The study presents a clinical case of complex treatment of a patient with high comorbidity (Charlson comorbidity index = 6 points) who had severe sepsis (SOFA score = 8 points) with multiple foci of pyogenic infection (spinal epiduritis, paravertebral and subdural abscesses, purulent meningitis, bilateral lower lobe pneumonia). The syndrome-based approach with the use of minimally invasive approaches in the early stages (no later than 12 hours from the onset of clinical manifestations of the disease) ensured a favorable outcome. Based on the results of surgical treatment, a conclusion was made about the tactics of surgical treatment in patients with spinal infection against the background of sepsis.

The Kimmerle anomaly is one of the varieties of craniovertebral junction anomalies. Currently, it is one of the main causes of vertebrobasilar insufficiency, vertebral pain and vegetative syndromes. Despite a sufficient number of publications on this problem, the Kimmerle anomaly still remains not fully understood. Insufficient awareness of primary care physicians about this pathology, a wide variety of clinical manifestations, the absence of pathognomonic neurological syndromes, the complexity of the analysis of imaging data cause difficulties in identifying this anomaly. The article describes the epidemiology, pathogenesis, and clinical picture of Kimmerle anomaly. Further, the paper presents modern methods of its diagnosis (spondylography, ultrasound, MRI, MSCT, etc.) and treatment. In conclusion, the authors present ways to optimize the diagnosis and treatment of Kimmerle anomaly.

Based on the analysis of modern literature, surgical approaches to the treatment of chronic pain syndrome in cancer patients are presented. The definition and classification of chronic pain syndrome is given, its pathophysiology is described. The frequency of occurrence in the population and its dependence on the stage and localization of malignant neoplasm is shown. For practical use, an algorithm for the diagnosis of chronic pain syndrome and the basic principles of its therapy are presented. As the 4th step of the World Health Organization pain relief ladder, surgical methods for the treatment of chronic pain syndrome are separately considered. Three main types of surgical interventions (neuromodulating, neurodestructive and anatomical) are described, indications and contraindications to their use are indicated.

Fibular tunnel syndrome is the most common tunnel syndrome of the lower extremity. The compression of the peroneal nerve leads to motor and sensory disorders, which is manifested by weakness of the muscles that normally provide dorsiflexion of the foot and toes, abnormal gait, and loss of sensitivity. The paper presents the etiology, pathogenesis, and clinical picture of this disease. Particular attention is paid to modern methods of treating this pathology. Decompression of the common peroneal nerve is an effective and safe treatment for fibular tunnel syndrome. At the moment, the majority of clinicians do not associate the clinical manifestations with damage to the peroneal nerve, which leads to diagnostic errors and, as a result, to incorrect treatment tactics and a decrease in the patients’ quality of life for a long time.

Ailm: to assess metabolic processes in the serous layer of the large intestine in the acute period of spinal injury.Materials and Methods: the experiment was carried out on laboratory animals — Wistar rats (n = 20). Spinal injury was simulated by complete transection of the spinal cord at the level of Th5-Th6 vertebrae. Metabolic changes in the intestinal wall were assessed before injury, 3 and 24 hours after spinal cord transection. Metabolism was assessed in vivo using fluorescence time-resolved macroimaging technology (macroFLIM) by autofluorescence in the spectral channel of the metabolic cofactor NAD(P)H.Results: a significant (p = 0.041) increase in the mean fluorescence lifetime (τm) by 12% and the lifetime of the long component (τ2) of the NAD(P)H cofactor by 13% (p = 0.008) was detected 24 hours after injury. MacroFLIM showed an increase in the intensity of metabolism in the large intestine wall.Conclusion: for the first time in an in vivo experiment, it has been shown that the acute period of spinal injury is accompanied by an increase in metabolic activity in the tissues of the large intestine. The revealed phenomenon confirms the role of the large intestine in compensatory reactions to spinal injury and open up new possibilities for therapy in the acute period of spinal cord injury.

In Russia, more than 450,000 cases of Stroke are registered annually, while the risk of recurrence is 10- 30% per year. Mortality from cerebrovascular diseases is on the 3rd place among all pathologies. The reduction of the risks of recurrent Stroke is realized through the opening of Stroke prevention centers, the objectives of which are to conduct a consultative reception, prescribe a complex of diagnostic and therapeutic measures and dynamic monitoring of patients in order to prevent the possibility of recurrent Stroke. The article describes the principles of operation and organization of these centers.

RELEVANCE A special place in the development of enteral insufficiency is given to dysproteinemia, which is one of the leading causes of the development of decubital ulcers in patients with spinal cord injury. Early enteral nutrition partially solved this problem, but the incidence of bedsores still remains high and reaches 68%. The risk of metabolic disorders in the acute period of spinal injury is largely determined by non-occlusive intestinal ischemia against the background of spinal shock, neurohumoral dysregulation; intra-intestinal and intra-abdominal hypertension; change in intestinal microflora. Pathological changes in the intestinal wall occur during the first 20 days after injury and further exacerbate chronic maldigestion, malabsorption, intestinal dyskinesia in patients with traumatic spinal cord disease. New knowledge about the features of early enteral nutrition in patients in the acute period of traumatic spinal cord disease will reduce the risk of decubitus ulcerative defects. AIM OF THE STUDY To study the dynamics of metabolic processes in the tissues of the small intestine in the acute period of spinal injury. MATERIAL AND METHODS Wistar rats (n=22). Spinal injury was simulated by acute complete transection of the spinal cord at the level of Th5–Th6 vertebrae. The assessment of metabolic changes in the cells of the serous membrane of the intestine was performed immediately, 3 and 24 hours after injury. The metabolism was assessed in vivo using fluorescence time-resolved macroimaging technology FLIM by autofluorescence in the spectral channel of the metabolic cofactor nicotinamide adenine dinucleotide (phosphate). RESULTS The acute period of spinal cord injury is accompanied by a change in the endogenous autofluorescence of the serous membrane of the small intestine: a statistically significant decrease in the mean fluorescence lifetime (τm), the lifetime of the long component (τ2), and the relative contribution of the long component (а2) in 24 h after injury was recorded. The changes observed using FLIM confirm the catabolic type of metabolism in the tissues of the small intestine after spinal cord injury. CONCLUSION For the first time in the experiment in vivo it has been shown that the acute period of spinal injury is accompanied by a violation of metabolic processes in the tissues of the small intestine. This fact requires a more balanced approach in calculating the calorie content of nutrients used for early enteral nutrition in patients with spinal cord injury.

Cerebrovascular disease ranks third after coronary artery disease and cancer among the causes of death in the Russian Federation. Currently, carotid endarterectomy is used for primary and secondary stroke prevention, and in brachiocephalic artery lesions. The authors of the article developed a new method of eversion carotid endarterectomy. Its immediate and long-term results are studied. The new method was compared with R. Kieny eversion carotid endarterectomy. The clinical safety and efficacy of the new method were demonstrated.

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.

The article presents a review of the literature on the topic of interventional treatment of pain in oncological practice. The epidemiology, classification and mechanism of oncological pain are presented. Aspects of the use of interventional methods of pain syndrome treatment, including neurolysis and blockade, are considered. The technique, indications, contraindications, complications are described for each minimally invasive intervention.

Metastasis of malignant tumors in the spine is a common problem of cancer patients. Modern neuroimaging methods make it possible to identify secondary lesions of the spinal column at an early stage. Currently, the approach to the treatment of metastatic spinal lesions is multidisciplinary and requires the approach of doctors of different specialties: neurosurgeon, radiologist, chemotherapist, neurologist and rehabilitologist. Currently, a combination of several treatment methods is optimal: surgery, radiation and drug therapy. Systemic drug therapy is an integral part of long-term control of spinal metastases and depends on the histological structure of the malignant neoplasm and its ability to respond to drug exposure. The article also describes modern methods of radiation therapy. To date, there is no unity of views and an unambiguous standardized, scientifically based approach to solving the existing problem, however, further study of it will be able to ensure the choice of the optimal algorithm for the curation of patients with metastatic spinal lesion. After all, proper treatment of secondary damage to the spinal column will allow the patient to prevent neurological deficit and persistent pain syndrome, to maintain an optimal quality of life.

Tumors of the spinal cord include several nosological units and are classified depending on their location and histological type. The article presents the general characteristics, classification, and epidemiology of spinal cord tumors. The paper presents the clinical manifestations of intradural extramedullary tumors of the spinal cord. The main methods of diagnosing extramedullary tumors of the spinal cord are highlighted. Furthermore, the paper details the modern aspects of the surgical treatment of spinal cord tumors. Particular emphasis is placed on the complications of surgical interventions. The radicality of neurosurgical treatment of spinal cord tumors depends not only on the location and size of the tumor, but also on its histological structure, which determines the outcome of the disease.

The article highlights the history of Morton's neuroma study. The epidemiology, etiology, and main risk factors that act as a trigger in the development of this pathology are presented. The main pathogenesis links are revealed. Modern ideas about the development of the pathological process and the results of morphological studies are reflected, indicating that a pseudoneuroma is formed on the intermetatarsal nerve during microtrauma. Modern methods of diagnostics and criteria for making a diagnosis are listed. The role of CT, MRI, radiography, and ultrasound is shown. The clinical picture of the disease is presented. The measures for the prevention and conservative treatment of Morton's neuroma are described. The significance of therapeutic and diagnostic blockades is indicated, as consequent regression of the pain syndrome is a confirmation of Morton's neuroma in the patient. The diseases with which it is necessary to differentiate the described pathology are listed. The main methods of surgical interventions performed for Morton's neuroma are presented.

Malignant neoplasms remain the leading cause of death worldwide. The spine is a target for metastasis more often than other skeletal bones. This article details the principles of diagnosis, treatment, and the clinical picture of secondarylesions of the spinal column. The causes of pain syndrome in cancerous lesions of the spine are reviewed: compression of nerve structures, pathological fractures, spinal instability, lytic foci and paraneoplastic pain syndrome. The causes and patterns of each type of pain syndrome are described in detail. The article presents the scales used to predict the life expectancy of these patients: Tokuhashi, Tomita and Bauer. The effectiveness of these scales is compared. The selection criteria for surgical treatment of patients with metastatic lesions of the spine are described in detail. Modern methods of surgical treatment of secondary lesions of the spinal column are presented: palliative, subtotal, total (enblock resections). The indications and contraindications for each type of surgical treatment are described. Methods of intraoperative hemostasis are described, with the special attention given to preoperative tumor embolization. The errors and complications of this technique are described in detail. The correlation dependence of intraoperative blood loss volume on the embolization terms is presented. Modern trends in the development of surgical methods in metastatic spinal tumors are described in conclusion.

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.