INTRODUCTION Critical lower limb ischemia is a widespread disease that occurs due to atherosclerotic lesions of the arteries with progressive narrowing of their lumen. Clinically critical ischemia is manifested by pain at rest, resistant to narcotic analgesics, and/or ulcerative necrotic process on the legs. In the absence of treatment, patients undergo amputation of the lower limb. Almost all patients die 10 years after amputation of the lower limb at the level of the thigh. Currently, there are following methods of treatment of critical ischemia: conservative therapy, direct revascularization, lumbar sympathectomy and neurostimulation.AIM OF STUDY To present the data of modern scientifi c literature on the use of lumbar sympathectomy and epidural spinal cord stimulation in the treatment of critical lower limb ischemia.MATERIAL AND METHODS This review presents the latest data obtained as a result of studying domestic and foreign literature on the treatment of critical lower limb ischemia with lumbar sympathectomy and epidural spinal cord stimulation. Currently, lumbar sympathectomy is performed by surgical (open, mini-access and endoscopic) and percutaneous (chemical or radiofrequency) methods. Percutaneous access is becoming widespread due to its minimally invasiveness, maximum accessibility, ease of performance and low cost. Epidural spinal cord stimulation is performed for resistant pain syndrome. The mechanism of action of spinal stimulation is to block the transmission of nerve impulses at the level of the gelatinous substance of the posterior horns of the spinal cord during stimulation of afferent fi bers of a larger diameter (type A-alpha and A-beta fi bers).CONCLUSION Spinal neurostimulation and lumbar sympathectomy are promising methods of treatment for critical lower limb ischemia in case of impossibility of direct revascularization. Lumbar sympathectomy can reduce the intensity of pain and improve the quality of life of patients. According to a number of studies, epidural spinal cord stimulation signifi cantly reduces the likelihood of amputation of the lower limb, and also reduces the intensity of pain in patients refractory to conservative therapy, as well as in those who are not indicated for direct revascularization of the arteries of the lower extremities. More large-scale studies are needed to determine the indications for the above methods.

Черепно-мозговая травма является одним из наиболее частых видов повреждений и занимает первое место среди причин летальности и инвалидизации трудоспособного населения. Одним из путей улучшения качества оказываемой экстренной нейрохирургической помощи лицам с тяжелой черепно-мозговой травмой представляется своевременная экстренная диагностика повреждений головного мозга. Выбор правильного диагностического метода позволяет оценить объем, тяжесть травмы и выбрать правильную тактику лечения. В работе подробно описаны специальные методы магнитно-резонансной томографии, применяемые в диагностике черепно-мозговой травмы (МР-цистернография, перфузионная МРТ, МР-спектроскопия, диффузионно-взвешенная и диффузионно-тензорная МРТ). Описаны диагностические возможности, преимущества и недостатки каждого метода.

1240% of people with low back pain have spinal instability in degenerative-dystrophic diseases of the spine. The paper highlights the biomechanical basis for the development of segmental instability and discusses various hypotheses for the development of this condition. The authors describe the modern methods of neuroimaging used in the diagnosis of segmental instability, such as radiography, functional spondylography, CT, functional CT, MRI. Further, the paper presents provocative tests used in the diagnosis of instability: passive extension of the lumbar spine, standing, sitting, pron-instability, "scissors", compression of spinous processes, forward lean in standing position, and some others. The authors shared their experience in diagnosing segmental instability. However, the discrepancy between the data of instrumental examinations and patient complaints, poorly studied rotational and lateral instability in osteochondrosis indicate the need for a more detailed study of the instability of the spine as a whole.

Reconstructive plastic surgery procedures — cranioplasty in particular — are finding their way into the current dayto-day neurosurgery practices. A defect in the skull bones leads not only to cosmetic defects and related psychological problems, but can also cause neurological disorders. Reconstruction of skull defects is considered an important neurosurgical stage of craniocerebral injury victims’ recovery. Currently, there are no clear established algorithms or timing for cranioplasty. This paper presents data on the history and stages of the development of reconstructive neurosurgery. The efficiency of treatment of the syndrome of the trephinated with cranioplasty has been proven. The key materials used to close the skull bones defects are presented and the requirements for the material used for closing cranial defects are described. Advantages and disadvantages of materials currently used — autograft bone, allograft bone, reperen, polyetherketone, polymethylmethacrylate, titanium, hydroxyapatite — are presented in detail. A separate section of the article is devoted to the methods of transplant modelling — 3D printing and stereolithography. This is followed by the stipulation of the key principles of cranioplasty.

Traumatic brain injury is one of the most frequent types of injuries and ranks first among the causes of mortality and disability of the working population. The timely diagnosis of brain damage is one of the ways of improving the quality of emergency neurosurgical treatment of severe traumatic brain injury. Choosing the right diagnostic method allows you to assess the volume, severity of the injury and apply the correct treatment tactics. This paper describes in detail the special methods of magnetic resonance imaging used in the diagnosis of traumatic brain injury (MR cisternography, perfusion MRI, MR spectroscopy, diffusion-weighted and diffusion tensor MRI). The diagnostic capabilities, advantages and disadvantages of each method are discussed.

Ежегодно 1,5 млн человек погибает от черепно-мозговой травмы, из них 50 тыс. – в России. Современная диагностика черепно-мозговой травмы (ЧМТ) снижает смертность и повышает качество медицинской помощи. В статье рассматриваются современные инструментальные методы диагностики ЧМТ: рентгенография и КТ черепа, КТ-ангиография, КТ-цистернография (КТ-Ц), КТ-перфузия и селективная церебральная ангиография. Рассмотрены преимущества и недостатки каждого из методов. Также описаны показания к каждому из вышеперечисленных методов.

12–40% лиц с болью в пояснице имеют нестабильность позвоночника при дегенеративно-дистрофических заболеваниях позвоночника. В работе освещены биомеханические основы развития сегментарной нестабильности и представлены различные гипотезы развития данного состояния. Приведены современные методы нейровизуализации, применяемые в диагностике сегментарной нестабильности: рентгенография, функциональная спондилография, КТ, функциональная КТ, МРТ. Также в работе приведены провокационные тесты, применяемые в диагностике нестабильности: пассивное разгибание поясничного отдела позвоночника, стояние, сидение, прон-нестабильность, «ножницы», компрессия остистых отростков, в положении стоя наклон вперед и др. Авторы поделились своим опытом диагностики сегментарной нестабильности. Несоответствие данным инструментальных обследований и жалоб пациента, малоизученные ротационная и боковая нестабильность при остеохондрозе указывают на необходимость более детального изучения нестабильности позвоночника в целом.

Every year, 1.5 million people die from traumatic brain injury, 50 thousand of them in Russia. A modern diagnostics of traumatic brain injury (TBI) reduces the mortality and improves the quality of medical care. The article discusses the advanced instrumental methods for diagnosing TBI: X-ray and CT of the skull, CT angiography, CT cisternography (CT-C), CT perfusion and selective cerebral angiography. The advantages and disadvantages of each method are considered. The authors also described the indications for each of the above-mentioned methods.

Of all injuries to the nervous system, the percentage of peripheral nervous system injuries is 1-6%. Of this number, injuries to the brachial plexus and its branches account for between 60 and 81 %. This topic is relevant because inadequate treatment of traumatic injuries of the brachial plexus leads to permanent disability. The paper presents a clinical classification of traumatic injuries: according to the mechanism of damage: closed (traction and as a result of a blow to the clavicle area with compression of the brachial plexus), open (stab-cut, gunshot); on the topographical level: postganglionic, intraspinal, trauma of secondary trunks. The level and nature of damage to the brachial plexus is determined by radiography, its functional state is determined by ENMG, ultrasound indicates a hematoma, MRI allows you to determine root avulsion, scar changes, CT myelography - preganglionic damage, and thermal imaging-lesion of plexus brachialis branches.Neurosurgeons, traumatologists, reconstructive and plastic surgeons are engaged in surgical treatment of mold plexus injuries. Currently, 4 accesses are used: supraclavicular posterolateral (intervention on the upper and middle trunk, saves blood vessels), subclavian (operations on secondary bundles, short branches, also used if necessary for neurotic intercostal nerves), transaxillary (visualizes the lower trunk), posterior supraclavicular (wide access for all trunks, but causes instability of the cervical spine). A clinical case of traumatic right brachioplexopathy resulting from a motorcycle accident reflects the complexity of patient routing, differential diagnosis between vascular and neurosurgical pathology, and long-term rehabilitation. This case demonstrates the complexity of diagnosis and rehabilitation of patients with this pathology. It is concluded that the most effective operation for severing spinal roots is neurotization.