[Traumatic intracranial aneurysms following combat damage]. / Travmaticheskie anevrizmy golovnogo mozga pri boevykh povrezhdeniyakh.

OBJECTIVE: To develop the principles for the treatment of traumatic intracranial aneurysms after combat damage to skull and brain. MATERIAL AND METHODS: There were 18 patients with traumatic intracranial aneurysms from February 2022 to the present. Of these, 15 ones had gunshot penetrating wounds of the skull and brain. In 3 cases, aneurysms developed after explosive injury. All patients underwent computed tomography (CT) of the brain, CT angiography of brain vessels and selective cerebral angiography. We analyzed nature of brain damage, trajectory of the wounding projectile and aneurysm location to determine predictors of traumatic intracranial aneurysms. Surgical treatment was performed in all cases. RESULTS: Hemorrhagic manifestations were observed in 11 patients. In 4 cases, traumatic intracranial aneurysms were diagnosed before rupture. Blunt head injury was followed by subarachnoid hemorrhage in 2 cases and ischemic stroke in 1 case. Endovascular or microsurgical intervention was performed depending on location of aneurysm, clinical manifestations and severity of brain damage. In case of distal aneurysms, endovascular and microsurgical destructive interventions prevailed. At the same time, proximal aneurysms (within or below the circle of Willis) required reconstructive endovascular treatment. CONCLUSION: Traumatic aneurysms should be suspected in all patients with penetrating craniocerebral injuries. Follow-up is contraindicated for traumatic intracranial aneurysms due to high risk of hemorrhage.

[Metallic foreign bodies of brain ventricles]. / Metallicheskie inorodnye tela zheludochkov golovnogo mozga.

Head injuries are often associated with intracranial foreign bodies that require decision making on the need for certain surgical treatment. Intraventricular foreign bodies are rare, so the question of surgical tactics is still open. OBJECTIVE: To summarize the experience of treating the wounded with intraventricular foreign bodies. MATERIAL AND METHODS: Treatment outcomes in victims with foreign bodies in lateral ventricles are presented. Searching in the e-Library, PubMed, Google Scholar databases included the following keywords: «penetrating wounds¼, «foreign bodies¼, «cerebral ventricles¼, «gunshot injury¼, «ventricular foreign bodies¼. We analyzed data on the treatment of victims with intraventricular foreign bodies. RESULTS: Three victims underwent surgery, and foreign bodies were removed from the occipital horn of the lateral ventricle, third ventricle and temporal horn of the lateral ventricle. Conservative approach was preferred in 1 case. Follow-up ranged from 1 month to 7 years, GOS score - 3-4 points. Disability was due to severe injury and not associated with surgical treatment per se. We found 16 publications matching the searching criteria. Treatment methods varied from standard surgical approaches to stereotactic management. The indication for removal of foreign bodies was their migration through the ventricular system and occlusive hydrocephalus. None patient had neurological aggravation. CONCLUSION: Intraventricular foreign bodies are rare and present certain difficulties in choosing the method and timing of treatment. Indications for their removal are migration, occlusive hydrocephalus and infectious complications. The method of removal is determined depending on location, magnetic properties, nature of injury, surgical preferences and other factors.

[Transradial approach in neuroendovascular procedures]. / Analiz primeneniya transradial'nogo vnutrisosudistogo dostupa v neirokhirurgicheskoi praktike.

OBJECTIVE: To evaluate safety and feasibility of transradial approach for neuroendovascular procedures and to familiarize neurosurgeons and neuroradiologists with the capabilities and limitations of this approach, as well as technical features influencing its effectiveness. MATERIAL AND METHODS: A retrospective analysis was performed in 270 patients who underwent transradial neuroendovascular procedures between January 2015 and December 2019. Diagnostic and surgical interventions were performed in 203 (75.2%) and 67 (24.8%) patients, respectively. The authors comprehensively describe catheterization technique and choosing the instrument for effective and safe transradial access. RESULTS: The right vertebral and both common carotid arteries were the most accessible for selective catheterization (100% of cases). The left common carotid artery was catheterized in all cases, the left internal carotid artery - only in 92% of cases. If catheterization of the left vertebral artery was necessary, we used the left-sided radial approach. Conversion to femoral approach was required in 2.6% of cases for the left internal carotid artery disease (n=7). Radial artery occlusion occurred in 3.7% of cases (n=10) and was asymptomatic in all cases. We present a video clip (https://youtu.be/3wZ6O8u-lpk) devoted to various surgical interventions through radial approach. CONCLUSION: Radial approach is safe and feasible and may be used for neuroendovascular procedures.

[Middle meningeal artery embolization for chronic subdural haematoma. Case series and literature review]. / Embolizatsiya srednei obolochechnoi arterii kak metod lecheniya khronicheskikh subdural'nykh gematom. Seriya klinicheskikh sluchaev i obzor literatury.

Middle meningeal artery embolization as primary method for treatment of chronic subdural hematomas became more popular in past decade. There are few large case series (>150 patients) and literature reviews characterizing advantages and drawbacks of endovascular treatment and technical features of surgeries. In this manuscript, the authors report 11 patients with chronic subdural hematoma scheduled for middle meningeal artery embolization and review the literature data on this issue.

[Combat gunshot skull and brain injuries]. / Boevye ognestrel'nye raneniya cherepa i golovnogo mozga.

There have been over 15 ended and ongoing armed conflicts in the world between 2014 and 2020. The total number of irrecoverable losses in these conflicts exceeded 800 000 people. In modern conflicts, gunshot head wounds account for 37.4% of sanitary losses of surgical profile. These injuries are characterized by high mortality rate. Changes in fighting nature entail changes in structure of wounds and treatment approaches. OBJECTIVE: To analyze treatment strategy and features of surgical interventions for combat gunshot head injuries considering literature data for the period from 2014 to 2020. MATERIAL AND METHODS: We analyzed the PubMed and eLibrary databases using the following keywords: head gunshot wound, traumatic brain injury, head trauma, combat trauma, wartime injury. We selected the reviews, original articles and case reports devoted to head gunshot wound management for the period 2014-2020. Manuscripts in Russian, Ukrainian and English with available abstract and/or full-text article were reviewed. Data on the incidence and structure of craniocerebral injuries, mortality and treatment strategy were analyzed. RESULTS: We found 24 publications matching searching criteria. The majority of manuscripts were devoted to craniocerebral wounds received by combatants and civilians during the hostilities in the south-east of Ukraine (7 manuscripts), in Iraq and Afghanistan (4 manuscripts), as well as in the Syrian Arab Republic (12 manuscripts). Craniocerebral wounds occupy a leading position in overall structure of gunshot wounds and result the highest mortality compared to other wounds. There is a tendency towards the prevalence of bullet wounds over splinter wounds. CONCLUSION: Modern wars and armed conflicts are characterized by changes in the structure of gunshot wounds. Craniocerebral injuries are ones of the most severe and characterized by high mortality. Data on their incidence and structure of gunshot craniocerebral wounds are advisable to be used in planning and organizing care for the wounded, as well as for development of preventive measures.

[Synchronous schwannoma and ependymoma of the cauda equina]. / Sochetanie shvannomy i ependimomy konskogo khvosta spinnogo mozga.

The article presents a case of surgical treatment of primary multiple benign tumors of the cauda equine of different histological origin: spinal nerve root schwannoma and ependymoma of the filum terminale.

[Clinical and morphological risk factors for epilepsy in patients with glial and metastatic brain tumors]. / Kliniko-morfologicheskie faktory riska razvitiya epilepsii u bol'nykh s glial'nymi i metastaticheskimi opukholyami golovnogo mozga.

OBJECTIVES: To estimate the incidence of epileptic seizures in patients with glial and metastatic brain tumors and to identify clinical and morphological risk factors for epileptic seizures in patients with glial and metastatic brain tumors. MATERIAL AND METHODS: The study included 225 (88.6%) patients with glial brain tumors and 29 patients (11.4%) with metastatic tumors. RESULTS: Statistically significant differences in the incidence of epileptic seizures depending on age, histological characteristics of the tumor, degree of malignancy, tumor localization, involvement of the cerebral cortex, the presence of the midline shift were obtained. CONCLUSIONS: Epilepsy and epileptic seizures was found to develop in 51.11% and 24.14% of cases in glial and metastatic brain tumors, respectively. Risk factors for developing epileptic seizures include younger age (up to 57 years), histological characteristics corresponding to diffuse astrocytomas, anaplastic astrocytomas, oligodendrogliomas, oligoastrocytomas, grade I-III malignancy, lesion of the temporal lobe, involvement of the cerebral cortex. Factors that reduce the risk for attacks include age over 57, histological characteristics corresponding to glioblastomas and metastatic tumors, grade IV malignancy, subcortical localization of the tumor, damage to the occipital lobe, involvement of the commissural pathways, subtentorial localization of the tumor, the absence of lesions of the temporal and frontal lobes of the brain, the involvement of both brain hemispheres, damage to two or more brain lobes, the presence of a midline shift.

[Stereotactic photodynamic therapy for recurrent glioblastoma. Case report and literature review]. / Stereotaksicheskaya fotodinamicheskaya terapiya v lechenii retsidiva glioblastomy. Sluchai iz praktiki i obzor literatury.

We report a patient with recurrent glioblastoma in eloquent brain area. Stereotactic fluorescence biospectroscopy and stereotactic photodynamic therapy of tumor in opercular area of the left frontal lobe under neurophysiological monitoring were carried out. Literature data on this issue were analyzed.

[Retrospective analysis of endovascular thrombectomy in anterior cerebral circulation out of 6-hours «therapeutic window¼ in regional vascular centers of Saint-Petersburg]. / Retrospektivnyi analiz rezul'tatov vnutrisosudistoi tromboembolektomii v karotidnom basseine za predelami 6-chasovogo «terapevticheskogo okna¼ v regional'nykh sosudistykh tsentrakh Sankt-Peterburga.

OBJECTIVE: Based on a retrospective analysis, to evaluate technical results and functional outcomes at discharge after endovascular thrombectomy (EVT) in anterior circulation out of 6-hours «therapeutic window¼ in patients with stroke. MATERIAL AND METHODS: The retrospective analysis of EVT in 594 acute stroke patients (303 male, 291 female, median age 69 years) with the anterior circulation large vessel occlusion was performed. EVT was carried out before 6 hrs in 550, later in 44 patients. Time to artery puncture was defined as a cut point. Patients were included in the study if they met the criterion for 0-6 hours «therapeutic window¼. RESULTS: No significant differences in functional outcomes at discharge assessed with the Rankin scale (mRs 0-2 29.8% and 20.5% p<0.19; mRs 3-5 38.7% and 38.6% p<0.99; mRs 6 31.5% and 40.9% p<0.2) and the rates of intracranial haemorrhage, haemorrhagic transformation and symptomatic haemorrhagic transformation (4% and 0% p<0.17; 20.9% and 29.5% p<0.49; 10.1% and 11.4% p<0.78) were observed in patients exposed to EVT before 6 hrs and later. CONCLUSION: EVT in anterior circulation stroke over 6 hrs «therapeutic window¼ based on the criterion for 0-6 hrs provides comparable functional outcomes at discharge without the increase in the frequency of intracranial haemorrhages, haemorrhagic and symptomatic haemorrhagic transformations.

[Fourth ventricle meningiomas. A case report and literature review]. / Meningiomy IV zheludochka golovnogo mozga. Sluchai iz praktiki i obzor literatury.

Intraventricular meningiomas are rare and account for approximately 0.5 to 3% of all meningiomas and 9.8 to 14% of all intraventricular tumors. Most rarely, intraventricular meningomas occur in the third and fourth ventricles. The article reviews the literature devoted to meningiomas of a rare localization, in the fourth ventricle. On the basis of published surgical procedures and neuroimaging data, we divided posterior cranial fossa meningiomas into tumors completely located in the fourth ventricle cavity and those with a partial intraventricular component, which are not associated with any structures outside the ventricle. The reason for this study was our own clinical observation.

[Pathological changes in human brain biopsies from patients with idiopathic normal pressure hydrocephalus]. / Patologicheskie izmeneniia v bioptatakh golovnogo mozga patsientov pri idiopaticheskoi normotenzivnoi gidrotsefalii.

AIM: To analyze specific changes in brain tissue of patients with idiopathic normal pressure hydrocephalus at cellular and subcellular levels. MATERIAL AND METHODS: Brain biopsies from 32 patients with idiopathic normal pressure hydrocephalus were investigated by light and electron microscopy. Biopsies were made in 3 points (the cortex, subcortical and periventricular white matter during ventricular catheter positioning). RESULTS: A number of pathological features of idiopathic normal pressure hydrocephalus were identified. Most frequent were the exhaustion of brain tissue, enlargement of perivascular spaces, aseptic necrosis, and amyloid and Lewy body's formation. CONCLUSION: The changes in brain tissue of patients with idiopathic normal pressure hydrocephalus transform our views on its mechanisms. It becomes clear that idiopathic normal pressure hydrocephalus is part of common neurodegenerative process that has characteristic features affecting clinical manifestations of the disease.

[Comparative analysis of the efficiency of dura mater defect repair in cerebral surgery]. / Sravnitel'nyi analiz éffektivnosti plastiki defektov tverdoi obolochki pri operatsiiakh na golovnom mozge.

The need in replacement of a dura mater (DM) defect occurs in more than 40% of cerebral interventions. Various artificial DM substitutes facilitate solving this problem; however, their efficacy compared to that of patient autogenous tissues has been poorly understood. AIM: We aimed to study the efficacy of various substitutes in repair of dura mater defects. MATERIAL AND METHODS: The study included patients with various intracranial pathologies who were operated on at the Neurosurgery Clinic of the Military Medical Academy in the period between 2010 and 2017, and who underwent repair of the DM during surgery. In surgery for the supratentorial structures, patient autogenous tissues, grafted non-resorbable materials, or applicable collagen matrices were used as substitutes. Depending on the type of substitute material, patients were divided into groups to assess the efficacy of DM closure by comparing the rate of postoperative liquorrhea. In surgery for the posterior cranial fossa (PCF), applicable dural substitutes were not used; in this cohort, the efficacy of autogenous tissues and synthetic materials was compared. RESULTS: In 232 patients, the total rate of liquorrhea was 23.7%. In supratentorial surgery (175 cases), the use of autogenous tissues (n=73), synthetic materials (n=42), and collagen matrices (n=60) was associated with CSF exfusion in 13 (17.8%), 13 (31.0%) and 16 (26.7%) cases, respectively; in statistical analysis, these results were comparable (p>0.05). In PCF surgery (57 cases), the use of autogenous tissues (n=34) significantly more effective (p=0.021) prevented liquorrhea compared to synthetic materials (n=23): complications occurred in 4 (11.8%) and 9 (39.1%) cases, respectively. CONCLUSION: If a DM defect is located supratentorially, the choice of a dural substitute affects the rate of CSF exfusion and related complications. The use of autogenous tissues in PCF surgery statistically significantly reduces the rate of liquorrhea compared to that of synthetic materials.

[Segmental agenesis of the cervical internal carotid artery with collateral blood supply from the ascending pharyngeal artery and intercavernous anastomosis: a clinical case and literature review]. / Segmentarnaia ageneziia tservikal'nogo segmenta vnutrennei sonnoi arterii s kollateral'nym krovosnabzheniem iz voskhodiashchei arterii glotki i mezhkavernoznogo anastomoza (klinicheskoe nabliudenie i obzor literatury).

The article presents a clinical case of segmental agenesis of the cervical ICA with collateral blood supply to the ICA territory through the intercavernous anastomosis and ascending pharyngeal artery with the branching primitive stapedial artery - the aberrant ICA variant. A feature of the case is a unique combination of the intercavernous anastomosis and the aberrant ICA, which provide collateral blood flow in cervical ICA agenesis. In the world literature, there are no reports of similar combinations. The discussion provides information on the stages of circle of Willis formation and presents a literature review of cases of intercavernous anastomoses associated with ICA agenesis.

[Outcomes of endovascular thrombectomy for acute stroke in regional vascular centers of a metropolis (St.-Petersburg)]. / Rezul'taty lecheniia ishemicheskogo insul'ta s primeneniem vnutrisosudistoi tromboémboléktomii v usloviiakh regional'nykh sosudistykh tsentrov v megapolise (Sankt-Peterburg).

AIM: To assess technical results and close functional outcomes of acute ischemic stroke (AIS) in patients treated with endovascular thrombecomy (ET) in regional vascular centers (RVC) of St-Petersburg. MATERIAL AND METHODS: Retrospective analysis of 183 patients with AIS, including 143 patients with AIS due to a large intracranial vessel occlusion in anterior (AC) and 25 patients in posterior cerebral (PC) circulation, 15 with isolated extracranial carotid occlusion treated in 6 RVC in 2017 was performed. All patients underwent ET. RESULTS AND CONCLUSION: Effective reperfusion (mTICI 2b-3) was achieved in 71.5% (71.3% AC, 72% PC). On discharge, 35,7% patients had good (mRs 0-2) functional outcome (37.1% AC, 28% PC). The incidence of symptomatic intracranial hemorrhage (according to ECASS II criteria) was 10.7% (9.1% AC, 20% PC), the mortality was 29.2% (22.4% AC, 68% PC).). The results of our study show the possibility of effective and safe application of ET in patients with AIS in the anterior and posterior cerebral circulation in regional vascular centers of St.-Petersburg.

[Spinal dural arteriovenous fistulas. A series of clinical cases and an analysis of the literature data]. / Dural'nye spinal'nye arteriovenoznye fistuly. Seriia sobstvennykh klinicheskikh nabliudenii i analiz dannykh literatury.

Spinal dural arteriovenous fistulas (SDAVFs) are the most common vascular malformation of the spinal cord, causing segmental lesions of the spinal cord due to venous ischemia. Functional outcomes of treatment in SDAVF patients are favorable, but the rate of improvement varies from 25 to 100%, which complicates prediction of the treatment outcome. AIM: the study aim was to identify a relationship between fistula localization and clinical manifestations and evaluate the effect of disease duration and severity of neurological impairments on immediate and long-term treatment outcomes, based on analysis of the literature and own data. MATERIAL AND METHODS: In September 2016, we performed a PubMed search for publications using keywords 'spinal arteriovenous fistula', 'treatment', and 'outcome'. We selected publications containing information on the patient's age, fistula location, disease duration, and evaluation of symptom severity (Aminoff-Logue scale) preoperatively, postoperatively, and at least 3 months after surgery. The analysis also included data on patients operated on at the clinic. A total of 187 patients were included in the analysis. RESULTS: The fistula was most often located at the T6, T7, and T9 level, with motor disorders being more severe for fistulas located at or below the T9 vertebra. Surgical isolation of the fistula improved the functional state of patients, with patients under the age of 60 years having a better prognosis for recovery of impaired functions. Motor disorders significantly regressed in the early postoperative period in all patients, but in the long-term period, there was worsening of motor disorders in patients with a better baseline functional state.

[A new concept of organization and scope of neurosurgical care in the US army during armed conflicts in the early 2000s]. / Novaya kontseptsiya organizatsii i soderzhaniya pomoshchi po profilyu 'Neirokhirurgiya' v armii SShA v khode vooruzhennykh konfliktov nachala KhKhI veka.

Military operations in various parts of the world in the early 2000s are becoming more regionalized; new warfare tactics emerge, which makes it necessary to review and modify the neurosurgical care system. The article reviews the results of original studies on this issue and summarizes the experience of the US Army medical service in Afghanistan and Iraq. The article discusses the structure of sanitary losses, organization and scope of medical and evacuation neurosurgical measures, types and techniques of surgical interventions, and the rate of complications. We describe five levels of neurosurgical care echelons and an implemented "injury control - neurosurgery" concept; particular attention is paid to the peculiarities of research and specialist training. We demonstrate that implementation of the new concept for organization and scope of neurosurgical care has improved treatment outcomes and reduced the mortality rate in the mentioned military conflicts of recent years compared to those in the Vietnam War. We may conclude that the described experience of the US Army can be used to improve the efficacy of neurosurgical care to the wounded and victims of armed conflicts.

[Clinical guidelines for the use of intraoperative fluorescence diagnosis in brain tumor surgery].

In this paper, we present a review of current literature on the application of intraoperative fluorescence diagnosis and fluorescence spectroscopy using 5-aminolevulinic acid in surgery for various types of brain tumors, both alone and in combination with other neuroimaging methods. Authors' extensive experience with these methods allowed them to develop a set of clinical guidelines for the use of intraoperative fluorescence diagnosis and fluorescence spectroscopy in surgery of brain tumors.

[Dopplerographic predictors of cognitive status dynamics of patients after carotid angioplasty with stenting].

The authors present dopplerographic predictors of cognitive status dynamics of patients undergoing carotid angioplasty with stenting. It was stated that the cognitive status dynamics depended on the initial condition of patients and reactivity coefficient on hypercapnia in target vascular pool.

[The formation of the School of Military Neurosurgery of the Military Medical Academy].

The article is devoted to stages of formation of the school of military neurosurgery. Famous pioneers of this school were Vsevolod Galkin and Boris Samotokin. Their scientific works were based on personal experience of treatment for the battle scull and brain injuries during the Great Patriotic War. The main aim of the activity of the talented researcher Vitally Khilko was to develop microneurosurgery, neuroimmunology and fundamental researchers of cerebral blood flow pathology. Boris Gaidar and Valeriy Parfyonov reorganized the echelon neurosurgical care system in a relatively short time. This reorganization formed the basis of the modem principles of specialized neurosurgical care in armed conflicts. At the present time department of neurosurgery is the leading methodological and clinical center of military neurosurgery in Russia.