According to the order of April 15, 1935, the opening of the Department of Neurosurgery, the first head of which was Nikolai N. Burdenko, laid the foundation for the development of neurosurgical activity and training of neurosurgical personnel in the USSR within the walls of the Russian Medical Academy of Medical Sciences (TsIUV). N.N. Burdenko was an outstanding Soviet surgeon, one of the founders of neurosurgery, academician of the Academy of Sciences of the USSR (1939) and the Academy of Medical Sciences of the USSR (1944-1946), Hero of Socialist Labor, honorary member of the British Royal Society of Surgeons and the Paris Academy of Surgery, Colonel General of Medical Service.

According to the literature, recurrent disc herniation of the lumbar spine occurs in 5-10% of cases. Objective. To develop an algorithm for surgical treatment of recurrent lumbar spine disc herniation based on analysis of risk factors of relapse and assessment of intra- and postoperative period. MATERIAL AND METHODS:The study included 61 patients with recurrent intervertebral disc herniation. Thirty patients underwent repeated microdiscectomy without transpedicular fixation, 31 patients - resection of recurrent disc herniation with transpedicular fixation (PLIF technique). The control group included 63 patients without recurrent disc herniation. Mean follow-up period was 3.5 years. RESULTS:Discectomy with transpedicular fixation is characterized by larger extent, prolonged surgery time and rehabilitation period. However, there is lower risk of recurrent disc herniation and CSF leakage. Repeated microdisectomy without transpedicular fixation is characterized by smaller extent and shorter surgery time, as well as faster recovery period. Nevertheless, we have higher risk of recurrent disc herniation and CSF leakage. We developed a method for assessing the probability of recurrent intervertebral disc herniation. This algorithm allows us to predict the probability of recurrent disc herniation in a particular patient with 86.7% accuracy. CONCLUSION:We proposed an algorithm for choosing surgical treatment of recurrent disc herniation. Microdiscectomy without fixation is advisable for the risk of recurrent disc herniation <30%, discectomy with transpedicular fixation - for risk of disc herniation >30%.

Surgical treatment of peripheral nerve injuries is effective in only 50% of cases. This is primarily due to the significant extent of the diastasis between the fragments of the damaged nerve, in which autoplasty has to be performed. The drawbacks of this technique are the formation of scar tissue, possible necrotisation of the autograft, mismatch of the donor and recipient nerve diameters. In order to overcome these drawbacks and improve the efficiency of surgical intervention, the study presents a clinical case of successful multifascicular ulnar nerve autoplasty with the use of domestic biodegradable biomaterials SpheroGel and ElastoPob, revascularization of the autograft with a connective tissue flap on a vascular pedicle. A persistent regression of local pain syndrome was observed in the early postoperative period. The effectiveness of the performed surgical intervention was confirmed by ultrasound examination: there was no evidence of neuroma in the area of the operation, regeneration of nerve bundles was noted at the site of stitching. Positive dynamics was observed in the results of VAS, DN4, DASH questionnaires.

OBJECTIVE:To analyze available literature data on the role of genetic factors in degenerative disc disease.METHODOLOGY:We reviewed the PubMed, MEDLINE, Cohrane Library, e-Library databases using the following keywords: degenerative spine lesions, intervertebral disc herniation, pathogenesis, genetic regulation.RESULTS:Searching depth was 2002-2022. We reviewed 84 references. Exclusion criteria: duplicate publications, reviews without detailed description of results, opinions. Finally, we included 43 the most significant studies.CONCLUSION:There are literature data on proinflammatory cytokines, growth factors and osteodestructive processes in pathogenesis of degenerative disc disease. However, there is only fragmentary information about the role of genetic regulation of these processes. Some factors, such as microRNA, TGF-b, VEGF, MMP are still poorly understood.

Glioblastoma is the most malignant primary brain tumor. For treatment uses a combined regimen that is currently available: surgery, radiation and chemotherapy. However, so far the median survival of patients does not exceed 14 months. In this connection, there is a constant search for effective methods. Improvement in radiation therapy has led to the possibility of its intraoperative, which is a practical and effective method aimed at getting rid of the remaining tumor cells, reducing the spread of the tumor and filling the therapeutic gap between surgery and subsequent chemotherapy and radiation therapy. Intraoperative radiation therapy (IORT) allows you to deliver the required tumoricidal dose exactly to the target, minimally affecting the surrounding healthy tissues.Goal: Establishment of the safety of intraoperative irradiation of patients with malignant gliomas with the INTRABEAM device (Carl ZEISS, Germany) with a dose of up to 40 Gy on the applicator.Material and methods: The study involved 15 patients, the average age of which was 51 years, the ratio of men and women was 4:6, the average Karnofsky index before surgery was 97. After surgical removal of the tumor, an express biopsy was performed. Next, intraoperative irradiation was performed with the INTRABEAM device (Carl ZEISS) at a dose of 40 Gy, followed by an assessment of the Karnofsky index, early postoperative and delayed possible complications.Results: In all patients operated on with intraoperative irradiation and subsequent adjuvant radiochemotherapy, the method was well tolerated, there were no wound healing features or identified complications, there were no cases of wound liquorrhea, wound inflammation.Conclusion: Intraoperative irradiation after surgical removal of the tumor can be recommended as a safe method for the treatment of malignant gliomas in addition to existing combination therapy.

Objective: to demonstrate the result of successful treatment of a patient with cystic vestibular schwannoma. Currently, there is no single approach to choosing a surgical treatment method of cystic vestibular schwannoma. When choosing tactics, neurosurgeons are guided, as a rule, by the location of the tumor and the thickness of its walls. Emptying the cyst can also lead to a change in the existing relationship of the tumor with neighboring structures, especially with the facial nerve. The chosen method of treatment of this disease in the form of total removal of cystic vestibular schwannoma under the control of neurophysiological monitoring made it possible to achieve early activation of the patient and avoid postoperative complications, preserve the function the facial and trigeminal nerves involved in the tumor capsule.

At present, the search for effective ways of restoring peripheral nerves with anatomical damage continues. Autoplasty still remains the gold standard, which, however, is not without its drawbacks. The use of nerve implants for promoting directional axon growth is essential and promising. Objective: to study the biomechanical properties of laboratory samples of an artificial nerve conduit (NGC) made of hybrid biomaterials and to, on cadaveric material, assess the technical feasibility of using them in surgical practice to repair extended peripheral nerve defects. Material and methods . The objects of the study were three electrospun NGC samples: from synthetic material (polycaprolactone, PCL) and hybrid biomaterials (PCL + gelatin or PCL + collagen). The work compared the physical and mechanical properties of NGC: stiffness, plasticity, elasticity, brittleness, resistance to chemical attack, their ability to be impregnated with liquid media, permeability, possibility of making an anastomosis between the implant and the nerve during surgical procedure. Cadaveric material was the object of the study: we used a dissected superficial sensory branch of the human right radial nerve, 2 mm in diameter, isolated on the forearm, about 12 cm in length, because it most corresponded to the diameter of the NGC samples tested. After surgery, the echogenic features of the implants and their anastomoses with the nerve were assessed by ultrasound imaging. Results. It was found that hybrid NGC samples, based on their biomechanical properties, are fundamentally suitable for use in surgical practice, to ensure growth and replacement of a peripheral nerve defect. However, the best composition of a nerve guide can be established after comparative preclinical study of the biocompatible and functional properties of hybrid material samples. Conclusion. The physical and mechanical properties of the investigated NGC samples made of hybrid biomaterials meet the technical requirements for implantable nerve conduits for surgical application.

Peripheral nerve diseases are one of the socially significant problems in the healthcare system of the Russian Federation. Effective care for patients suffering from these diseases is an important task for healthcare, as so as they are accompanied by prolonged disability. However, at present we do not have data that could fully demonstrate the medico-social and medico-economic aspects of carpal tunnel syndrome (CTS) and other peripheral nerve diseases in the Russian Federation. The aim of the study is to improve the quality of medical care for patients with carpal tunnel syndrome based on the analysis of statistical data of patients operated on for this pathology in the S. P. Botkin City Clinical Hospital. Material and methods. The patients in the study were all adult men and women who underwent surgical treatment of CTS at S. P. Botkin City Clinical Hospital in the period from 2016 to 2022. The sources of information about the treated patients were the information of medical information systems used in the hospital in different years. Statistical and visualization tools of the Microsoft® Excel® spreadsheet were used to obtain descriptive statistics and present data graphically. Results. In the S. P. Botkin City Clinical Hospital, which is the clinical base of the Department of neurosurgery of the Russian Medical Academy of Continuous Professional Education, in the period from 2016 to 2022, 692 surgical interventions were performed for patients with CTS. The analysis of statistical data has shown results comparable with the available literature data, however, a distinctive feature is an extremely long history of the disease before surgical treatment. Conclusions. Currently, in our country, there is an underestimation of the importance of peripheral nerve diseases, therefore, their separate statistical accounting in the structure of neurological morbidity is extremely important. Another important task is a multidisciplinary approach that provides high-quality medical care to patients with this pathology.

The purpose of the study was to improve classification of neurogenic (neuropathic) pain syndromes. This will make it possible to define the indications for appropriate analgesic surgery for each type of drug-resistant neurogenic pain syndrome. Incorrect management of neurogenic pain syndromes is usually associated with underestimation of pathogenetic prerequisites for its occurrence. Differentiation of compression, deafferentation and mixed neurogenic pain syndromes makes it possible to determine appropriate surgery and avoid tactical errors. Moreover, this approach allows you to save patients from unreasonable long-standing suffering. Patients with chronic pain syndromes often become disabled, sometimes in the prime of life, and isolated from society and family. Therefore, treatment of chronic pain is currently an urgent problem.

Background and importance The supraorbital "keyhole" approach has been described for the treatment of basilar artery aneurysms. Transpalpebral approach (TPA) is an alternative minimally invasive route to aneurysms of the Circle of Willis with excellent functional and cosmetic outcomes. Clinical presentation 53-years-old female who presented with an incidentally found 6.3 mm BA aneurysm with 3.1 mm neck diameter, admitted to our department of neurovascular surgery. Clipping was performed through TPA, with endoscope assistance and intraoperative ICG angiography. The patient's postoperative course was uneventful and was discharged home on postoperative day 5 without any complications. Conclusion First time in the literature described keyhole TPA with eyelid incision to BA aneurysm. TPA is technically difficult and requires some experience to work through deep and limited surgical corridor. This technique can be good alternative to traditional fronto-lateral, supraorbital keyhole craniotomies.

Introduction. Reintervention in patients with spinal disk herniation is shown to significantly decrease likelihood of favorable outcomes in the postoperative period. Thus, it is important to individually assess risk factors for and likelihood of spinal disk herniation recurrence for each patient, and choose a suitable surgical option. Objective: to evaluate changes in the levels of immunoregulatory mediators in the blood serum and extracted spinal disc tissue of allegedly healthy individuals and patients with lumbar disk herniation relapses. Materials and methods. We examined 60 patients. The control group included 19 patients with traumatic spinal cord injuries at the lumbar level. The main group included 41 patients with spinal disk herniation. Twenty-two individuals had primary herniation while 11 patients presented with single clinical and neurological relapses at the pre-operated lumbar level and 8 patients presented with recurrent relapses. Solid-phase enzyme immunoassay detected proinflammatory cytokines (interleukin-6, tumor necrosis factor-), chemokines (interleukin-8, monocyte chemoattractant protein-1), growth factors (vascular endothelial growth factor, transforming growth factor-1), and osteodestruction markers (osteoprogesterin, matrix metalloproteinase-8) in the blood serum and the extracted spinal disc tissue. Results. We found that spinal disk destruction and chronic inflammation developed with both locally and generally elevating levels of proinflammatory cytokines/chemokines, growth factors, and matrix metalloproteinase 8. Conclusion. The results emphasize the significance of local changes in the studied parameters to choose and plan personalized surgical treatment in patients with spinal disk herniation.

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.

The article presents the work of a multidisciplinary team of experts from various fields of medicine to optimize the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology» for use in clinical practice. The survey of respondents was conducted from June 28 to September 28, 2021. As a result of this survey, by repeatedly making edits and clarifications during communication with respondents, the final version was obtained, which allows assessing the patient's subjective sensations by the nature and localization of pelvic pain, sensitivity disorders and pelvic organ function. The main objective of this Questionnaire is to differentiate patients with neurogenic pain from a huge number of patients with chronic pelvic pain. This aspect will allow a more targeted approach to the diagnosis and pathogenetically justified treatment of patients, including after appropriate instrumental examinations. The work of a multidisciplinary team implies a higher degree of objectification and terminological accuracy of the Questionnaire under discussion. The presented version of the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology» will be primarily used in coloproctological patients with pelvic pain problems and anal incontinence and obstructive defecation. Further studies will be directed to the clinical evaluation of the results of the work carried out.

OBJECTIVE:To describe the features of diagnosis and surgical treatment of thoracic spine fracture in a patient with ankylosing spondylitis.MATERIAL AND METHODS:We present a patient with ankylosing spondylitis, blunt thoracic spine trauma and Th10-Th11 fracture, spinal cord compression and contusion and moderate lower extremity paresis. Preoperative and postoperative CT and MRI (after 8 months) were performed for control of decompression.RESULTS:The authors identified the main factors affecting the quality of life of patients with spine fractures following ankylosing spondylitis and formulated treatment algorithm.CONCLUSION:Active strategy is advisable for spine fractures following ankylosing spondylitis: spinal cord decompression, creation of anatomical compliance in the damaged vertebral segment and its fixation by transpedicular system. A similar surgical treatment of spine fractures following ankylosing spondylitis makes it possible to achieve early activation of patients and reduce rehabilitation period.

One of the main causes of the development of debilitating pain syndrome after surgical treatment of a herniated disc is herniation recurrence. This pathology dictates the need to perform reoperation on an already operated segment of the spinal column, which complicates the technique of surgical intervention and negatively affects the relief of pain syndrome. In the presented review of scientific publications selected from the medical literature databases PubMed, E-library and Cochrane, the current problems of the pathogenesis of recurrent herniated discs in the lumbar spine are considered. The concept of risk factors for the development of recurrent disc herniation is highlighted, their characteristics are given, and the significance of each of them in the development of recurrent disc herniation is analyzed.

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.

The article describes the technology for detecting and studying late phenomenon in stimulating electroneuromyography in order to objectively assess the state of innervation. The standard study of the motor response (M-response), Pudendal nerve terminal motor latency testing (PNTML), using the St. Mark's electrode from the external sphincter and pelvic floor muscles provides information only about efferent innervation at the distal part of the n. pudendus. At the same time, there are sparse reports in the literature on the study of the state of the mixed-fiber pudendal nerve along its entire length from its exit from the intervertebral foramen to the distal part using the St. Mark's electrode, the method is not clearly described, which, accordingly, causes the lack of application of the technique in clinical practice. The authors of this article cite the methodology for studying the late phenomenon in the form of a mixed feedback-reflex in stimulating electroneuromyography, describing the need to consistently use both methods of its registration.

Objective. The study objective was to compare the effects of minimally invasive and traditional surgical approaches for treating patients with unruptured intracranial aneurysms (UIAs) to assess efficacy and safety of the keyhole concept in neurosurgery.Material and methods. We made a comparison of the microsurgical treatment outcomes of 204 patients harbouring UIAs who were operated on in the period from 2014 to 2019. Patients were divided into two groups: operated on using traditional approach (n = 85, 41.7%) and minimally invasive approach (n = 119, 58.3%). Patients of the first group were operated on using pterional (n = 31), orbitozygomatic (n = 16) and lateral supraorbital (n = 38) approaches; the second group patients underwent surgery using trans-eyebrow supraorbital (n = 35), minimal pterional (n = 38), trans-eyebrow transorbital (n = 20) and transpalpebral transorbital (n = 26) approaches. Rate of intraoperative and postoperative complications, surgery duration and postoperative in-hospital stay period were the factors to compare. The Modified Rankin Scale was used as a neurological outcomes measure. Also cosmetic results of surgery, hypesthesia from the site of the surgical approach, temporomandibular joint disorder and facial asymmetry were evaluated.Results. Compared to the traditional approach, minimally invasive technique incurred shorter surgery duration (р = 0.051) and inpatient stay (р > 0.001). Intraoperative and postoperative complication rates (р > 0.05) as well as functional outcomes (р > 0.05) were comparable between the two groups, while cosmetic effects (р < 0.05) were greater in minimally invasive group of UIA patients.Conclusion. Microsurgical treatment of UIA patients using minimally invasive approach is considered safe and effective. Adequate selection of patients for operation and exhaustive neuroimaging data assessment for choosing of neurosurgical technique are obligatory factors for keyhole surgery. The authors recommend using minimally invasive concept only for experienced neurosurgical teams in specialized clinics.