarachnoid hemorrhage (aSAH) living in remote, inaccessible, rural areas cannot be provided with urgent neurosurgical care on the spot. They require medical evacuation (ME) to neurosurgical hospital. The purpose of the study was to investigate effect of complex (multi-stage) and simple (one-stage) logistic scheme of ME of patients in acute period of aSAH on the outcome of the disease. The retrospective analysis of results of surgical treatment in 145 patients with aSAH hospitalized in regional vascular center (RVC) in Yakutsk in 2017-2018 was carried out. The subjects were allocated into 3 groups: group 1 - patients from regions of the Republic of Sakha, who underwent ME to the RSC using simple transportation scheme; group 2 - patients from regions of the Republic of Sakha who underwent ME using complex transportation scheme; group 3 (control) - patients hospitalized from territory of Yakutsk. The RVC hospitalized 145 patients. The sanitary aviation delivered 91 (62.8%) patients from districts of the Republic to the RVC. The duration of time from the onset of disease to surgical treatment: in group 1-2 days; in group 2-4 days; in group 3, 2 days (p = 0.018). The frequency of re-rupture of cerebral aneurysm in the group 1 and group 2 did had no statistically significant differences (19,1% and 32.7%) (p = 0.142). Mortality: in group 1 7.1%; in group 2 8.2%; in group 3 7.4% and no statistically significant differences between groups 1 and 2 (p = 1,000), between groups 1 and 3 (p = 1,000) and between groups 2 and 3 (p = 0.886). When applying complex logistic scheme of ME, transportation over considerable distance does not deteriorated course of disease and results of surgical treatment of patients with aSAH in acute period of hemorrhage.

[Intraoperative brain shift in neuronavigation. Causes, clinical significance and solution of the problem]. / Intraoperatsionnoe smeshchenie mozga pri primenenii neironavigatsii. Prichiny, klinicheskaya znachimost' i puti resheniya problemy.

Intraoperative brain shift is the main cause of inaccurate navigation. This limits the use of both conventional and functional neuronavigation. Causes of brain shift are divided into surgical, pathophysiological and metabolic ones. Brain shift is usually unidirectional and directed towards gravitation. Brain dislocation depends on lesion size and its location. Shift is minimal in patients with tumors <20 ml and skull base neoplasms. Small craniotomy, retractor-free surgery and no ventriculostomy are valuable to reduce brain shift. Brain dislocation increases during surgery that's why marking of eloquent lesions at the beginning of surgery and primary resection near subcortical tracts minimize the risk of damage to conduction pathways. Augmented reality and manual shift of marked objects are the cornerstones of linear correction of brain shift in modern navigation systems. In case of nonlinear brain shift, sonography and intraoperative magnetic resonance imaging can clarify location of surgical target and cerebral structures.

[Intraoperative magnetic resonance imaging in surgery of brain gliomas]. / Intraoperatsionnaya magnitno-rezonansnaya tomografiya v khirurgii gliom bol'shikh polusharii.

Intraoperative magnetic resonance imaging (iMRI) is used in surgery of supratentorial gliomas to assess resection quality, as well as in neoplasm biopsy to control the needle position. Scanners coupled with operating table ensure fast intraoperative imaging, but they require the use of non-magnetic surgical tools. Surgery outside the scanner 5G line allows working with conventional instruments, but patient transportation takes time. Portable iMRI systems do not interfere with surgical workflow but these scanners have poor resolution. Positioning of MRI scanners in adjacent rooms allows imaging simultaneously for several surgeries. Low-field MRI scanners are effective for control of contrast-enhanced glioma resection quality. However, these scanners are less useful in demarcation of residual low-grade tumors. High-field MRI scanners have no similar disadvantage. These scanners ensure fast detection of residual gliomas of all types and functional imaging. Artifacts during iMRI are usually a result of iatrogenic traumatic brain injury and contrast agent leakage. Ways of their prevention are discussed in the review.

[Functional magnetic resonance imaging in neurosurgery]. / Funktsional'naya magnitno-rezonansnaya tomografiya v neirokhirurgii.

The study is a short review of articles concerning functional magnetic resonance imaging (fMRI) and its practical application in neurosurgery. Advantages and disadvantages of the methods are considered, the results of surgical treatment of patients using functional navigation are presented. Separate attention is paid to fMRI precision, a new resting-state method of visualization. Practical advices of fMRI application in neurooncology and surgery of arteriovenous malformations are given.

[Functional magnetic resonance imaging in neurosurgery]. / Funktsional'naya magnitno-rezonansnaya tomografiya v neirokhirurgii.

The review of publications on functional magnetic resonance imaging (fMRI) and its practical application in neurosurgery is presented. Advantages and disadvantages are selected taking pathogenesis into account. Results of surgical treatment with use of functional navigation are described. Separate attention is paid to fMRI precision by its comparing with direct cortical stimulation. New resting-state method of visualization is observed. Practical advices are given of fMRI application in neurooncology and surgery of arteriovenous malformations.

[Two-stage contralateral combined microvascular and wide-lumen anastomosis inTwo-stage contralateral combined microvascular and wide-lumen anastomosis in a patient with acute ischemic stroke patient with acute ischemic stroke]. / Dvukhetapnyi kontralateral'nyi kombinirovannyi mikrososudistyi i shirokoprosvetnyi anastomoz u patsienta s ostrym ishemicheskim insul'tom.

Common carotid artery (CCA) thrombosis is a rare cause of ischemic stroke. In available literature, we found no studies devoted to cerebral revascularization for CCA occlusion in acute period of ischemic stroke. Successful treatment of concomitant occlusion of CCA, internal (ICA) and external carotid arteries (ECA) with microvascular anastomoses is very interesting for various specialists. To demonstrate the possibility of contralateral cerebral revascularization in a patient with CCA, ECA and ICA occlusion in acute period of ischemic stroke. Two-stage intervention was performed in a patient with ischemic stroke and carotid artery occlusion. At the first stage, EICMA was formed between the right superficial temporal artery and the M4 branch of the middle cerebral artery (MCA), at the second stage - anastomosis between the right and left ECAs using an autologous arterial graft from the radial artery. There is no generally accepted surgical strategy for CCA occlusion. Contralateral revascularization with blood flow redirecting from the right carotid artery to the left one makes it possible to avoid thrombectomy from the affected CCA and ECA. We have undertaken this method for the first time. We have not found such an approach in the available literature. This report demonstrates the possibility of successful cerebral revascularization in acute period of ischemic stroke in patients with combined occlusion of CCA, ICA and ECA.

[Intracerebral hemorrhage grading scales for the prediction of stroke outcome]. / Shkaly prognoza iskhoda u bol'nykh s gemorragicheskim insul'tom.

The authors consider the prognostic models and grading scales for the patients with primary intracerebral hemorrhage and discuss the influence of some factors, like a patient age, intracerebral hematoma location and volume, intraventricular hemorrhage and development of obstructive hydrocephalus. The grading scales are described in terms of its' administering to patients before conservative treatment and surgery. A comparative analysis of the scales regarding the convenience and relevance of their use in clinical practice is carried out.

[Locoregional anesthesia in endoscopic surgery of intracerebral hypertensive hemangiomas]. / Lokoregionarnaya anesteziya v endoskopicheskoi khirurgii vnutrimozgovykh gipertenzivnykh gematom.

INTRODUCTION: Currently, minimally invasive methods of surgical treatment of hypertensive intracerebral hematomas (ICHs) are actively used. However, anesthetic management of these surgeries are unclear. Moreover, advisability of locoregional anesthesia (LRA) for endoscopic aspiration of hypertensive ICHs has not been studied. OBJECTIVE: To analyze application of regional anesthesia in minimally invasive surgery of hypertensive intracerebral hematomas. MATERIAL AND METHODS: Patients were divided into 2 groups. Group 1 included 45 patients who underwent surgery under total intravenous anesthesia with mechanical ventilation (TIVA + mechanical ventilation), group 2 (n=43) - surgery under LRA. The incidence of pneumonia and postoperative outcomes in accordance with the GOS grading system were analyzed depending on the method of anesthesia. RESULTS: Pneumonia was 3 times more common in the first group (33%) that required prolonged ventilation and tracheostomy. Thus, there were 9 tracheostomies (20%) in the first group. In the second group, one patient required mechanical ventilation on the second postoperative day due to severe chronic obstructive pulmonary disease followed by deterioration of respiratory failure. Tracheostomy was also performed in this case. According to analysis of GOS outcomes, the LRA group was characterized by 4 times lower mortality and 1.5 times greater number of patients with good recovery and moderate disabilities compared with the first group. CONCLUSIONS: LRA is a feasible and effective method for the anesthetic management of minimally invasive surgery in patients with hypertensive ICHs. This approach ensures decrease of mortality rate, increase of good neurological outcomes and reduce pulmonary infectious complications.

[Malignant cerebellar infarction: clinical course and surgical treatment]. / Zlokachestvennyi infarkt mozzhechka: klinicheskoe techenie i khirurgicheskoe lechenie.

AIM: To clarify the indications for surgical treatment of malignant cerebellar infarction (CI). MATERIAL AND METHODS: Eighty patients with CI were studied. The malignancy of CI was understood as the development of mass effect in the posterior cranial fossa, accompanied by the decrease in consciousness due to compression of the brain stem and/or the development of occlusive hydrocephalus. The patients were divided into 2 groups. The group of malignant CI included 55 patients (68.75%) (group I), the group of benign CI included 25 patients (31.25%) (group II). Patients of group I were divided into subgroups, one of them underwent surgical treatment (surgical subgroup), and another only conservative (conservative subgroup) treatment. Surgery efficacy criteria were: restoration of consciousness to 15 points according to GCS and/or restoration of the fourth ventricle and the quadrigeminal cistern configurations. Results of treatment were assessed according to the Glasgow outcome scale. RESULTS: Malignant CI occurred more frequently in patients with the volume of ischemia exceeding 20 cm3 (p<0.05) in the first day of the disease. The threshold value of mass effect, which can cause further a malignant CI, was 3 points according to the M. Jauss scale. In the group of patients with malignant CI, surgical treatment reduced the mortality rate from occlusion and dislocation syndrome by 35.8%. The most effective type of intervention was a combination of decompressive trepanation of the posterior cranial fossa and external ventricular drainage. CONCLUSION: In patients with CI with the volume more than 20 cm3 and signs of mass effect in the posterior cranial fossa on the scale of M. Jauss 3 points or more, the malignant course of the disease develops in 67% of cases. These patients require careful monitoring, and, in case of development of malignant CI, surgical treatment is necessary.

[Results of implementation of a 'Complex of measures to improve medical care for patients with stroke in the Russian Federation']. / Rezul'taty realizatsii 'Kompleksa meropriiatii po sovershenstvovaniiu meditsinskoi pomoshchi patsientam s ostrymi narusheniiami mozgovogo krovoobrashcheniia v Rossiiskoi Federatsii'.

Vascular diseases of the brain and heart are the main cause of death and disability of the population of the Russian Federation. The social and economic burden of acute cerebral circulation disorders necessitated the development of a national program for the care of patients with acute vascular diseases. As a result of the implementation of a set of measures to improve medical care for patients with stroke over the past decade, the regions of the Russian Federation managed to create an 'insult network', equip the departments with high-tech diagnostic and therapeutic equipment, and train medical personnel. Due to the implementation of modern methods of treatment of stroke, the rates of disability and mortality from stroke have decreased.

[Operations of revascularization in surgery of cerebrovascular aneurysms].

Surgical revascularization of the brain is one of the most important trends in the development of neurosurgery. Restoration of adequate blood flow through pre- and intracerebral arteries promotes prevention and treatment of ischaemic lesions of the brain in various pathology. The present work was aimed at analysing the experience gained in performing revascularizing operations in patients with cerebral aneurysms at the department of neurosurgery. The authors analysed therapeutic outcomes in a total of 45 patients presenting with giant and complex aneurysms of cerebral arteries and treated from 2009 to 2014. Of the 45 patients with giant and complex aneurysms of cerebral arteries, 31 (68.8%) patients underwent open microsurgical interventions (including 10 patients with the use of different variants of revascularizing operation) and 14 (31.2%) patients were subjected to endovascular exclusion of the aneurysm from the blood flow. It was shown that performing revascularizing operations in patients with complex and giant aneurysms of cerebral arteries makes it possible to compensate circulation in the interested arterial basin and to obtain good functional results.