[Anterior transpetrosal (Kawase) approach for petroclival meningioma with trigeminal neuralgia: case report and literature review]. / Perednii transpiramidnyi dostup (dostup Kawase) pri petroklival'noi meningiome s trigeminal'noi nevralgiei: opisanie klinicheskogo nablyudeniya i obzor literatury.

The authors present a patient with petroclival meningioma complicated by trigeminal neuralgia. Resection of tumor via anterior transpetrosal approach with microvascular decompression of the trigeminal nerve was performed. A 48-year-old female patient presented with left-sided (V1-V2) trigeminal neuralgia. Magnetic resonance imaging revealed a tumor 33´27´25 mm with a base adjacent to the top of petrous part of the left temporal bone, tentorium cerebelli and clivus. Intraoperative examination revealed true petroclival meningioma extending to trigeminal notch of petrous part of temporal bone. There was additional compression of trigeminal nerve by caudal branch of superior cerebellar artery. Total resection of tumor was followed by disappearance of vascular compression of trigeminal nerve and regression of trigeminal neuralgia. Anterior transpetrosal approach provides early devascularization and resection of true petroclival meningioma, as well as wide imaging of anterolateral surface of the brainstem, identification of neurovascular conflict and vascular decompression.

[Interposition and transposition techniques of vascular decompression for hemifacial spasm]. / Interpozitsionnaya i transpozitsionnaya metodiki vaskulyarnoi dekompressii pri gemifatsial'nom spazme.

OBJECTIVE: To analyze the vessels compressing facial nerve root exit zone and efficacy of interposition and transposition techniques of vascular decompression for hemifacial spasm. MATERIAL AND METHODS: Vascular compression was evaluated in 110 patients. Implant interposition between vessels and nerve was performed in 52 cases, transposition of arteries without contact between implants and nerve - in 58 patients. RESULTS: Compressing vessels were anterior (44), posterior (61) inferior cerebellar, vertebral (28) arteries and veins (4). Multiple compressing vessels were found in 27 cases. Premeatal meningioma and jugular schwannoma were accompanied by vascular compression in 2 cases. Immediate regression of symptoms was observed in 104 patients, partial regression - in 6 patients. Transient facial paresis (4) and impaired hearing (5) were noted after implant interposition. Redo vascular decompression was performed in one case. CONCLUSION: The most common compressing vessels were cerebellar arteries, vertebral artery and veins. Transposition of arteries is highly effective technique with low incidence of VII-VII nerve dysfunction but relatively slow regression of symptoms.

[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.

[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.

[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.

[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.

[Evolution of surgical approaches to the anterior and middle cranial fossa: from extended craniotomy to the supraorbital keyhole approach]. / Évoliutsiia khirurgicheskikh dostupov k perednei i srednei cherepnym iamkam: ot rasshirennoi kraniotomii k supraorbital'nomu keyhole-dostupu.

At early history of neurosurgery, the use of extended craniotomy was dictated by poor illumination, inadequate visualization, and the lack of accurate diagnosis. The technological progress development and the emergence of highly informative neuroimaging, microscopy, and neuroendoscopy minimized neurosurgical approaches and, accordingly, approach-associated complications. At present, the fundamental philosophy of minimally invasive surgery is of particular topicality because this surgery contributes to rapid recovery of patients and reduces the period of hospital treatment. The aim of the article is to provide a brief historical overview of the evolution of surgical approaches to the skull base, ranging from extended craniotomy to minimally invasive interventions.