Analysis of historical and modern approaches to teaching neurosurgery by professional communities and public authorities in the United States, the European Union and the Russian Federation makes it possible to develop a modern training program regarding content and duration. High-tech and dynamically developing specialty has acquired several large sub-specializations over the past decades. Each direction requires a long-term training and a special program. Training in neurosurgery in the modern world takes 5-7 years and involves acquisition of clinical and scientific knowledge. Some issues are brought up for discussion by professional community. Solution of these problems will provide an opportunity for international integration of the Russian training program for neurosurgeons. High level of neurosurgery in our country and a single educational space with the European community will allow exchanging students, adopting foreign experience and sharing our own experience.

Among the founders of Russian neurosurgery Isaac Savelyevich Babchin was the longest-living - almost 94 years! Frail physically, he preserved his powerful intellect. How wise and critical was his concluding speech at his 90th anniversary at the Polenov Institute!

May 7, 2021 was the 90th anniversary of the birth of an outstanding Russian neurosurgeon, corresponding member of Russian Academy of Sciences, Laureate of the State Prize of USSR, Professor Yury Mikhailovich Filatov.

OBJECTIVE:This research is aimed to study the clinical and MRI predictors of coma duration, the intensity of critical care, and outcome of traumatic brain injury (TBI). MATERIAL AND METHODS:The data from 309 patients with TBI of varying severity were included in the analysis, of whom 257 (86.7%) were treated in the intensive care unit (ICU), including 196 (63.4%) patients admitted in a comatose state lasting longer than 1 day. All patients underwent brain MRI within 21 days after the injury. MRI findings were classified according to MRI grading scale of brain damage level and localization proposed previously. RESULTS:The proposed MRI grading significantly correlated with the Glasgow coma (GCS, r=-0.67; p<0.0001) and Glasgow outcome (0.69; p<0.001) scores in the entire group. In a subgroup of comatose patients (GCS<9) it correlated with coma duration (r=0.52; p<0.0001). Spearman correlation analysis showed a significant relationship between the MRI classification and a number of parameters: ICU length of stay (r=0.62; p<0.0001), the duration of artificial ventilation (r=0.47; p<0.0001), the rate of artificial ventilation, sedatives, analgesics, mannitol, hypertonic saline and vasopressors usage (p<0.01). These data confirm the relationship between higher grades of MRI classification (deep brain damage) and the need for the escalation of intensive care main components. CONCLUSION:Our results support the hypothesis that the levels and localization of brain damage, estimated by the proposed MRI grading scale, might be predictors of coma duration, intensity and duration of intensive care, and TBI outcomes. A prognosis based on clinical and neuroimaging data comparison can be valuable for planning and efficient use of the hospital beds and ICU resources, for optimizing the patient flow and timing of patient transfer to neurorehabilitation facilities.

The aim of this study is to systematize the modern methods used for reconstruction of extensive and complex skull defects. Special attention is paid to computer technologies, including 3D imaging and CAD/CAM. Laser-based stereolithography is thoroughly reviewed among other additive technologies. We present our view of the problem associated with proper timing of cranioplasty and choice of materials for it. Complications of skull defect reconstruction are also discussed.

In 1929, a surgeon N.N. Burdenko and a neurologist V.V. Kramer founded the first neurosurgical clinic in Moscow, which was reorganized to the Institute of Neurosurgery in 1932. The Institute has come a long way through military and peaceful years, overcoming all sorts of obstacles. It has constantly developed, built, and modernized, and now this is the National Medical Research Center of Neurosurgery. In this article, we describe the history of the Institute/Center and its staff who have had a significant impact on the development of domestic and global neurosurgery.

Supratentorial hematoma is the most common mass lesion found in traumatic brain injury (TBI) and is associated with high mortality and disability rates.The annual incidence of the aforementioned is 20 cases per 100,000 populations.

The development of post-traumatic hydrocephalus (PTH) after severe traumatic brain injury can cause, in some cases, severe impairment of consciousness and prevent rehabilitation of patients. The influence of cerebrospinal fluid (CSF) circulation disorders on processes of consciousness recovery is a fundamental problem that requires in-depth research. The issues of differential diagnosis, results of surgical treatment of PTH, and its complications in patients in the vegetative status (VS) and minimally conscious state (MCS) remain poorly covered.MATERIAL AND METHODS:We performed a retrospective analysis of the long-term outcomes of surgical treatment in 82 PTH patients in the VS (38 cases) and MCS (44 cases).RESULTS:A significant clinical improvement occurred in 60.6% of VS patients and in 65.9% of MCS patients. The rate of shunt infection was high and amounted to 21.05% in the group of VS patients and 20.4% in the group of MCS patients. The rate of shunt system dysfunction was 26.05% in the first group and 20.4% in the second group. Postoperative mortality (associated directly with treatment complications) was 3.6%. Total mortality was 10.9%.DISCUSSION:The positive effect of shunting surgery in patients with gross impairment of consciousness was associated with transition to higher levels of consciousness. The high rate of complications, especially infections, was due to a serious condition of patients and comorbidities, in particular chronic infection foci. Shunt system dysfunction was not a factor of the adverse outcome of surgical treatment because rarely led to irreversible consequences, but required repeated surgery. Mortality after shunting surgery was significantly higher in patients with gross impairment of consciousness than in other groups of patients. We found a correlation between deaths in VS patients and shunt infection in the postoperative period.CONCLUSION:CSF shunting surgery is an important step in surgical rehabilitation of PTH patients. To assess the contribution of various risk factors to the development of shunt infection and to develop measures reducing its rate, further prospective studies are needed.

The diagnosis of head injury should be based on certain principles. Each of them is important and has its own history. The authors summarize the experience of treatment of head injury using clinical and neuroimaging methods at the NN Burdenko Neurosurgery Institute (now the NN Burdenko National Research Center for Neurosurgery) for more than 30 years. The following principles of diagnosis of head injury were suggested and tested in clinical practice: severity of patient's state; clinical syndromes; topical diagnosis; neuroimaging; phasicity; age-related approach; data synthesis; sufficiency; individual approach. Taken together, these principles provide complete personalized diagnosis and prognosis which allow choosing an optimal management of the patient. The strategy for better diagnosis, prognosis and treatment of head injury is the combined use of clinical, neuroimaging and ethical approaches.

One of the frequent consequences of severe traumatic brain injury is posttraumatic hydrocephalus that not only hampers the processes of consciousness recovery, rehabilitation, and social adaptation of patients but also is the cause of disability. Pathological processes underlying the clinical picture of posttraumatic hydrocephalus and the relationship between CSF circulation disorders and structural changes in the brain substance have not been adequately studied. Of particular importance are patients in the chronic vegetative or minimally conscious state, recovery from which is blocked by posttraumatic hydrocephalus. The question of reversibility of impaired consciousness depending on the disease duration has remained open. High risks of purulent-inflammatory complications of shunting surgery are especially important in patients with chronic infection foci (tracheostomy, gastrostomy, epicystostomy, prolonged bladder catheterization, pressure ulcers, etc.), but their actual effect on the shunting outcomes has not been revealed. Posttraumatic hydrocephalus remains a topical neurosurgical problem requiring clarification of its diagnostic criteria, differentiation from atrophy-related ventriculomegaly, and comprehensive development of pathogenetic and therapeutic aspects.

The authors report on the problem of Traumatic Brain Injury(TBI) and main ways of its solution. Special emphasis is beingplaced on literature data bank and personal experience in studyingand making precise diagnosis of diffuse and focal brain damageusing Diffuse-tensor MRI (DT-MRI) and its other modalities.A comparative analysis of DT-MRI findings in 8 healthyvolunteers and 22 patients in coma with severe diffuse axonalinjury (DAI) at the period of 217 days after trauma demonstratedsignificant changes in the corpus callosum and corticospinaltracts (CST) caused by DAI. Fractional anisotropy wasconsidered the most sensitive indicator of their damage in theearly stage of DAI. The authors developed and described a newapproach to the management of brain concussion which allows out-patient treatment of such patients provided there is no focaldamage at GCS 15 and on condition thorough neurological andregular CT- and MRI examinations are performed.

Clinical manifestations and outcomes of the brain concussion were comparatively and dynamically analyzed in two groups of patients (totally 355 pts, aged from 16 to 35 yrs, no concomitant somatic and neurological diseases): those who were admitted to hospital in the acute period of head injury (201 pts) and patients treated at home (154 pts). Clinical data were controlled by CT and MRI studies. Followup lasted 1 year. It was revealed that in the acute period, regression of objective and subjective signs were noted in patients of both groups almost at the same time (45days after trauma). Catamnesis showed complete recovery in 89,0% pts treated in the acute stage in hospital and in 90,3% treated at home. In the longterm period only 11% pts of group I and 9,7% pts of group II showed the consequences non leading to disability like psychovegetative syndrome. Based on the obtained results it is possible to conclude that brain concussion without any severe complications in the acute period of head injury can be treated at home.

Traumatic brain injury (TBI) is one of the main causes of mortality and severe disability in young and middle age patients. Patients with severe TBI, who are in coma, are of particular concern. Adequate diagnosis of primary brain injuries and timely prevention and treatment of secondary injury mechanisms markedly affect the possibility of reducing mortality and severe disability. The present guidelines are based on the authors' experience in developing international and national recommendations for the diagnosis and treatment of mild TBI, penetrating gunshot wounds of the skull and brain, severe TBI, and severe consequences of brain injury, including a vegetative state. In addition, we used the materials of international and national guidelines for the diagnosis, intensive care, and surgical treatment of severe TBI, which were published in recent years. The proposed recommendations for surgical treatment of severe TBI in adults are addressed primarily to neurosurgeons, neurologists, neuroradiologists, anesthesiologists, and intensivists who are routinely involved in treating these patients.

Rational intensive care needs to be based on monitoring vital functions. Neuromonitoring, monitoring of blood flow, respiration, arterial and cerebral oxygen saturation should be performed in patients with suppressed wakefulness (GCS score ≤8). The optimal measures include continuous monitoring of intracranial pressure (ICP) and cerebral perfusion pressure (CPP), monitoring of cerebral oxygen saturation (measuring brain tissue oxygen tension, cerebral oximetry in the parainfrared range, or measuring hemoglobin oxygen saturation in the jugular vein bulb through a catheter placed retrograde), monitoring arterial pressure (invasive procedure is preferred), pulse oximetry, monitoring carbon dioxide concentration in respiratory gas and heart rate). Where possible, these primary diagnostic measures should be expanded by ultrasonography of the cerebral vessels, monitoring central venous pressure, systemic hemodynamics, evaluation of the acid–base balance of arterial and venous blood, and tissue microdialysis [1—9].

Traumatic brain injury (TBI) is one of the major causes of death and disability in young and middle-aged people. The most problematic group is comprised of patients with severe TBI who are in a coma. The adequate diagnosis of primary brain injuries and timely prevention and treatment of the secondary injury mechanisms largely define the possibility of reducing mortality and severe disabling consequences. When developing these guidelines, we used our experience in the development of international and national recommendations for the diagnosis and treatment of mild traumatic brain injury, penetrating gunshot wounds to the skull and brain, severe traumatic brain injury, and severe consequences of brain injuries, including a vegetative state. In addition, we used international and national guidelines for the diagnosis, intensive care, and surgical treatment of severe traumatic brain injury, which had been published in recent years. The proposed guidelines concern intensive care of severe TBI in adults and are particularly intended for neurosurgeons, neurologists, neuroradiologists, anesthesiologists, and intensivists who are routinely involved in the treatment of these patients.

The Vascular Department of the Burdenko Neurosurgical Institute is one of the country's first dedicated departments engaged in treatment of patients with cerebrovascular diseases. The modern vascular service of the Institute is represented by several departments and groups: the Department of Microsurgical Treatment of Vascular Diseases, a group of Reconstructive Brachiocephalic Surgery, and the Department of Endovascular Surgery and Neurodiagnosis that is also engaged in intra-arterial chemotherapy and angiographic diagnosis. The neurovascular service of the Institute is a rightful leader of Russia in the number operations and their complexity: patients with the most serious and unusual pathologies are referred to the Institute from across the country. The achievements of the service are based on science and clinical practice that underlie progressive improvement in the diagnosis, surgical methodology, and recovery of neurovascular patients. On November 02, 2016, the Vascular Department of the Burdenko Neurosurgical Institute will celebrate the 50th anniversary of its foundation.

Нейрохирургия, сравнительно молодая и одна из сложнейших областей медицинской практики, за столетие своего развития в качестве автономного направления достигла невероятных успехов во многом благодаря тому, что интегрировала достижения научно-исследовательской деятельности, совершенствования медицинской техники и операционных методов. Вместе с тем нейрохирургия всегда сама была источником фундаментальных знаний о нервной системе и не только черпала информацию из таких разделов, как генетика, биохимия и физиология, но и обогащала их данными о патологических и нормальных состояниях и функционировании нервной системы. Этот процесс взаимного обогащения, стимулируемый появлением всё новых технологических возможностей, не только демонстрирует продуктивность исследований, лежащих на пересечении фундаментальных и практико-ориентированных дисциплин, но и позволяет надеяться на увеличение положительной статистики по числу спасённых и возвращённых к нормальной жизнедеятельности больных с различными травмами и органическими заболеваниями, в частности, благодаря методам нейропротекции и стимуляции нейрогенеза, или, по крайней мере, на улучшение качества жизни в случае неизлечимых заболеваний, в том числе с использованием методов нейромодуляции.