OBJECTIVE:To evaluate the efficacy and safety of laparoscopic assistance for peritoneal catheter implantation in adults scheduled for ventriculoperitoneal shunting. MATERIAL AND METHODS:A prospective study enrolled 38 patients divided into 2 groups: laparoscopic approach (n=18) and mini-laparotomy (n=20). Surgery time, incision length, pain syndrome and catheter position were assessed. RESULTS:In the main group, surgery time was significantly shorter (40.0 [37.0; 44.0] versus 48.0 [46.0; 50.0] min, p<0.001). The same was true for duration of abdominal stage (10.0 [9.0; 12.0] and 15.0 [14.0; 16.0] min, respectively, p<0.001). The incision length was 15 [14; 16] versus 49 [47; 52] mm (p<0.001). VAS score of pain were lower in the main group (4.5 [4.0; 5.0] versus 5.5 [5.0; 6.0] points; p=0.048). Pain regression was faster (4.0 [3.0; 5.0] versus 7.0 [6.0; 8.0] days; p<0.001). Laparoscopy ensured accurate catheter positioning in all patients. CONCLUSION:Laparoscopic assistance in ventriculoperitoneal shunting reduces surgery time and invasiveness, ensures accurate catheter positioning and reduces pain. This method is effective in complicated and intact abdominal anamnesis, and improves immediate outcomes.
OBJECTIVE:To present rare clinical cases of atlantoaxial osteoarthritis (AAOA), review modern surgical methods and describe our experience in surgical treatment of this pathology. MATERIAL AND METHODS:The study included five patients who underwent surgery for AAOA. All patients presented with persistent drug-resistant pain. Unilateral degenerative damage to the paired atlantoaxial joint was present in four patients, bilateral damage - in 1 case. Posterior atlantoaxial fusion (Gallie technique) was performed in one case. Screw C1-C2 fixation (Harms technique) and arthrodesis of damaged atlantoaxial joint were carried out in four cases. RESULTS:All patients decreased VAS score of pain by 6-7 points (mean 6.6) after surgery. A follow-up examination confirmed successful fusion in each case. All patients experienced significant limitation of head rotation due to atlantoaxial articulation blockage associated with concomitant spondyloarthrosis. CONCLUSION:Drug-resistant pain and/or cervical myelopathy are indications for surgical treatment of AAOA. Posterior fusion is the only effective method for pain relief. Relief of clinical symptoms minimizes lost head rotation. Harms fusion technique enables complete consolidation thanks to stable fusion. Atlantoaxial arthrodesis enhances C1-C2 vertebral block.
Magnetic resonance spectroscopy (MRS) is a complementary imaging technique enabling non-invasive metabolic characterization of tissues in clinical practice. Proton MRS is more common for analysis of metabolites such as lactate and choline. This is valuable for preoperative assessment of glioma grade. However, it does not directly reflect phosphate energy metabolism. Phosphorus MRS enables assessment of phosphorus-containing compounds involved in tumor energy metabolism and membrane turnover. OBJECTIVE:To assess the role of phosphorus MRS in metabolic characterization of low-grade and high-grade gliomas. MATERIAL AND METHODS:The study included 46 patients with gliomas: 31 patients with high-grade gliomas and 15 patients with low-grade gliomas. The control group comprised 15 healthy volunteers. All participants underwent phosphorus MRS with assessment of spectral parameters of phosphorus-containing metabolites, metabolic ratios and intracellular pH. RESULTS:Phosphorus MRS revealed differences in metabolic profile of tumor tissue between high-grade and low-grade gliomas. High-grade gliomas were characterized by signs of impaired energy and membrane metabolism, including changes in phosphorus-containing metabolite ratios and shift in intracellular pH. Low-grade gliomas demonstrated less severe metabolic alterations. CONCLUSION:Phosphorus MRS is a promising complementary imaging modality for non-invasive assessment of metabolic features of gliomas. This method may be used to refine their biological characteristics at the preoperative stage.
Effective intraoperative speech mapping requires specific test with standardized linguistic material. The last one should capture speech function supported by brain region targeted for resection. It is necessary to develop a test tailored to specific patient's needs and document intraoperative linguistic support. The objective of this report was to describe the procedure of intraoperative speech testing and battery of intraoperative tests for Russian language. We correlated intraoperative tests with brain regions and speech functions, as well as presented an application for intraoperative linguistic testing.
Background. Despite advances in endovascular technologies, microsurgical clipping is still a relevant treatment for cerebral aneurysms. Blood flow reduction techniques become necessary in some cases (no adequate proximal and distal blood flow control). Rapid ventricular pacing is a new effective technique for controllable hypotension and aneurysm sac relaxation. Objective. To demonstrate successful rapid ventricular pacing in microsurgical clipping of a large aneurysm of vertebrobasilar confluence in acute period of SAH. Material and methods. A 64-year-old patient with SAH from vertebrobasilar confluence aneurysm underwent successful microsurgical treatment. The patient underwent surgery on the second day after hemorrhage. Surgery was performed through a right-sided retrosigmoid approach. Two episodes of rapid ventricular pacing were used to relax the aneurysm and reduce the risk of intraoperative rupture. The effect was achieved almost immediately after initiation with episodes lasting no more than 50 seconds. Controllable hypotension minimized bleeding. There were no postoperative neurological complications. CT angiography showed complete exclusion of aneurysm. The patient was discharged after 10 postoperative days. Conclusion. Rapid ventricular pacing may be justified in the treatment of complex cerebral aneurysms when surgical blood flow control is difficult. Large-scale studies are needed to develop patient selection algorithms for this surgery.
Tentorial meningiomas account for 3—6% of all intracranial meningiomas. Complexity of topographic and anatomical location along with variability of surgical approaches underscores the importance of investigating these tumors. A systematic review was conducted in accordance with the PRISMA 2020 guidelines. We enrolled the studies devoted to outcomes after microsurgical treatment between 1984 and 2024. Demographic characteristics, neuroimaging data and postoperative outcomes were estimated. A total of 18 studies were selected. There were 668 patients, mean age was 52.6 years (478 females, 190 males). Mean tumor diameter was 33±5.4 mm. Preoperative hydrocephalus was detected in 17.1% of cases. The rate of gross total resection was 78%, complication rate — 34.3%, mortality rate — 3.3%. Microsurgical resection is the gold standard for meningiomas. The purpose of surgery is safe resection of tumor while preserving neurovascular structures. Adjuvant therapy may be considered for small tumors or subtotal resection.
Background. Schwannomas are benign (WHO Grade I) tumors of peripheral nerves arising from Schwann cells. Discrepancies between biological behavior and histological characteristics of tumor may exist. We consider it appropriate to describe such a case and compare it with literature data. Material and methods. A patient with subcutaneous schwannoma of the lower third of the right leg complicated by skin ulceration is presented. A review is devoted to data on atypical clinical course of schwannomas. Results and discussion. A 55-year-old man presented with tumor in the lower third of the right leg and skin ulceration 3.5×3 cm. The tumor appeared 10 months ago and significantly enlarged. Open biopsy revealed WHO Grade 1 schwannoma. Atypical course of disease required an extended resection of tumor and simultaneous skin defect closure with split-thickness thigh skin flap. Two months after surgery, the wound healed via primary intention. There were no signs of tumor recurrence, and Karnofsky score was 100. Conclusion. Atypical course of cutaneous schwannoma with ulcers complicates accurate and timely diagnosis, as well as complicates patient management, selection of primary specialist and surgical approach. Benign tumor verified by biopsy and clinical manifestations typical for soft tissue cancer can require early surgical intervention based on oncological principles.
Background. Currently, aesthetic assessment becomes important after head and neck surgeries. Anterolateral approaches are common in neurosurgery, and frontotemporal contour deformities with asymmetry are the most common aesthetic defects. In 68% of cases, such sequelae can lead to severe psycho-emotional disorders. Autologous fat grafting (lipofilling) is a minimally invasive method with low risk of complications and stable long-term results. It is widely used in plastic reconstructive surgery but not routine after neurosurgical interventions. Material and methods. We present 4 cases of autologous fat grafting in patients with frontotemporal deformities after previous craniotomies. A 5-point Likert scale was used for subjective assessment of aesthetic outcomes after lipofilling. Results. “Complete satisfaction” with results was achieved in three patients; one patient rated the result as “satisfactory”. No postoperative complications were registered. Mean volume of injected autologous fat tissue per a procedure was 23.5 ml. The second procedure of lipofilling was required for two patients to achieve satisfactory results. Conclusion. These cases demonstrate feasibility of autologous fat grafting in patients with frontotemporal deformities after previous craniotomies. This method can be used as one of the options for minimally invasive soft tissue augmentation in temporal region considering graft survival, acceptable aesthetic outcomes and low risk of complications. When planning treatment, it is necessary to account for natural resorption of autologous fat tissue that often necessitates multiple lipofilling procedures.
Background. Preservation of venous structures and prevention of cortical trauma during resection of parasagittal meningioma are key factors ensuring high quality after surgery. However, venous circulatory disorders are possible despite these principles. Objective. To describe contralateral cerebral venous thrombosis and compare own findings with literature data on cerebral venous thrombosis in parasagittal meningioma. Results and discussion. A 53-year-old man with parasagittal meningioma of posterior third of superior sagittal sinus bordering the middle third on the right developed local thrombosis of sinus and parietal vein, as well as contralateral secondary intracerebral hemorrhage in 9 days after surgery. We did not remove tumor remnant inside the sinus. Superior sagittal sinus was not opened. Meningioma matrix coagulation was performed using direct spray mode. Enoxaparin sodium (subsequently switched to rivaroxaban) and citicoline were prescribed. The Karnofsky score recovered to 90 points after 3 months. In accordance with the PRIZMA recommendations, we reviewed the PubMed and Google Scholar databases using the keywords «parasagittal AND meningioma AND venous AND thrombosis». We found 12 and 2.540 manuscripts, respectively. Analysis of all abstracts in PubMed database and 200 most relevant papers in Google Scholar database identified 3 eligible reports. Clearly, such complications are extremely rare. Conclusion. Contralateral thrombosis of bridging vein after resection of parasagittal meningioma is unique and deserves attention. Timely diagnosis and anticoagulation can lead to complete regression of neurological symptoms.
Background. Radiofrequency thermocoagulation (RFTC) allows for destruction of epileptogenic zone during stereo-electroencephalographic (stereo-EEG) monitoring. This technique can serve therapeutic and diagnostic purposes in the treatment of patients with drug-resistant epilepsy (DRE). Objective. A systematic review of literature data on RFTC, its technique, efficacy, and safety in patients with DRE. Material and methods. This review was conducted according to the PRISMA 2020 criteria and registered in the PROSPERO registry. Two researchers selected studies in three stages using appropriate keywords. Studies with sample size ≥ 5 patients devoted to RFTC in patients with DRE were included. Studies demonstrating the effectiveness of RFTC for seizures with a minimum follow-up of 6 months were eligible. Case reports, reviews, manuscripts without available full text and non-eligible studies were excluded. Results. The review included 41 articles and 1.417 patients. The main causes of RFTC during stereo-EEG were contraindications for resection, the need for additional information on location of ictal zone, coagulation as an additional method for epileptogenic zone destruction and treatment of seizures in patients with indications for resection. The overall complication rate ranged from 0% to 60% (in 5.3% of patients). Neurological deficit was transient in 64% of cases. Favorable outcomes (Engel I) after RFTC without additional treatment were achieved in 24.9% of patients with DRE. Conclusion. Stereo-EEG navigated RFTC is a promising technique for examination and treatment of patients with DRE. It is safe and effective. However, standardization of coagulation parameters and prospective multiple-center studies are needed to obtain more accurate data.
Objective. To describe a rare complication of non-penetrating traumatic brain injury. Material and methods. We present a 16-year-old patient with multiple skeletal lesions and mild traumatic brain injury (TBI). Two weeks after injury, clinical status suddenly worsened due to large subdural hematoma without signs of subarachnoid hemorrhage despite normal neuroimaging data at baseline. Results. Examination revealed pericallosal artery aneurysm. Microsurgical intervention with aneurysm excision was performed. Histological examination revealed thrombotic masses containing fibrin and no vascular walls of aneurysm. Therefore, the aneurysm was regarded as traumatic false aneurysm resulting from detachment of small artery. There were no neurological disorders at discharge. Conclusion. Acute subdural hematoma in delayed period after TBI requires CT angiography to rule out traumatic aneurysm.
Objective. To analyze the factors contributing to postoperative anosmia and to evaluate the effectiveness of preventive strategies in microsurgery for cerebral aneurysms. Material and methods. The study included 117 patients with unruptured anterior circulation aneurysms who underwent surgery at the Burdenko Neurosurgery Center in 2024—2025. All patients underwent olfactometric assessment preoperatively, after 5—7 postoperative days and 6 months after surgery. Clinical, anatomical (CT angiography) and intraoperative factors were analyzed. Results. Postoperative anosmia occurred in 55 (47%) patients with bilateral involvement in 11 (20%) cases. Anosmia developed in 70.2% of patients with anterior communicating artery (ACoA) aneurysms. Significant anatomical predictors were superior (p=0.01) and anterior (p=0.01) ACoA aneurysm dome orientation. Intraoperative risk factors included nerve compression by brain spatula (p<0.001) and arachnoid dissection of the nerve. In some cases, we noted a single-stage flow of blood along anterior cranial fossa base from olfactory tract during frontal lobe traction and arterial dissection. This «red drop» sign was an intraoperative marker of nerve injury (p=0.04). Transsylvian approach for middle cerebral artery aneurysms ensured 100% preservation of olfactory function (p<0.001). After 6 months, olfactory function recovered in 33.3% of patients. Previous COVID-19 was associated with worse recovery (p=0.05). Conclusion. Postoperative anosmia is a frequent complication in aneurysm surgery. The main predictors are ACoA aneurysm and intraoperative traction-induced avulsion of the nerve. Preventive strategies include selection of less traumatic approach and minimized pressure on olfactory nerve. Arachnoid dissection of the nerve is not recommended.
Background. Traditional histological classification of meningiomas has low prognostic accuracy and necessitates integration of molecular biomarkers. However, current data are fragmented and require rigorous synthesis. Objective. To develop a meta-analysis protocol for quantitative assessment of the influence of molecular profile of meningiomas on long-term outcomes (overall survival and recurrence-free period) after surgical or combined treatment. Material and methods. The article provides historical analysis of transformation of evidence-based medicine standards from narrative reviews to algorithmic guidelines (QUOROM, MOOSE, PRISMA). The choice of the PRISMA-P 2020 protocol and Cochrane methodology as the standard for this study is justified. Results. A meta-analysis design was developed to assess the impact of genetic profile (TERT, CDKN2A/B, NF2 status, DNA methylation) on the risk of recurrence. Inclusion criteria (PICOTS) cover all types of meningiomas. The protocol regulates searching strategy, independent screening (Rayyan) and risk of bias assessment using the QUIPS tool. Statistical synthesis of data is planned to identify the hierarchy of risk factors. Conclusion. Implementation of this protocol will ensure creation of a valid evidence base for stratification of risk of meningioma recurrence based on molecular genetic profile.
Background. Vagoglossopharyngeal neuralgia (VGFN) is an uncommon facial pain syndrome caused by neurovascular conflict. Objective. To evaluate anatomical relationships between cranial nerves IX—X and compressing arteries, as well as effectiveness of vascular decompression (VD) in these patients. Material and methods. VD via retrosigmoid approach was performed in 9 patients with VGFN. Age of patients was 33—72 years. There were 4 males and 5 females. Two ones had right-sided lesions, 7 — left-sided lesions. Mean follow-up period was 8.5 years (range 3—15). Results. Neurovascular conflict was caused by posterior inferior cerebellar artery (PICA) in 6 cases, anterior inferior cerebellar artery (AICA) and PICA in 2 cases, PICA and vertebral artery in 1 case. Interposition technique was used in 7 cases, transposition of vessels — in 2 cases. Complete relief of VGFN was achieved in all patients. Mild dysphonia without dysphagia was registered in 1 case and regressed throughout 1.5 months. There were no VGFN recurrences. Conclusion. VD is a highly effective surgical method for VGFN with low rate of complications and pain recurrences.
The advantage of asymmetrical sliding knot is that it is tightened by pulling only one «main» end of suture, while the other «wrapped» end is inserted into the wound. This method eliminates the need for additional instruments or devices to insert the knot into a narrow and deep wound. OBJECTIVE:To evaluate feasibility of asymmetrical sliding knots for microsutures in transnasal endoscopic skull base repair. MATERIAL AND METHODS:Asymmetric sliding suture was used to attach free autofascial flap to dura mater edges in 25 cases of transnasal endoscopic surgeries with intraoperative cerebrospinal fluid leakage. Craniopharyngiomas were resected in 19 cases, pituitary adenoma in 1 case, meningocele in 1 case, sinonasal carcinomas in 2 cases, chondrosarcoma in 1 case and chordoma in 1 case. RESULTS:Postoperative cerebrospinal fluid leakage was not observed in any case. CONCLUSION:We confirmed feasibility of asymmetric sliding knots to form microsutures in transnasal endoscopic skull base repair. The key technical parameters of necessary sutures, specifics of needle insertion through the dura mater and free autofascial flap, limitations and difficulties encountered by the authors are described. Sliding interrupted microsutures can be recommended to form dense layer of autologous tissues in transnasal endoscopic skull base repair.
Brain abscesses are relatively rare, yet they are life-threatening infections with high risk of persistent neurological impairment in survivors. Effectiveness of therapy depends on understanding the range of probable pathogens. This enables optimal empirical therapy avoiding broad-spectrum combinations and associated risks of drug-drug interactions. Available Russian literature predominantly contains case reports and reviews resulting in a lack of up-to-date epidemiological data on brain abscesses. OBJECTIVE:To analyze current etiological and epidemiological data in a cohort of patients with verified brain abscesses. MATERIAL AND METHODS:A single-center retrospective study enrolled 41 patients with primary brain abscesses between 2022 and 2025. The diagnosis was confirmed by contrast-enhanced MRI and/or intraoperative findings. Exclusion criteria: extracranial abscess, concomitant intracranial or head soft tissue infection and recurrent abscesses. RESULTS:Abscesses occurred as complications of neurosurgery in 16 (39%) out of 41 patients, ENT diseases - in 4 (9.8%) cases. Odontogenic route of infection was established in 4 (9.8%) cases, and 2 (4.9%) patients had previous traumatic brain injury. Etiology was unknown in 36.6% of cases. Gram-positive cocci prevailed: Staphylococcus spp. (26.8%) and Streptococcus spp. (19.5%). CONCLUSION:These data highlight the need for regular updating of local epidemiological data on brain abscesses. A thorough analysis of anamnestic data in these patients can enable informed and timely prescription of appropriate empirical antimicrobial therapy. Choice of this therapy depends crucially on spectrum of probable pathogens, especially in the absence of microbiological verification.
Traumatic brain injury (TBI) is characterized by high mortality and severe disability worldwide representing a major social, economic, and medical problem. Pathogenesis of secondary brain damage is underpinned by a cascade of neuroinflammatory reactions triggered by cytokine release. Key mediators include interleukin-6 (IL-6) and interleukin-2 (sIL-2R) system. However, their daily dynamics in acute period of severe trauma and relationship with intracranial hypertension remain poorly understood. MATERIAL AND METHODS:The study was conducted at the Burdenko Neurosurgical Center. Inclusion criteria: acute TBI, admission within 24 hours, age 18-75 years. Exclusion criteria: atonic coma, decompensation of chronic diseases. IL-6, sIL-2R, C-reactive protein, and procalcitonin were assessed. RESULTS:There were 74 patients with severe TBI (19 women, mean age 34.0±12.5 years). The mortality rate was 14.9% (11 patients). Biphasic cytokine dynamics was revealed. Early increase in IL-6 on day 1 reflected extent of primary injury. On the 2nd day, IL-6 levels remained significantly higher in patients with fatal outcome (median 40.2 vs. 22.4 pg/ml, p<0.05). Secondary increase was recorded after 3 days and coincided with manifestation of infectious complications peaking on day 5. On day 5, sIL-2R levels were found to be more than 2.5-fold higher in patients with fatal outcome (1660.0 vs. 649.0 pg/ml, p<0.05). In fatal patients, we found strong direct correlation between IL-6 and intracranial pressure (rho=0.71), as well as inverse correlation with cerebral perfusion pressure. CONCLUSION:Biphasic cytokine response develops in acute phase of severe traumatic brain injury. Early phase (2 days) is characterized by increased IL-6 according to extent of primary cerebral injury. The second phase (days 3-14) is associated with infectious complications and characterized by increased sIL-2R and IL-6. It is not their absolute value, but temporal dynamics is prognostically significant. No IL-6 reduction by 48 hours after injury indicates uncontrollable neuroinflammation and potentially unfavorable outcomes. Peak (more than 2.5 times) increase in sIL-2R on day 5 is a marker of transformation of protective inflammation into systemic hyperinflammatory syndrome. Direct correlation between IL-6 and intracranial hypertension in fatal patients confirms pathogenetic role of this cytokine in secondary brain injury. IL-6 and sIL-2R monitoring may enable timely identification of patients with high risk of fatal intracranial hypertension and ensure a personalized approach to intensive care.
OBJECTIVE:To determine the indications for surgical correction of lumbar lordosis in patients with multilevel degenerative lumbosacral spinal stenosis. MATERIAL AND METHODS:A prospective pilot study was conducted at the Perm City Clinical Hospital No. 4 between 2022 and 2025. Patients with multilevel degenerative lumbosacral spinal stenosis presenting with clinical manifestations of compressive syndromes, as well as persistent back pain refractory to conservative treatment, were enrolled. All patients underwent the following additional examinations: pain assessment (VAS scores), functional status (the Oswestry Disability Index and the Roland-Morris Disability Questionnaire), standing full-spine radiography with calculation of sagittal balance parameters. RESULTS:The study group consisted of 22 patients with multilevel lumbar spinal stenosis at the following levels: L3-L4-L5 in 6 (27.3%) patients, L4-L5-S1 in 13 (59.1%) patients, and L2-L3-L4-L5 in 3 (13.6%) patients. Mean pathological reduction of lumbar lordosis relative to individual normative value was 17.8° (min 8.3°, max 22.6°). All patients underwent surgical intervention. After 3 postoperative months, standing radiographs demonstrated achievement of target lumbar lordosis along with regression of neurological symptoms in all patients. VAS score of pain decreased by 2.8 times (95% CI 1.7-4.2). Disability according to the Roland-Morris questionnaire improved by 3.3 times (95% CI 2.1-4.7). Quality of life across various domains assessed by the Oswestry Disability Index improved by 3.1 times (95% CI 1.1-3.8). CONCLUSION:In patients with multilevel degenerative lumbosacral spinal stenosis (Schizas grade C or D) accompanied by compressive syndromes and drug-resistant back pain, surgical interventions are indicated for reduced lumbar lordosis and impairment of at least one sagittal balance parameter, including pelvic angle, pelvic tilt, ThI pelvic angle, sagittal vertical axis. Correction of lumbar lordosis in this patient population results in significant reduction of back pain and QoL improvement.
INTRODUCTION:In modern neurooncology, molecular and clinical-morphological markers are used to assess prognosis and select treatment strategies for glioblastoma. Currently, researchers are focusing on microRNAs in biological fluids that can predict outcomes of disease. OBJECTIVE:To analyze serum expression of miR-130, miR-148, miR-194, and miR-605 in patients with glioblastoma depending on clinical and molecular genetic parameters of tumor. MATERIAL AND METHODS:The study included 39 patients with newly diagnosed glioblastoma (IDH-wildtype, WHO Grade 4) between 2021 and 2023 (median age 55 years; 95% CI 47-61). Expression of miR-130, miR-148, miR-194, and miR-605 was assessed in serum samples collected before chemoradiotherapy. Patients underwent combined therapy: maximal tumor resection, chemoradiotherapy (60 Gy) with temozolomide and adjuvant chemotherapy. MicroRNA levels were determined by real-time PCR. MGMT methylation, TP53 and Ki-67 expression, recurrence-free survival and tumor metabolic activity (SPECT) were analyzed. RESULTS:There was a significant association between miR-148 expression and MGMT promoter methylation (increase by 1.6 times). MiR-194 expression decreased by 1.2 times. MiR-130 increased by 1.5 times with MGMT methylation and Ki-67 >25%. In patients with TP53 expression >10%, MiR-130 increased by 3 times. No association was found between expression of microRNAs and SPECT data. CONCLUSION:MiR-148 is associated with MGMT methylation and can have prognostic significance. Reduced miR-194 with MGMT methylation and increased miR-130 with high Ki-67 and TP53 indicate involvement of these microRNAs in formation of aggressive glioblastoma phenotype and their potential as prognostic biomarkers.
This article presents definition, clinical course and distinctive features of dural fistulas of the craniovertebral junction. Anatomical and pathogenetic aspects of this pathology are discussed. The authors present a rare case of dural fistula of the craniovertebral junction. The article discusses diagnostic and treatment methods for dural fistulas of the craniovertebral junction. The most significant and favorable treatment options are described.
