Metastases are considered to be a key mechanism for the spread of malignant tumors, whereby tumor cells separate from the primary site and form new tumor nodes in various parts of the body. Bone tissue, including the spine, is often affected by metastases, which can significantly worsen the prognosis and quality of life of patients. Metastasis comprises a complex multistep process during which tumor cells undergo molecular and phenotypic changes enabling them to migrate and adapt to new conditions in the body. Bone metastases can be osteolytic, causing bone destruction, or osteoblastic, stimulating excessive bone formation. Tumor cells enter the bone and activate osteoclasts or osteoblasts, thereby leading to remodelling of bone tissue and formation of a closed cycle of bone destruction and tumor growth. The characteristics of tumor cells are determined by their genetic and epigenetic changes, as well as interaction with the environment. Understanding the molecular and pathophysiological aspects of spinal metastasis is essential to developing effective treatments and improving therapeutic approaches. The paper considers new therapeutic approaches aimed at overcoming spinal metastasis in order to improve the prognosis and quality of life of patients.

Morphology of injuries following gunshot wounds requires specific treatment approaches. Currently, there are no similar classifications for assessing fracture stability with subsequent tactical recommendations. Taking into account diagnostic limitations (contraindications for MRI due to implantable metal fragments, limitations of functional radiography of the spine in seriously injured patients), we make decisions considering CT data. In this study, we will determine severity of vertebral damage and effect of these damages on mechanical stability of spinal motion segments. In the future, CT-based assessment of inter-expert agreement will be performed. Finally, we will propose the scoring system for classification of spinal gunshot wounds. OBJECTIVE:To present a research protocol for development of new scoring system for unstable spinal gunshot wounds based on inter-expert agreement assessment. MATERIAL AND METHODS:To create a new tactical classification, we will distinguish and analyze clinical and CT data of patients with thoracolumbar spinal gunshot wounds. The Delphi method will be used to collaborate between several surgeons. A three-stage study will result a questionnaire (for 30 clinical cases). We will develop tactical scoring system and analyze statistical data (kappa). DISCUSSION:Various classifications have been developed for closed spinal injuries. These systems describe the nature of injury and allow one to develop tactical decisions for further actions. Another mechanism of injuries following gunshot wounds does not allow the classification of closed injuries to be adequately applied in some cases. Indeed, spinal structures follow either direct passage of a wounding projectile through the spine or transferring the energy of this projectile in contrast to classical compression, distraction and rotational-translation mechanisms typical for closed trauma.

Object of the study. Thoracoscopic microdiscectomy (TM) is used for surgical treatment of thoracic disc herniations (TDH). The purpose of this study was to analyze the factors influencing the dynamics of outcomes in the early and late postoperative period Materials and methods/ The study had a retrospective, single-center, observational cohort design. The series included all patients without exception who underwent TM from January 2018 to December 2022. Outcomes were assessed according to the Macnab scale adapted for the thoracic spine. Postoperative complications were classified according to the Clavien-Dindo Classification. Statistical univariate analysis of the data was carried out using the Fisher»s method and the Mann-Whitney U test. Multivariate analysis was performed using multiple linear regression with stepwise elimination. Results/ A total of 36 patients were operated on using the TM technique. These included 22 (61 %) women and 14 (39 %) men. The median age was 45±15 years. Early outcomes were assessed 2 months after the patients» surgery. The median duration of long-term outcomes was 22±12 months. The statistical analysis of early outcomes revealed a connection between the localization of a disc herniation in the lower thoracic spine (Th8 — Th12) with simultaneous surgery at two levels and less favorable outcomes. The analysis of long-term outcomes showed that the only prognostic factor was the patient»s condition when assessing the early outcome. Thus, complete recovery was registered at the first control in 13 out of 15 (86 %) patients and at the last control in 13 out of 16 (81 %) patients (p <0.001). Conclusions. The analysis of early and long-term outcomes made it possible to identify factors that determine the dynamics of recovery after thoracoscopic microdiscectomy. The data obtained can be used in planning postoperative management of this group of patients.

IntroductionMeritocracy, a concept revered as the cornerstone of fairness and equal opportunity, is critically examined in the context of neurosurgery. This article challenges the notion that success in this demanding field is solely determined by individual abilities and effort. It reveals that factors such as background, gender, and socioeconomic status significantly influence one's career trajectory. By investigating how these systemic barriers impact admissions to neurosurgical training programs and professional advancement, the paper underscores the complexity of meritocracy in neurosurgery, suggesting that the meritocratic ideal is more nuanced and influenced by external variables than commonly believed.ResultsCertain universities deemed elite offer a curriculum divergent from that of their counterparts in low and middle-income countries. Students at these “elite” institutions gain exposure to new technologies and research incentives, which brings us to the realm of research. Remarkably, 75% of articles originating from developed nations account for just 25% of traumatic brain injury cases. This disparity highlights a significant research imbalance, and the common refrain underscores the need to bolster research capabilities in low-income countries. For neurosurgeons in the developing world, engaging in research often becomes a luxury due to multifaceted challenges. Financial barriers, including publication costs and paywalls for accessing articles, pose significant hurdles. Comparing salaries between countries underscores the glaring divide according to “Neurosurgeon Salary” in 2024. Neurosurgeons in the United States receive a median salary of $412,000 dollars per year, compared to $13,200 dollars in Latin America, as of June 2023. Given such incongruities, the prospect of even attending conferences or workshops abroad remains difficult for neurosurgeons from developing nations. Research isn't cast aside due to a lack of interest but due to resource limitations. The present landscape demands reconsideration.ConclusionWe underscore the journey towards a more inclusive and equitable future in neurosurgery as not just a goal, but a dynamic process fuelled by resilience, collaboration, and a commitment to diversity. The narrative promotes a collective endeavour to dismantle barriers and embrace innovation, emphasizing the importance of mentorship, cross-institutional collaboration, and the amplification of underrepresented voices.

Tuberous sclerosis complex (TSC) is a multisystem, autosomal-dominant, neurocutaneous syndrome that is characterized by the presence of hamartomas involving multiple organs, including the brain. Epilepsy is the most common neurological manifestation and the main cause of disability in children. Drug-resistant epilepsy is seen in 62.5 % of cases. The challenge of surgical treatment in these patients is the multifocal nature of epilepsy. Nonetheless, there is available data to suggest that surgical intervention is most likely to achieve long-term seizure freedom.The aim of the work – to analyze current data and aspects of surgical treatment of epilepsy associated with tuberous sclerosis in children.A literature search for was done on PubMed, Google Scholar, and eLIBRARY. RU for the period from 2000 to 2022. Search phrases included: TSC-associated epilepsy in children, epilepsy surgery in children with TSC, epilepsy surgery for TSC. The tubers are not the only source of epileptic activity; the perituberal brain tissue is also a proven focus. Currently, there is a tendency towards early pre-surgical evaluation and surgical treatment, which is recommended after the failure of two antiepileptic drugs. Considering the multiple brain lesions and multifocal epilepsy, the use of invasive electroencephalography is invaluable in the preoperative assessment of these patients. The effectiveness of resection surgery is 65–75 %. Over time, the proportion of patients in complete remission from seizures decreases. Lobectomy and tuberectomy plus procedures are favorable prognostic factors. Surgical treatmentsignificantly increasesthe chances of seizure freedom. Eliminating seizures in children has been shown to improve cognitive development.There is no algorithm for pre-surgical patient evaluation or selection criteria for surgical treatment. Some methods of presurgical evaluation are not included in the compulsory health insurance system, making early diagnosis and treatment very difficult. This leads to an increase in the number of patients with disabilities and a poor quality of life.

Lumbosacral lipomas are congenital spinal malformations caused by defects in primary and secondary neurulation during embryogenesis, leading to tethered spinal cord syndrome and neurological deficits. Understanding the embryological development and pathogenesis of these lipomas is crucial for improving surgical outcomes. Embryogenesis involves primary neurulation, where the neural plate forms and folds into the neural tube, and secondary neurulation, where the medullary cord forms and differentiates into the conus medullaris and filum terminale. Disruptions in these processes can result in lumbosacral lipomas. The premature disjunction theory suggests that early ectoderm separation allows mesenchymal invasion, while dorsal induction disorders and secondary neurulation defects involve mesodermal elements disrupting normal development, leading to lipomatous tissue tethering the spinal cord. The classification systems by Chapman, Arai, and Pang categorize lumbosacral lipomas based on anatomical and embryological features, aiding in surgical planning and prognosis. These classifications help neurosurgeons determine the complexity and associated risks of lipomas, guiding surgical techniques to minimize complications and improve outcomes. Understanding these classifications and the underlying embryology is essential for advancing treatment and patient care.

Introduction. The most prevalent symptom of central nervous system involvement in tuberous sclerosis complex is epilepsy, predominantly of a drug-resistant nature. In such cases, surgical treatment methods become a focal point for consideration. Purpose of the study: to analyze the outcomes of surgical treatment for drug-resistant epilepsy in children with tuberous sclerosis following stereoelectroencephalography. Materials and methods. A retrospective analysis of surgical outcomes for epilepsy in children with tuberous sclerosis after stereo-EEG was conducted. From April 2017 to December 2021, 23 patients underwent prolonged stereo-EEG monitoring. Based on the results of invasive EEG, resective surgery was performed on 14 patients. Primary resection of the epileptogenic zone was carried out in 11 cases (79 %), and repeated resection was performed in 3 cases (21 %). Tuberectomy was conducted in three cases, tuberectomy plus — in six patients, lobectomy — in three patients, multilobar resection — in three cases, and one patient had an extension of the previous resection area with cor ticoectomy. Results. In the follow-up period ranging from 12 to 78 months, ILAE I outcome was observed in 64 % of cases, ILAE IV in 29 % of children, and ILAE V in 7 % of cases. Antiepileptic therapy was discontinued in one patient, a decrease in drug load was noted in four patients, and an increase in drug load was obser ved in one patient. Conclusion. Surgical treatment of TSC-associated epilepsy in children requires a comprehensive pre-surgical examination in specialized centers, incorporating the invasive electroencephalography method. Given the multifocal nature of epilepsy, along with the combination of generalized and focal seizures, resective surgeryis worth considering as palliative treatment in some cases.

Introduction: Prevention of hemorrhagic disease in newborns (HDN) in recent years has significantly reduced the number of intracranial hemorrhages (ICH) associated with these pathologies and the most common etiological cause of hemorrhagic stroke in infants. However, the issues of intensive therapy for intracranial hemorrhages in young patients of various etiologies didn’t lose their relevance.Objective: Study of the peculiarities of approaches to intensive care in children with ICH. Material and methods: The medical documentation of 35 patients aged 21 days to 4 months with ICH of various etiologies from 2017 to 2021 was analyzed. Results: Due to the severity of their conditions, 83 % of patients required mechanical ventilation. In our case series of 29 children with vitamin K-deficient coagulopathy the mortality was 3.4 %. Cerebral vasospasm developed in 57.1 % of intracranial hemorrhage cases. The duration of stay in the intensive care unit and the duration of mechanical ventilation, in addition to the severity of the condition at admission, hemorrhagic shock and neurological deficit, were influenced by cerebral vasospasm and convulsive syndrome. Conclusion: A retrospective analysis of the results of the treatment of neonates with intracranial hemorrhages caused by a late form of HDN allowed us to identify factors affecting the severity of the condition and outcomes. Since the incidence of this severe pathology is relatively low, and the literature data are contradictory, the personal experience of each hospital is important.

The purpose of the study: to analyze the timing and types of treatment in infants diagnosed with intracranial hemorrhage (ICH) due to a ruptured vascular malformation. Materials and methods. The study included 4 infants with ICH; the causes of the hemorrhages were a rupture of arteriovenous malformation (AVM) in 2 (50 %) patients and arterial aneurysm (AA) in 2 (50 %) patients, aged less than one year. Hematoma evacuation was performed in 4 (100 %) patients. Microsurgical clipping and removal of the aneurysm was performed in 2 (50 %) patients, and total endovascular embolization was performed in 2 (50 %) patients. After surgical treatment, there were no fatal cases. Post-stroke epilepsy developed in 2 (50 %) patients who subsequently underwent functional peri-insular hemispherotomy, as a result of which the seizures were stopped completely. Posthemorrhagic hydrocephalus was observed in 1 (25 %) patient, who later underwent ventriculoperitoneal shunting. The article discusses the features of diagnostics and treatment tactics of children with vascular malformations in the acute and subacute periods of intracranial hemorrhage (ICH). Results. Complete disconnection of the vascular malformations from the cerebral circulation was successful in all cases. Conclusion. When intracerebral hematoma in infants is confirmed, vascular intracranial pathology must be ruled out first, and an individualized treatment approach for each patient is necessary. Patients diagnosed with a ruptured cerebral AVM should be treated as quickly as possible in a specialized pediatric stroke center.

Degenerative-dystrophic disease (DDD) and its complications is the most common condition in spinal neurosurgery. It affects about 80 % of all people over 80 and is the most common cause of disability in the middle-aged population. The main symptoms include mechanical back pain, symptoms of radiculitis and limping, limited mobility, and poor quality of life. Determining the pathophysiology, causes of DDD pain, as well as diagnostic tools and expected changes is paramount to improve patient care and satisfaction. In this paper, we present an overview of DDD pathophysiology, classification, and diagnosis.

Degenerative disc disease and facet joint disease involving the lumbar spine are common in the aging population and are the most frequent causes of disability. Surgical interbody fusion of degenerative levels is the most common management technique. This is an effective treatment option to stabilize the spine and reduce mechanical pain and provides indirect decompression of the neural elements while restoring lordosis and correcting the deformity. Depending on the direction of the approach to the vertebral column, various techniques have been described. Anterior lumbar interbody fusion (ALIF) offers clear and wide visualization of the disc allowing the use of large interbody grafts, which provide a significant biomechanical advantage over other types of fusion. The transperitoneal approach is a much older technique and it is not commonly performed unless in isolated cases with extensive retroperitoneal scaring following multiple abdominal surgeries. The transperitoneal approach has been associated with higher rates of bowel injury, ileus, and retrograde ejaculation, and is limited at the L5–S1 segment, hence many spine surgeons favor a retroperitoneal approach. The major setback of ALIF is the need for great vessel mobilization. This manipulation of the vessels may lead to deep vein thrombosis and a direct vascular injury. This makes vascular anatomy studies in the preoperative stage invaluable in avoiding vascular injury. Other complications include possible injury to intraperitoneal and retroperitoneal organs, especially in patients with previous surgery and adhesions. Manipulation of the intestines causes postoperative ileus which lasts a few days. Sexual dysfunction in form of retrograde ejaculation is another complication seen in patients following ALIF and this has been attributed to injury to the superior hypogastric sympathetic nerves in the lower lumbar region. This article reviews the ALIF procedure i. e., transperitoneal and retroperitoneal approaches, and the associated intraoperative, early, and late complications.

Introduction. Pseudoaneurysms of the subclavian artery are a rare pathology and most frequently occur due to trauma. According to the current literature, subclavian artery aneurysms account for 1 % of all peripheral artery aneurysms. This pathology, although rare, may be accompanied by the risk of rupture, thrombosis, or distal embolism of the arterial lumen. Objective. To demonstrate a clinical case of a patient with successful treatment of subclavian artery pseudoaneurysm by means of modern minimally invasive endovascular technique. Material and methods. The article presents our clinical case with the use of endovascular technique for the treatment of large posttraumatic pseudoaneurysm of the S2 segment of the left subclavian artery using the Bard LifeStream balloon stent graft.Discussion. Currently, direct surgery is considered to be the gold standard of treatment in extracranial aneurysms. Meanwhile, availability of minimally invasive methods allows minimizing the risk by performing endovascular treatment and thus reducing the risk of foreign bodies and infectious complications associated with a large volume of surgical intervention in direct surgery, reducing damage to the brachial plexus, decreasing the number of beddays, and contributing to early rehabilitation measures. The strategy of choice in favor of endovascular treatment should be individual for each patient taking into account such factors as localization, aneurysm size, compression of nearby cranial nerves, and concomitant pathology with high risk of open surgical treatment. Conclusions. Careful selection of patients for endovascular technique will ensure good long-term outcome using all advantages of this technique. At present, it is still relevant and crucial to minimize complications and iatrogenic postoperative lesions in patients with this disease. For this reason, endovascular surgeries should be performed at the stage of specialized medical care by an experienced surgeon.Key words: subclavian artery, false aneurysm, posttraumatic aneurysm, stent graft, endovascular treatment, open surgery, minimally invasive surgery.

Introduction. Spinal column and spinal cord injuries are one of the most severe types of trauma. The paper presents the results of examination and treatment of 80 patients with combat spinal column and spinal cord injuries treated in the neurosurgical department of the FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. Purpose. To analyze the structure of incoming wounded patients and the results of treatment of patients with combat spinal injury in the conditions of a multidisciplinary medical center. Materials and methods. The paper analyzes the results of treatment of 80 patients with combat spinal column and spinal cord injuries treated in the Neurosurgery Center, FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. The inclusion criteria were the radiological signs of combat spinal injury upon admission to the hospital. Upon admission, all patients underwent pan CT scan, their somatic and neurological status was assessed, and laboratory parameters were evaluated. Gunshot wounds were found in 66.25 % (n=53) of the patients, and blunt combat injuries to the spine were found in 33.75 % (n=17). Concomitant injuries were sustained by 81.25 % (n=65) of the studied patients. Prior to admission to the Neurosurgery Center, neurosurgical care was provided to some of the wounded. Spinal surgery was performed in 30.0 % (n=24) of the cases, and 56.25 % (n=45) were operated on for injuries to other anatomical regions and organ systems. Results. 69 % (n=55) of the patients underwent neurosurgical treatment. The indication for surgery in 56.4 % (n=31) of the patients was instability in the spinal motion segment (SMS). Both one-stage (anterior or posterior stabilization) and two-stage operations consisting of posterior and anterior approaches, including with the use of minimally invasive techniques (8 cases), were performed. In 23 patients, foreign body removal was performed, including by means of videoimage endoscopy (in 5 cases). On average, the wounded had an operation on the 5th day after the injury. At discharge, motor neurological improvement or complete recovery was seen in 21.1 % (n=16) of the patients, while motor disorders remained at the initial level in 78.9 % (n=60). Sensory disorders decreased in 13.1 % (n=10), while 84.2 % (n=64) showed no improvement in sensory level. There was a significant decrease in the intensity of the pain syndrome. However, the number of patients with neuropathic pain decreased slightly (41 patients among all the examined at discharge versus 42 at admission). The functions of the pelvic organs were restored in 8.25 % (n=7) of the patients. At the stage of treatment in the specialized center, 49 % (n=39) of the patients had complications in different organ systems. The mortality rate was 2.5 % (n=2).

Epithelioid hemangioendothelioma (EHE) is one of the rarest vascular tumor found in the brain. In the pediatric group of patients, the proportion of EHE is only 0.02% of all brain neoplasms, and therefore oncogenesis and the causes are currently not well understood. Intracranial localization of EHE is extremely rare, nevertheless, this type of neoplasm should be included in the differential diagnostic series when multiple small intracerebral masses with hypointense MR signal in T2 mode are detected on magnetic resonance imaging. No specific therapy is currently developed for this disease, the optimal treatment is surgical removal of the volumetric mass if this type of treatment is possible. This article presents a clinical case of a primary multiple CNS lesion in a 14-year-old child with a long history of epilepsy. According to our data, the presented clinical case is the only one registered in the world, with primary multiple CNS EHE of the brain in the pediatric population

To date, the effectiveness and safety of reconstructive surgery for steno-occlusive lesions of the internal carotid artery (ICA) have been proven by multicenter cooperative studies Despite this, the indications and tactics of surgical treatment of patients with extra-intracranial tandem stenotic lesions of the ICA remain controversial. In the period 2010-2020, 32 patients with symptomatic (15 cases) and asymptomatic tandem ICA lesions were hospitalized for surgical treatment. The distribution of tandem lesions was as follows: 10 patients had bicarotid hemodynamically significant stenotic and occlusive lesions of the ICA ostium in combination with stenosis of more than 50% of the petrous (4 cases), cavernous (8 cases), and clinoid segments (5 cases), of these, four had bilateral intracranial stenosis; 22 patients with hemodynamically significant lesions of the ICA and vertebral artery (VA) in combination with stenosis of more than 50% of the petrous (10 cases), foramen lacerum (2 cases), cavernous (16 cases), clinoid (14 cases), and ophthalmic segments (1 cases), of these, six had bilateral intracranial stenosis of the ICA. All patients underwent staged surgical interventions on the arteries of the carotid and vertebrobasilar systems. In the postoperative period, there was one case of repeated ischemic stroke in the territory of the reconstructed artery after the application of extra-intracranial microanastomosis (EICMA). There were no relapses of restenosis or acute cerebrovascular accident (CVA) in the follow-up. Staged reconstructive and revascularization treatment is safe and effective for tandem extra-intracranial lesions of the ICA. It is necessaryto continue further study of this issue in order to develop unified tactics and methods of surgical treatment.

The paper considers a case of surgical treatment of a patient with a completed stroke in the brain stem in anamnesis and with a clinical picture of chronic vertebrobasilar insufficiency caused by combined occlusion of the right vertebral artery (VA), hypoplasia of the left VA, and pathological tortuosity of the right internal carotid artery (ICA). The patient underwent extra-anatomical reconstructive surgery: simultaneous lowering of the loop of the right ICA and its resection in the middle third with redressement and reimplantation in the proximal third of the ICA with the formation of the ICA-ICA end-to-side anastomosis and the subsequent creation of an end-to-side anastomosis between the free end of the resected ICA and the V3 segment of the right VA. In addition, a case of surgical treatment of isolated bifurcation of the common carotid artery (CCA) that occurs when the proximal CCA is occluded and the blood flow is maintained in the external carotid artery (ECA) and ICA is considered. These reconstructive surgical interventions for combined lesions of the main arteries of the head are safe and reliable methods for the treatment of chronic cerebral ischemia and effective prevention of recurrent ischemic strokes.

Tortuosity of the internal carotid artery with dysplastic changes in the form of aneurysms and diverticula should be attributed to a rare pathology. The pathology of this localization makes open surgery difficult due to access trauma and a high risk of arterio-arterial embolism with the development of cerebrovascular accident. The method of reconstructive intervention is offered, using ultrasound dopplerographic control and there is a result of successful application of the method in the patient with pathological tortuosity of subcranial part of the internal carotid artery combined with diverticula.

This article is devoted to the literature review on the topic of giant pituitary adenomas. The characteristics of giant pituitary adenomas and various methods of treating the disease will be considered. When diagnosing this disease, a clinical examination is not sufficient; it is necessary to use the neuroimaging method, which makes it possible to determine the degree of the tumor spread and the peculiarities of its location relative to the chiasm. The absolute method of choice for treating giant pituitary adenomas is surgical; other methods are used in special cases or as an adjunct. There is no single algorithm for surgical strategy for managing this disease; this applies to tumors which size exceeds 4 cm in diameter.

Of the total number of circulatory disorders in the vertebrobasilar basin (VBB), which reaches 30 % of all diagnosed disorders of cerebral circulation, transient forms acquire the character of stable in 25–30 % and progress to the stage of complete stroke in 25–50 out of 100 patients within 2–5 years of the disease. The level of disability at the same time reaches 80 %. To date, there are no recommendations and developments for the management of patients with combined lesions of the extracranial arteries occurring against the background of the syndrome. The known methods of diagnosis of VSN are based on the assessment of clinical and hemodynamic, structural and morphological features and the results of dynamic observation. These methods allow using expensive equipment and repeated long-term examinations to objectify the condition of HA, and with the help of rotational samples to determine the probable genesis of VSN. However, the disadvantage is the low level of availability to attract expensive equipment and a dichotomically qualitative approach to the diagnostic process. Therefore, a diagnostic algorithm was developed, on the basis of which it is possible not only to determine the indications for reconstructive operations on V1 PA arteries with the VDN clinic, but also to predict the clinical effectiveness of the operation, but also to predict the effectiveness of surgical treatment.

Neoplasms of the pineal region include an extensive list of pathological formations, which represent one of the most difficult areas for surgical treatment. The resolution of hydrocephalus in pineal tumors is one of the most important tasks in the treatment of tumors of this localization. In the presented work, we report on an alternative surgical strategy for the management of certain patients with pineal neoplasms, which allows treating the symptomatic manifestation of hydrocephalus by endoscopic third ventriculostomy and further conducting specific therapy or observing pathological formation in the pineal region and the posterior parts of the third ventricle.