The article is devoted to stages of formation of the school of military neurosurgery. Famous pioneers of this school were Vsevolod Galkin and Boris Samotokin. Their scientific works were based on personal experience of treatment for the battle scull and brain injuries during the Great Patriotic War. The main aim of the activity of the talented researcher Vitally Khilko was to develop microneurosurgery, neuroimmunology and fundamental researchers of cerebral blood flow pathology. Boris Gaidar and Valeriy Parfyonov reorganized the echelon neurosurgical care system in a relatively short time. This reorganization formed the basis of the modem principles of specialized neurosurgical care in armed conflicts. At the present time department of neurosurgery is the leading methodological and clinical center of military neurosurgery in Russia.

A combined method of surgical treatment of glial tumors of the brain is proposed for decreasing risk of complications. The method includes microsurgical ablation of the main volume of the neoplasm and stereotaxic cryodestruction of the residual part of the tumor. Combined surgical treatment was used in 12 patients. The results obtained show that the proposed method elevates the efficacy of surgical method, facilitates increased indices of survival rate and maintenance of quality of life of the patients at the tolerant level.

Aim of the study was to evaluate the safety and efficiency of stereotactic cryodestruction of supratentorial astrocytomas that were located deeply in the brain and/or within eloquent areas.We examined 74 patients aged 18-64 years with supratentorial gliomas of different grade located in deep or eloquent brain areas. All the patients underwent stereotactically guided cryodestruction of the tumor. The survival rate was evaluated by the Kaplan-Meier method. The chi-square method was used for comparative analysis of results of this study with available data from the literature. For the analysis of the prognostic importance of various factors the Cox proportional hazards model was applied. The average survival period was 12.4 months for glioblastoma (control group--6.4 months, p=0.04), and 46.9 months for anaplastic astrocytoma (control group--18 months, p=0.006). For patients with fibrillar-protoplastic astrocytoma the 5-year survival rate was 95.7%. The frequencies of complications did not exceed those of the routine surgical interventions in patients with brain tumors. We found that stereotactic cryodestruction as well the Karnofsky performance score were statistically reliable prognostic factors (p=0.0377 and p=0.0006, respectively), while the extent of cryodestruction and the residual tumor mass did not influence the survival rate. Stereotactic cryodestruction is a safe surgical procedure, which results in statistically significant improvement of survival in patients with supratentorial gliomas located within deep and/or eloquent areas of brain.

The investigation included 340 patients with cerebral gliomas. Under analysis there were age, gender, neurological status and Karnovsky status before and after operation, localization of the tumor, type and volume of surgical intervention, postoperative complications. It was shown that radical extirpation of glial formations facilitated more favorable course of the postoperative period. Partial ablation of gliomas is associated with greater risk of the development of postoperative complications and neurological dysfunctions. As the main method of surgical treatment of patients with gliomas located in the functionally significant and deep areas of the brain stereotaxic cryotomy is thought to be indicated.

Longstanding complex examination of problems of delivery of medical care to patients of neurosurgical profile, effectuating in Military-medicine academy by Kirov S.M., permitted to observe evacuation and treatment of patients of neurosurgical profile, their social rehabilitation and returning to their work, estimated the advantages of 2-stages evacuation of patients and delivery in hospitals of Center in comparison with multistage one. Were examined questions of rehabilitation, help to families of lost or invalid military servicemen. The authors, observed economical and social questions, made a conclusion: patients of neurosurgical profile have to receive medical care in specialized and equipped institutes of central level of rear of state occurring once and in full volume.

The work presents an experience with the diagnosing of synchronous tumors of double localization in 256 patients. Operations were performed on 146 of them. Single-stage operations were made in 55 cases. When performing single-stage operations, 20 patients were found to have cancer of the lung with distant metastases or cancer of other localization with a metastasis in the lung. In the other 35 patients the diagnosis of true polyneoplasia was made followed by radical operations. Advantages of single-stage operations are shown, performing the first stage of the operation on the lung being substantiated. The five year survival after surgical treatment of multiple primary cancer was 15%.

The authors present an experience with diagnosing and treatment of 16 patients suffering from lung cancer with solitary metastasis into the brain. The examination performed has shown that in 7 out of 16 patients the surgical treatment was found to be not expedient. This solution was based on the detection of an extensive spread of lung cancer: multiple metastasis outside the thoracic cavity and the brain or inside the brain, and in one case--due to a considerable reduction of indices of the functional and reserve capacities of respiration and blood circulation. Single-step operations were carried out in 9 patients with lung cancer with a solitary metastasis into the brain (resection of the lung with an ablation of the brain metastasis). Out of the 9 patients operated on 6 patients survived for as long as 1.5 to 2 years, one patient lived longer than 4 years. Two other patients operated upon in June 2003 and March 2004 are still alive and feel much better. Satisfactory results of treatment of these patients show such methods to be expedient.

The development of an informative, noninvasive technique for evaluating the reserve of the cerebral circulatory system is a topical task of clinical angioneurology. The authors developed methods of Doppler evaluation of an autoregulatory response from hyperemic changes after short-term regional hypotension caused by digital compression of the cervical carotid. They calculated the indices acceptable in routine clinical practice, defined the range of their values in health and in typical variants of cerebral circulatory insufficiency in patients with disseminated neurosurgical pathology. The carotid compression test by recording linear blood flow velocity in the cerebral arteries is a safe, valid, and reproducible method of semiquantitative assessment of the autoregulation reserve which may be used to determine the tension of resistive vessels in the middle cerebral arterial bed as an important index of the functional status of the cerebral circulatory system.

The authors present an analysis of their experiences with performing more than 330 video endoscopic operations on the autopsy material and in 172 patients. In 54 of these patients operations were performed for traumatic intracranial convex hematomas, in 21 for adenomas of the hypophysis, in 14--for arterial aneurysms, and 53 patients with discogenic radiculitis, spinal tumors, consequences of severe spinal traumas. In 25 patients the endoscopic videomonitoring was made during excision of the tumors, paratumorous cysts and abscesses of the brain, decompression of the optic nerve, plasty of the anterior cranial fossa fundus with closing the liquor fistulas. Intraoperative angioscopy in carotid endarterectomy was fulfilled in 5 patients. The video endoscopy was proved to result in less traumaticity of the radical surgery. It is a valuable and highly informative method giving optimum results in performing many microsurgical operations.

The article describes results of an anatomo-clinical investigation using video-endoscopy and contact microvascular dopplerography in surgery of cerebral aneurysms. The endoscopic anatomy of cisterns of the cerebral base was studied in 36 corpses of adult humans. More than 200 video-endoscopic operative interventions were performed on sectional material. Video-endoscopy in combination with contact microvascular dopplerography was conducted in the clinic on 20 patients with aneurysms of the brain. Main advantages of endoscopy used in combination with microvascular dopplerography during clipping the aneurysm are formulated. Complex using the two methods described gives less volume of the access and traumaticity of the intervention but not less radical effect. It is a valuable and highly informative method which optimizes performing the operation and has less amount of postoperative complications.

The functional performance of modern neuroimaging methods allows early and virtually nonivasive diagnosis of arteriovenous malformations. Combined use of x-ray computer tomography, magnetic resonance imaging, and transcranial dopplerography is most promising because this meets the requirement for unity of morphological and functional methods of noninvasive diagnosis. Cerebral angiography should now be used only for preoperative examination of patients.

The potentialities of current Neuroimaging methods were established to allow one to make an early minimally invasive diagnosis of arteriovenous [correction of arterioventricular] malformations. The most promising method is a combined use of X-ray computer and magnetic resonance tomography with transcranial Doppler echography, which is in conformity with the unity principle of morphological and functional non-invasive diagnostic methods. At present, cerebral angiography should be used only in combination with preoperative examination of these patients.

The work is devoted to investigation of possible use of transcranial dopplerography as a method of noninvasive diagnosing of arteriovenous malformations of the brain. An analysis of results of investigations in 89 patients with suspected arteriovenous malformations was made. A close correlation is confirmed between the parameters of the blood flow and the volume, diameter and type of the structure of the supplying arteries. Transcranial dopplerography was shown to allow the detection of arteriovenous shunts in the brain vessels which is one of main symptoms of the arteriovenous malformations.

Under analysis were results of diagnostics in 89 patients with suspected arteriovenous malformations (AVM) obtained by the method of ROC-analysis. The examination included computed tomography (CT) and transcranial dopplerography (TCDG) performed by the standard method. The total sensitivity of TCDG in diagnosing AVMs as a nosological form was 89.5% which is considerably higher than the possibilities of CT. Malformation having a torpid course were diagnosed correctly reliably more often (100%) than those with hemorrhagic debut (78.6%). Most perspective is the principle of unity of "morphological" and functional methods of noninvasive diagnostics. Sensitivity of the complex diagnostics of AVMs was 92.9%, diagnostics of malformations with a torpid course being without errors.

1. Data on AVM morphology alone do not allow reliable prognosis of hyperemic complications in the early postoperative period after the malformation surgery.

The incidence of vascular abnormalities in the pattern of central nervous diseases is steadily increasing. Arterioventricular malformations (AVM) are of great significance among cerebrovascular diseases to be surgically treated. A comprehensive examination of 57 patients with AVM, which involved cerebral angiography, transcranial Doppler at the stages of surgical treatment led to the conclusion that the application of AVM morphological characteristics alone did not allow the development of specific complications, hyperemic ones in particular, to be accurately predicted in the early postoperative period after elimination of malformation. It was suggested that due to the naturally significant relationship of Doppler indices of blood flow in the nutrient arteries having structural malformations and showing cerebral circulatory disorders, the use of values of the linear velocity of blood flow in and the reactivity and resistance in the nutrient arteries enables one to predict a risk for hyperemic complications after AVM elimination to a high precision and to define a preferable surgical intervention. The priority employment of transcranial Doppler in the diagnostic examination of patients with AVM will optimize an instrumental preliminary study, make a correct treatment policy, improve the outcomes of surgical intervention, and reduce the length of hospital stay.