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Introduction. Idiopathic obstruction of the foramen of Monroe is an extremely rare pathology in adults and accounts for 1 % of all forms of occlusive hydrocephalus. The largest described series of patients with such pathology includes 4 adult patients. Four types of the foramen of Monro obstruction have been distinguished: type A – atresia, or stenosis, type B – morphological obstruction (membrane), type C – functional obstruction, type D – patent foramen. These patients usually undergo endoscopic or shunting surgery. Currently no algorithm exists for the treatment of such patients.Materials and methods. From 2004 to 2019 year 251 adult patients with idiopathic hydrocephalus were treated at the N. N. Burdenko National Medical Research Center of Neurosurgery. Of these, 11 people (4.4 %) had signs of obstruction at the level of the foramen of Monro. The average age of the patients was 41.9 years (25–67 years). The condition was more prevalent among women (8 female, 3 male patients). The most common symptoms were headaches and nausea. None of the patients showed signs of intracranial hypertension upon examination of the fundus. Magnetic resonance imaging of the brain demonstrated expansion of one or both of the lateral ventricles, stenosis of foramina of Monro, or their occlusion by membranes.Results. Patients were divided into 3 groups depending on the type of foramen of Monro obstruction. Type A obstruction was observed in 8 patients: in patients with unilateral obstruction (3 patients), only septostomy was performed, while among the patients with bilateral obstruction, 3 patients underwent septostomy followed by reconstruction and stenting of the right foramen of Monro (1 of these patients later required a shunting procedure), and in 2 patients, a shunting procedure was performed at initial presentation. Type B obstruction was observed in 2 patients: a patient with unilateral obstruction underwent septostomy and dissection of the membrane, and 1 patient with bilateral obstruction underwent septostomy, dissection of the membrane, and foraminal stenting. In a patient with type C obstruction, a septostomy and stenting of the right foramen of Monro were performed. Based on postoperative MRI data, the dimensions of the ventricles of the brain decreased or did not change. Most patients showed a complete regression of symptoms or their significant reduction, while one patient’s condition stabilized after surgery. There were no fatal outcomes or persistent complications. The follow-up period ranged from 4 to 60 months (29.4 months on average).Conclusion. In cases of idiopathic obstruction of the foramen of Monro, endoscopic surgery can be used as the treatment of choice.

Objective. To assess the incidence of influenza in the epidemic season 2018/19 and to analyze severe cases that required extracorporeal membrane oxygenation (ECMO). Patients and methods. A total of 5,939 patients diagnosed with influenza and acute respiratory viral infections (ARVIs) were treated in S.P.Botkin Clinical Hospital for Infectious Diseases of Saint Petersburg in 2018–2019. The highest incidence was observed in the late January – early February. We tested 2,527 patients (42,5%) using polymerase chain reaction (PCR); of them, 1,014 patients (40,1%) were PCR positive for influenza. The vast majority of them (99.3%) were infected with influenza A. One hundred and thirty patients required treatment in the intensive care unit (ICU) (2.2%; 95% CI 1.8%; 2.6%). Results. Severe forms of the disease were primarily caused by influenza H1N1. Respiratory failure was treated by oxygen therapy in 81.7% of patients, artificial ventilation in 15.3% of patients, and ECMO in 3 patients (2.9%; 95% CI 0.6%; 8.5%). Conclusion. Approximately 0.01% to 1.6% of patients admitted to a hospital for infectious diseases with influenza or ARVI during the epidemic season require ECMO. Key words: influenza, respiratory failure, incidence, extracorporeal membrane oxygenation

This paper concerns different types of power fluid in hydraulic drives of mechanical vehicles. It also considers filtering methods of fluid power systems. The importance of research is established by technology assessment of fluid discharge strainers for power fluid filtration.

Petroclival meningiomas (PCMs) are benign, slowly growing tumors. Surgery still remains the main treatment option for them. The desire for total resection of large extended PCMs often leads to the development or worsening of persistent neurological deficits. This paper presents a review of the world literature devoted to petroclival meningiomas. We discuss the issues of PCM classification, biology, diagnosis, and selection of the optimal algorithm for their treatment.Петрокливальные менингиомы (ПКМ) - доброкачественные, медленно растущие опухоли. Основным методом их лечения до сих пор остается хирургический. Стремление к радикальному удалению распространенных ПКМ больших размеров часто приводит к появлению или усугублению стойкого неврологического дефицита. Представлен обзор мировой литературы по проблеме ПКМ. Обсуждаются вопросы классификации, биологии, диагностики и выбора оптимального алгоритма их лечения.

The purpose of the study is to present the results of successful treatment of a patient with traumatic arterial aneurysm of the middle cerebral artery (MCA).A clinical case of traumatic arterial aneurysm of the M4 segment of MCA was studied. A patient with a ruptured traumatic aneurysm was transferred to Krasnogorsk City Hospital #1 for further examination and emergency surgery.On the sixth day after surgery, the patient was discharged in a satisfactory condition with almost complete regression of neurological symptoms.Treatment of traumatic arterial aneurysms requires an individual approach taking into account the past medical history, the clinical presentation, aneurysm location and anatomy, as well as the mechanism of injury. It is extremely difficult to suspect an arterial aneurysm after a patient had a traumatic brain injury as the incidence of this condition is very low. An angiographic study of cerebral vessels is needed for reliable diagnosis, not just solely performing standard computed tomography of the brain. Patients with this pathology require surgical intervention.Цель исследования - представить результаты успешного лечения пациента с редкой формой аневризмы - травматической артериальной аневризмой средней мозговой артерии (СМА). Материал и методы. Изучен клинический случай травматической артериальной аневризмы М4 сегмента СМА. Пациент с разрывом аневризмы был переведен в Красногорскую городскую больницу #1 для обследования и выполнения экстренного хирургического вмешательства. Результаты. На 6-е сутки после оперативного вмешательства пациент выписан в удовлетворительном состоянии, с практически полным регрессом неврологической симптоматики. Выводы. Лечение травматических артериальных аневризм требует индивидуального подхода с учетом данных анамнеза, клинической картины, локализации и анатомии аневризмы, а также механизма полученной травмы. Заподозрить артериальную аневризму после получения черепно-мозговой травмы крайне затруднительно ввиду низкой частоты встречаемости данной патологии. Для достоверной постановки диагноза необходимо выполнение ангиографического исследования сосудов головного мозга, а не только стандартной компьютерной томографии. Пациенты с такой патологией требуют хирургического вмешательства.

The effect of cryopreservation of bone marrow cells on the lifespan of mice after syngeneic transplantation has been studied in nonirradiated mice and 7 Gy-irradiated mice. Mice with the enhanced green fluorescent protein gene were the donors. Bone marrow cells were cryopreserved according to the method used in clinical practice in the field of bone marrow autotransplantation in the treatment for patients with cancer. Dimethyl sulfoxide dissolved in polyglucin at the final concentration of 5% acted as a cryoprotectant agent. Transplantation of the thawed stem cells was carried out without washing out the cryoprotectant. No side effects associated with the cryoprotectant toxicity were observed. It has been shown that staining of bonemarrow cells with trypan blue is a more selective technique to evaluate the extent of cell damage after cryopreservation. The mean lifespan of nonirradiated recipient mice was not statistically different from that of the intact control group. In irradiated recipient mice, the mean lifespan increased by 51 ± 2% compared to the group of irradiated controls. The analysis of a blood sample taken from the tail vein of irradiated mice revealed lifelong engraftment of donor-derived cells in the hematopoietic system of the recipient mice. Thus, model experiments on the syngeneic strain of mice showed that cryopreserved bone-marrow cells can be effectively used for cell therapy in autotransplantation in patients after X-ray radiation therapy.

The effect of anisotropy and shear strains on the performance of piezoelectric sensors and actuators in active damping of the resonance vibrations of a hinged rectangular plate is studied. To model the vibrations of the plate, Timoshenko’s hypotheses are used. The analytical solution of the problem is obtained by Fourier’s method. Formulas for the voltage that should be applied to the actuators to balance the mechanical load are derived. Similar formulas are obtained for the sensor voltage. Formulas for the damping coefficient for the case of using both sensors and actuators for active damping of the resonant vibrations of the plate are presented.

A study of the regenerative potential of bone marrow cells of donor mice that express the enhanced green fluorescent protein was conducted in mice irradiated at a dose of 7 Gy. Expression of this protein allowed us to carry out monitoring of the presence of donor cells in recipient blood over the entire lifespan of the recipient. The lifespan of young recipients increased by 93% after transplantation; for old recipients it increased by 15%. Total acceptance of the bone marrow, spleen, thymus, and blood of the recipient with donor bone marrow cells was demonstrated over the entire life of the recipient. Only the donor colonies were detected with the studied irradiation dose and number of transplanted cells (11.7 ± 0.4) · 106 on the spleen surface. The percentage of bone marrow and spleen cells that expressed the CD117 and CD34 stem cell markers in the recipient mice was above the control level for a long period of time after the irradiation. More than half of the cells with CD117, CD34, CD90.2, and CD45R/B220 phenotypes in the studied organs were donor cells. Further detailed study of the peculiarities of the engraftment of bone marrow cells, both without preliminary treatment of recipients and after the effects of extreme factors, will allow improvement of the methods of cell therapy.

This paper considers variety of hydraulic actuators. Also it shows analysis of hydraulic equipment. The contribution is important due to the fact that it determines influence of temperature on friction in hydraulic equipment. The paper examines the factors of reducing the performance of hydrofected machines during operation at low temperatures. The importance of the work is due to the fact that the effects of temperature on friction in hydraulic equipment are considered. An experiment was also conducted, due to which the influence of temperature on the wear resistance of the hydraulic cylinder was revealed.

In this paper, the methods of designing hydraulic drives with minimal energy losses are considered. As well as ways to reduce energy losses in hydraulic systems. The importance of the work is due to the fact that methods have been proposed to improve the reliability and environmental friendliness of the hydraulic drive.

In this paper, the problem of the influence of climatic conditions on the performance of a Hydraulic gear is considered. The importance of the work is due to the fact that the methods for solving the problem are proposed, namely, the use of preheating for a Hydraulic gear and an internal combustion engine under refrigeration. The use of hydrofected self-propelled vehicles in the northern regions in winter is considered. The factors determining the technical and economic indicators of hydrofected machines are revealed. The influence of negative temperature on the physical and mechanical properties of hydraulic equipment materials is also considered. Three main directions have been identified in which temperature affects the hydraulic drive. An experiment was conducted in which the dependence of the performance of the machine was revealed using a preheating device for the working fluid and without the device.

The information theory of aging assumes that decreased functionality of the whole organism and its systems is a result of decreased functionality of cellular repair mechanisms caused by the accumulation of genomic damages in the cells. A four-level cause-effect model of the interaction between the key processes during aging of highly organized multicellular organisms is proposed. Based on this model, some mathematical laws of changes in the viability of an organism are examined. The main fundamental factors that influence individual life expectancy, such as the initial amount of genomic damages at birth, the rate of its accumulation, and the pressure of the environment, are described. Additive and multiplicative interactions of the processes in different complex systems of a multicellular organism and their effects on its overall functionality (viability) are analyzed and the quantitative patterns of aging in a population of model organism are studied. The simulation provided the survival curves for species with different types of aging and a description of a compensation effect for species with aging that follows the Gompertz–Makeham law.

The goal of this work was to determine the effect of nonablative syngeneic transplantation of young bone marrow (BM) to laboratory animals (mice) of advanced age upon maximum duration of their lifespan. To do this, transplantation of 100 million nucleated cells from BM of young syngeneic donors to an old nonablated animal was performed at the time when half of the population had already died. As a result, the maximum lifespan (MLS) increased by 28 ± 5%, and the survival time from the beginning of the experiment increased 2.8 ± 0.3-fold. The chimerism of the BM 6 months after the transplantation was 28%. The data are discussed in the light of the need for mass banking of stem cells (SCs) of young people.

Approximately 6-9% of prostate cancer patients suffering from incontinent of urine after radical prostatectomy are in need of surgical correction of this condition after failure of conservative treatment for 12 months. The study involved 65 patients who were divided into 2 groups of follow-up. Group №1 (n = 31) - patients with mild urinary incontinence, group №2 (n = 34) - patients with medium (moderate) urinary incontinence. Follow-up median of the group №1 was 36 months, an average of 39.5 (12-84) months. Follow-up median of the group №2 was 36 months, an average of 41.65 (12-84) months. The overall efficiency of surgery in both groups was 84% and 82.4%.

Arachnoid cysts (AC) are spaces with cerebrospinal fluid covered with arachnoid membrane. Most cysts are supratentorial and only 10-12% of ACs are found in posterior cranial fossa. This disease is usually diagnosed in childhood. In adults, ACs make up 1.4% of all focal lesions. ACs of posterior cranial fossa are often localized behind the cerebellum or in cerebellopontine angle. Most patients with cysts do not have permanent symptoms and should be followed-up. Surgery is indicated for cysts complicated by focal and hydrocephalic-hypertension symptoms. Microsurgical or endoscopic procedures are used. Surgical approach is determined by the closest location of cyst to brain surface. The authors report non-standard surgical approach for giant AC of posterior cranial fossa complicated by obstructive hydrocephalus, intracranial hypertension and visual function impairment. Endoscopic third ventriculostomy was followed by AC fenestration through ventriculostomy. Symptoms disappeared within 6 months after surgery.Арахноидальные кисты (АК) представляют собой заполненные спинномозговой жидкостью пространства, выстланные арахноидальной оболочкой. Большинство кист располагается в супратенториальном пространстве, и только 10—12% из них встречается в задней черепной ямке. Заболевание чаще манифестирует в детском возрасте, у взрослых АК составляют лишь 1,4% среди всех объемных образований. АК задней черепной ямки располагаются чаще ретроцеребеллярно или в мостомозжечковом углу. Большинство пациентов с кистами не имеют постоянных симптомов и подлежат динамическому наблюдению. Кисты, вызывающие очаговые или гипертензионно-гидроцефальные симптомы, подлежат хирургическому лечению. Для хирургического лечения используется микрохирургическая или эндоскопическая техника операции. Доступ к кисте осуществляется в месте ее ближайшего расположения к поверхности мозга. В статье представлен случай нестандартного подхода к операции, обусловленного сочетанием гигантских размеров АК задней черепной ямки и окклюзионной гидроцефалии с признаками внутричерепной гипертензии на глазном дне и прогрессирующей утратой зрительных функций. После выполнения эндоскопической тривентрикулоцистерностомии через вентрикулостому выполнена фенестрация АК. Симптомы у пациентки полностью регрессировали в течение полугода после операции.

The objective was to produce anatomical preparations by injecting vessels with colored silicone to study the brain and skull base anatomy.Fresh, undissected, and unfixed cadavers were used. The internal carotid arteries and internal jugular veins were identified on both sides of the neck. The vessels were washed with running water. Then, a complex solution consisting of white silicone rubber, silicone oil (solvent), and a coloring pigment (red and blue pigments) at a ratio of 1:(0.9-1.1):(0.04-0.06), respectively, was prepared. About 30-60 s before injecting the complex solution into the vessels, a catalyst-hardener was added to the solution at a ratio of 1:(0.05-0.07). The complex solution was first introduced into the internal carotid artery until the solution came out from the contralateral internal carotid artery; then, the solution was injected into the internal jugular vein until the solution emerged from the contralateral internal jugular vein.The technique enables quick and high-quality visualization of both large and very small vessels of the brain and skull base.The proposed simple and inexpensive technique of manufacturing anatomical preparations improves the quality of training and mastering of microsurgical skills in residents and practicing neurosurgeons.Цель исследования - изготовление наглядных анатомических препаратов с инъекцией сосудов цветным силиконом для изучения анатомии головного мозга и основания черепа. Материал и методы. Используются свежие цельные нефиксированные кадаверы. На шее выделяются внутренние сонные артерии и внутренние яремные вены с обеих сторон. Сосуды промываются проточной водой. Далее готовится комплексный раствор, состоящий из резины белой силиконовой, силиконового масла-растворителя и окрашивающего пигмента (красный и синий) в соотношении 1:(0,9-1,1):(0,04-0,06) соответственно. За 30-60 с до введения комплексного раствора в сосуды, в комплексный раствор добавляется катализатор-отвердитель в соотношении 1:(0,05-0,07). Комплексный раствор вначале вводится во внутреннюю сонную артерию до момента появления комплексного раствора из внутренней сонной артерии с противоположной стороны, затем во внутреннюю яремную вену до момента появления комплексного раствора из внутренней яремной вены с противоположной стороны. Результаты. Способ позволяет быстро и качественно визуализировать как крупные, так и очень мелкие сосуды головного мозга и основания черепа. Заключение. Предлагаемый нами простой и недорогой способ изготовления анатомических препаратов способствует повышению качества обучения и развития микрохирургических навыков у резидентов и практикующих нейрохирургов.

We present a series of cases of a rare pathology, intracranial neuroenteric cysts, a review of the international literature, and the experience in treating this pathology.Seven patients with intracranial neuroenteric cysts underwent surgery at the Neurosurgical Institute in the period between 2000 and 2015.The main and only technique for treatment of intracranial neurenteric cysts is their resection.Авторами представлена серия наблюдений редкой патологии - нейроэнтерических кист интракраниальной локализации, а также обзор мировой литературы и опыт лечения данной патологии. Материал и методы. С 2000 по 2015 г. в Институте нейрохирургии оперированы 7 пациентов с нейроэнтерическими кистами интракраниального расположения. Заключение. Основным и единственным методом лечения таких кист является их удаление.

Background A thorough understanding of the central nervous system anatomy is a fundamental part of a neurosurgeon's training. Development of novel neurosurgical approaches and optimization of existing ones directly depend on the comprehensive study of topographic anatomy of the head and neck using cadaveric specimens. Staining the vessels of the arterial and venous systems of a cadaveric specimen aids a detailed study of the vascularization of anatomic structures of the brain. Here we describe an alternative expedited method for creating anatomic preparations of the human brain using colored silicone for vascular perfusion staining. Methods A nonfixed, whole cadaver (with the head intact), without central nervous system pathology, no later than 48 hours after death, is used to prepare the human brain specimen through staining of arterial and venous vessels. Results Our proposed method provides a fast and inexpensive approach to making anatomic preparations of the human brain with staining of the vascular system. The preparations thus obtained can be used for educational purposes, aiding the study of normal and topographic anatomy of the brain, as well as the development of new microsurgical and/or endoscopic approaches. Conclusions In experienced hands, our proposed method allows the creation of anatomic preparations relatively fast, at low cost, and with excellent quality.

to present the main topographic and anatomical features of the clivus and adjacent structures for improving and optimizing the extended endoscopic transnasal posterior (transclival) approach in removal of clival and ventral posterior cranial fossa lesions.We performed a topographic and anatomical study of 25 cadaver heads, the vascular bed of which was filled with colored silicone using the original technique for visualizing the bed features and individual variability.We present the main anatomical landmarks necessary for performing the extended endoscopic endonasal posterior approach. Superior, medial, and inferior transclival approaches provide access to the anterior surface of the upper, middle, and lower neurovascular complexes of the posterior cranial fossa.The endoscopic transclival approach can be used to reach ventral posterior cranial fossa lesions. The endoscopic transnasal transclival approach is an alternative to transcranial approaches to clival lesions.Цель исследования - представить основные топографоанатомические особенности строения ската и пограничных с ним образований с целью усовершенствования и оптимизации эндоскопического трансназального заднего расширенного (транскливальный) доступа при удалении патологических процессов области ската черепа и вентральных отделов задней черепной ямки. Материал и методы. Проведено топографоанатомическое исследование на головах 25 кадаверов, сосудистое русло которых наполнялось цветным силиконом, по авторской методике, для визуализации его особенностей и индивидуальной вариабельности. Результаты. Представлены основные анатомические ориентиры, необходимые для выполнения эндоскопического эндоназального заднего расширенного доступа. Верхний, средний и нижний транскливальный доступы обеспечивают подход к вентральной поверхности верхнего, среднего и нижнего нейроваскулярных комплексов задней черепной ямки. Заключение. Эндоскопический транскливальный доступ может быть применен для подхода к патологическим образованиям передних отделов задней черепной ямки. Эндоскопический эндоназальный транскливальный доступ является альтернативным по отношению к транскраниальным при хирургическом лечении патологических образований области ската.

The results of experiments on syngeneic and allogeneic transplantation of the whole fraction of mice bone marrow cells without irradiation are presented. The data were obtained on the dynamic of donor cell colonization of bone marrow, spleen, thymus, and blood of the recipient mice. The degree of immunogenicity of the donor cells for both syngeneic and allogeneic transplantation of bone marrow was determined based on the method of microspectral fluorescence analysis. The low immunogenicity degree of donor cells was demonstrated for both transplantation variants within the framework of the conducted experiment. It is important to note that the allogeneic transplantation did not cause any reduction in the mean lifespan of the mice. These results, in combination with the results of our previous studies in which an increase of average lifespan by 34% was shown with syngeneic transplantation within the C57BL/6 EGFP+ strain allow one to anticipate the development of various methods of cellular therapy without risk of fatal consequences of immunological incompatibility between donor and recipient.

A neurosurgical intervention in a patient on dual antiplatelet therapy is a serious challenge for both the neurosurgeon and anesthesiologist..The article describes a clinical case of a successful urgent neurosurgical intervention (ventriculoperitoneostomy for obstructive hydrocephalus caused by a large meningioma of the posterior surface of the petrous pyramid) in a patient on dual antiplatelet therapy (DAT) due to a recently placed coronary stent..Given a high risk of coronary stent thrombosis, the surgery was performed in the presence of ongoing DAT. There were no intracranial hemorrhagic complications, but subcutaneous hemorrhagic complications developed. The article discusses the features of managing similar patients whose number is growing.Нейрохирургическое вмешательство у пациента, получающего двойную дезагрегантную терапию (ДАТ), представляет серьезную проблему как для нейрохирурга, так и для анестезиолога. Материал и методы. Описано клиническое наблюдение, в котором достаточно срочное нейрохирургическое вмешательство (вентрикулоперитонеостомия по поводу окклюзионной гидроцефалии, обусловленной большой менингиомой задней поверхности пирамиды височной кости) было успешно произведено больному, получающему ДАТ в связи с недавно установленным коронарным стентом. Заключение. Учитывая высокий риск тромбоза коронарного стента, операция была произведена на фоне продолжающейся ДАТ. Интракраниальных геморрагических осложнений удалось избежать, но подкожных - нет. Обсуждаются особенности ведения таких пациентов, которых становится все больше.

An extended endoscopic endonasal approach is increasingly used in surgical treatment of space-occupying skull base lesions. The international literature reports only 20 cases of surgical treatment for fibrous dysplasia (PD) of the skull base using the endoscopic endonasal approach. We present our experience with the endoscopic endonasal approach in surgical treatment for giant fibrous dysplasia of the skull base, spreading to the right orbital cavity and nasopharynx.A 26-year-old male patient presented with cranial pain, Vth nerve dysfunction on the right, right keratopathy. OD=0.2 (near acuity - 0.3), OS=1.0, OD - incomplete eyelid closure of 2 mm, conjunctival injection, mucous discharge, corneal opacity in the lower pole and paracentrally, OS - normal appearance. Severe right-sided exophthalmos (more than 15 mm), impaired nasal breathing on the right, nasal (hemorrhagic) discharge. Magnetic resonance imaging and spiral computed tomography scans revealed a bone density lesion located in the area of the orbit, nasal cavity, maxillary sinus on the right, and labyrinth of the ethmoid bone. The patient underwent endonasal endoscopic resection of the lesion.The lesion was resected totally, which was confirmed by control SCT. Right-sided exophthalmos partially regressed (on the right: exophthalmos of 8 mm; protrusion: OD=23 mm, OS=15 mm; the eyeball was displaced downward and outward). The visual and oculomotor functions did not change. The neurological status remained at the preoperative level.Fibrous dysplasia of the skull base is an extremely rare disease. Modern techniques expand the indications for surgery of giant tumors of the skull base using minimally invasive approaches, in particular the endoscopic endonasal approach.Расширенный эндоскопический эндоназальный доступ находит все большее применение в хирургическом лечении объемных образований основания черепа. В мире описано всего 20 случаев оперативного лечения фиброзной дисплазии основания черепа (ФД) с использованием эндоскопического эндоназального доступа. Представляем наш опыт оперативного лечения эндоскопическим эндоназальным доступом гигантского патологического очага фиброзной дисплазии основания черепа, распространяющегося в полость правой орбиты и носоглотку. Клинический случай. Мужчина, 26 лет, с краниальным болевым синдромом, недостаточностью V нерва справа, кератопатией справа. OD=0,2 (вблизи — 0,3), OS=1,0, OD — несмыкание век 2 мм, конъюнктивальная инъекция, слизистое отделяемое, в нижнем полюсе роговицы и парацентрально помутнение роговицы, OS — спокоен. Выраженный правосторонний экзофтальм (более 15 мм), нарушение носового дыхания справа, выделения (геморрагического характера) из носа. На магнитно-резонансных томограммах и спиральных компьютерных томограммах выявлено образование костной плотности в области орбиты, полости носа, верхнечелюстной пазухи справа, лабиринта решетчатой кости. Произведено эндоскопическое эндоназальное удаление патологического очага. Результаты. Удаление патологического очага тотальное, что подтверждено контрольной СКТ. Частичный регресс правостороннего экзофтальма (справа — экзофтальм 8 мм, выстояние OD=23 мм, OS=15 мм, глазное яблоко смещено книзу и кнаружи). Зрительные и глазодвигательные функции без динамики. Неврологический статус на дооперационном уровне. Заключение. Фиброзная дисплазия основания черепа является крайне редким заболеванием. Современные технологии позволяют расширять показания к оперативному лечению гигантских новообразований основания черепа с использованием минимально инвазивных доступов, а именно эндоскопического эндоназального доступа.

Various suboccipital approaches are extensively used in modern neurosurgery for treatment of posterior cranial fossa disease. The main patient's positions on the operating table during surgery are half-sitting and lying ones.The article provides a detailed description and methodology of retrosigmoid suboccipital and median suboccipital approaches in a lying position.The retrosigmoid suboccipital and median suboccipital approaches in a lying position, when used correctly, provide a good view of the operating field with the minimal risk of complications associated with the patient's position on the operating table.Различные субокципитальные доступы активно используются в современной нейрохирургии при лечении патологии задней черепной ямки. Основные положения пациента на операционном столе при их выполнении - полусидя и лежа. Материал и методы. В статье приведены подробное описание и техника выполнения ретросигмовидного субокципитального и срединного субокципитального доступов в положении лежа. Заключение. Ретросигмовидный субокципитальный и срединный субокципитальный хирургические доступы в положении лежа при правильном их использовании обеспечивают хороший обзор операционного поля при минимальных рисках развития осложнений, связанных с положением пациента на операционном столе.Различные субокципитальные доступы активно используются в современной нейрохирургии при лечении патологии задней черепной ямки. Основные положения пациента на операционном столе при их выполнении — полусидя и лежа. Материал и методы. В статье приведены подробное описание и техника выполнения ретросигмовидного субокципитального и срединного субокципитального доступов в положении лежа. Заключение. Ретросигмовидный субокципитальный и срединный субокципитальный хирургические доступы в положении лежа при правильном их использовании обеспечивают хороший обзор операционного поля при минимальных рисках развития осложнений, связанных с положением пациента на операционном столе.

In this paper the method of life span extension of multicellular organisms (human) using reservation of stem cells followed by autotransplantation has been proposed. As the efficiency of this method results from the information theory of ageing, it is important to verify it experimentally testing the basic concepts of the theory. Taking it into consideration, the experiment on bone marrow transplantation to old mice from young closely related donors of the inbred line was carried out. It has been shown that transplanted animals exhibited a survival advantage, a mean life span increased by 34% as compared to the control. This result not only demonstrates the efficiency of the proposed method for life span extension of multicellular organisms, but also confirms the basis of the information theory of ageing.

Surgical treatment of skull base tumors invading the craniovertebral junction is a complex medical problem due to a high rate of adverse postoperative outcomes in these patients.The study aim was to optimize surgical treatment in patients with skull base tumors invading the craniovertebral junction.A comparative analysis of 2 groups of patients was performed. The study group included 28 patients with skull base and craniovertebral junction chordomas who underwent single-stage surgery, including posterior occipitospondylodesis and tumour resection using the transoral and combined transoral and transnasal approaches, in the period between 2000 and 2015. The control group included 21 patients with the same pathology who underwent microsurgery using the transoral approach without occipitospondylodesis in the period between 1990 and 2009.Most of the patients in both groups were operated on at late disease stages when they presented with gross clinical signs. The use of single-stage occipitospondylodesis and transoral skull base tumor removal significantly (compared to the control group) extends indications for surgical treatment of skull base tumors, which were previously considered unresectable, and provides better results.New surgical techniques significantly increase the completeness of tumor resection, decrease the rate of postoperative complications, accelerate the rehabilitation process, and improve the patient's quality of life.Хирургическое лечение опухолей основания черепа, распространяющихся на краниовертебральное сочленение, является сложной комплексной проблемой, так как количество неудовлетворительных исходов оперативных вмешательств в этой категории больных остается высоким. Цель исследования - оптимизация хирургического лечения пациентов с опухолями основания черепа, распространяющихся на краниовертебральное сочленение. Материал и методы. Проведен сравнительный анализ двух групп пациентов. В исследуемой группе - 28 пациентов с хордомами основания черепа и краниовертебрального сочленения, которым в период с 2000 по 2015 г. произведена одномоментная операция: задний окципитоспондилодез и удаление опухоли с использованием трансорального и сочетанного трансорального и трансназального доступов. В контрольной группе - 21 пациент с такой же патологией, но которые в период с 1990 по 2009 г. оперированы трансоральным доступом без предварительного окципитоспондилодеза. Результаты. Большинство больных обеих групп были оперированы в далеко зашедшей стадии заболевания, с грубой клинической симптоматикой. При использовании одномоментного окципитоспондилодеза и трансорального удаления опухоли основания черепа значительно (при сравнении с контрольной группой) расширены показания к оперативному лечению опухолей основания черепа, ранее считавшихся неоперабельными, а также получены более высокие результаты. Заключение. Разработанные и внедренные в клиническую практику новые хирургические технологии (способ удаления опухоли) позволяют значительно увеличить радикальность удаления опухолей, снизить уровень послеоперационных осложнений, ускорить реабилитацию, а также повысить качество жизни пациентов.

Delayed facial palsy is a complication developing 3 or more days after surgery. The etiology and pathogenesis of this condition has not been fully explored, and there are no treatment standards for it. As in the case of Bell's paralysis, glucocorticosteroids (GCSs) are currently used to treat delayed facial palsy. However, patients with contraindications to GCSs need new therapy modalities.We aimed to evaluate the efficacy and safety of botulinum therapy in patients with delayed facial palsy after neurosurgical interventions.We examined 33 patients with delayed facial palsy developed 3 or more days after resection of vestibular schwannoma. The main group included 18 patients with contraindications to GCSs who received injections of botulinum toxin A (BTA) into the facial muscles of the healthy side for muscle relaxation. The comparison group consisted of 15 patients who received a course of prednisolone (1 mg/kg/day) for 5-7 days. The efficacy of treatment was assessed using the House-Brackmann scale and Clinical Global Impression Scale. The follow-up period after therapy was 3 months.Delayed facial palsy was more common in the following cases: the facial nerve was located near the antero-inferior tumor pole; the tumor was adherent to the facial nerve; the tumor extended in the oral direction; the tumor had with unclear borders and was 11 to 30 mm in size. In most patients of both groups, facial muscle palsy developed more than 11 days after surgery. Treatment both in the main and control groups resulted in a significant improvement: complete regression of the facial asymmetry in patients of the main group and comparison groups 3 months after treatment onset was 83.3 and 93.3% (House-Brackmann scale), respectively.Botulinum therapy may be recommended for patients with delayed facial palsy developed after vestibular schwannoma resection, who have contraindications to GCSs.Отсроченная нейропатия лицевого нерва представляет собой осложнение, возникающее через 3 сут и более после оперативного вмешательства. Этиология и патогенез данного состояния до конца не изучены, стандарты лечения отсутствуют. По аналогии с параличом Белла в настоящее время для лечения отсроченной нейропатии лицевого нерва используют глюкокортикостероиды (ГКС). Однако для пациентов с противопоказаниями к их применению необходим поиск новых методов терапии. Цель исследования - оценка эффективности и безопасности ботулинотерапии у пациентов с отсроченной нейропатией лицевого нерва после нейрохирургических вмешательств. Материал и методы. Обследованы 33 пациента с отсроченной нейропатией лицевого нерва, возникшей через 3 сут и более после удаления невриномы слухового нерва. В основную группу вошли 18 пациентов с противопоказаниями к использованию ГКС, которым были проведены инъекции ботулинотоксина А (БТА) в мимические мышцы здоровой стороны лица с целью их расслабления. Группу сравнения составили 15 человек, которым был назначен курс преднизолона 1 мг/кг/сут длительностью 5-7 дней. Эффективность лечения оценивали по шкале House-Brackmann и Шкале общего клинического впечатления (Clinical Global Impression Scale). Срок наблюдения после проведенной терапии составил 3 мес. Результаты. Чаще всего отсроченная нейропатия лицевого нерва развивалась при расположении нерва у передненижнего полюса опухоли; при спаянности опухоли с лицевым нервом; при росте опухоли в оральном направлении; при опухоли с нечеткими границами и с размером от 11 до 30 мм. У большинства пациентов обеих групп время возникновения пареза мимических мышц составило более 11 сут после операции. На фоне проводимого лечения как в основной, так и в контрольной группе выявлена значимая положительная динамика: полный регресс асимметрии лица по шкале House-Brackmann составил 83,3 и 93,3% у пациентов основной группы и группы сравнения соответственно через 3 мес после начала лечения. Заключение. Ботулинотерапия может быть рекомендована пациентам с отсроченной нейропатией лицевого нерва, возникшей после удаления невриномы слухового нерва, при противопоказаниях к ГКС.

Radiation therapy of small vestibular schwannomas is quite often used as an effective alternative to surgical treatment. At the same time, 2-10% of patients are detected with radioresistant tumors progressing to varying degrees, which is associated with continued tumor growth. In these cases, a decision on surgical resection or re-irradiation of the tumor is made depending on the neurological symptoms, patient's somatic status, and neuroimaging data. Surgical outcomes and intraoperative findings in pre-irradiated patients have been poorly represented in the literature, for which reason we decided to conduct this study. The paper presents a series of patients with vestibular schwannomas who underwent surgical removal of the tumor after radiotherapy.A total of 39 patients with vestibular schwannomas after radiotherapy underwent surgery at the Burdenko Neurosurgical Institute in 2007-2017. Of these, 22 patients had a tumor removed after a previously performed combined surgical and radiotherapy treatment (group I), and 17 patients underwent tumor resection after previous radiological treatment (group II). The surgical outcomes were studied depending on various factors, and an analysis of the morphological changes in vestibular schwannomas after radiological treatment was carried out.In group I, the tumor was resected totally in 18% of patients, almost totally in 5% of patients, subtotally in 68% of patients, and partially in 9% of patients. In group II, the tumor was resected totally in 6% of patients, almost totally in 12% of patients, subtotally in 76% of patients, and partially in 6% of patients. We found that post-radiation changes in patients undergoing surgery led to an increase in the response of neurovascular structures to surgical intervention, development of pronounced fibrosis around tumors, and changes in the structure of tumors that became more solid. As a result, surgical morbidity increased, and the patient's quality of life after surgery deteriorated.Лучевая терапия, обычно небольших вестибулярных шванном, довольно часто применяется как эффективная альтернатива хирургическому лечению. При этом у 2-10% пациентов выявляются радиорезистентные опухоли, которые в разной степени прогрессируют, что связано с продолженным ростом опухоли. В таких случаях принимается решение о проведении хирургического удаления либо повторного облучения опухоли - в зависимости от неврологической симптоматики, соматического статуса пациента, данных нейровизуализации. Результаты операций и интраоперационные находки у ранее облученных больных в литературе описаны скудно, в связи с чем и было проведено наше исследование. В работе представлена серия наблюдений пациентов с вестибулярными шванномами, которым было проведено хирургическое удаление опухоли после лучевого лечения. Материал и методы. С 2007 по 2017 г. в ФГАУ НМИЦ нейрохирургии им. акад. Н.Н. Бурденко оперированы 39 пациентов с вестибулярными шванномами после лучевого лечения. Из них 22 больным удаление опухоли выполнено после ранее проведенного комбинированного хирургического и лучевого лечения (1-я группа), а 17 пациентам удаление опухоли произведено после предшествующего радиологического лечения (2-я группа). Изучены результаты операций в зависимости от разных факторов, а также проведен анализ морфологических изменений вестибулярных шванном после радиологического лечения. Результаты. В 1-й группе тотальное удаление опухоли было достигнуто у 18% пациентов, почти тотальное - у 5%, субтотальное - у 68%, частичное - у 9%. Во 2-й группе тотальное удаление выполнено у 6% пациентов, почти тотальное - у 12%, субтотальное - у 76%, частичное - у 6%. Выявлено, что в связи с развитием пострадиационных изменений при операциях у облученных больных отмечается повышение реакции сосудисто-нервных образований на хирургическое вмешательство, развивается выраженный фиброз вокруг опухолей и меняется структура самих опухолей, которые становятся более плотными. В итоге повышается хирургическая морбидность и ухудшается качество жизни пациента после операции. Заключение. Мы считаем, что субтотальное удаление облученных вестибулярных шванном уменьшает риск хирургической морбидности.

The experimental results on syngeneic and allogeneic transplantation of whole fraction of mice bone marrow cells without irradiation have been presented. Data on the dynamics of the donor cell colonization of bone marrow, spleen, thymus and blood of the recipient mice were obtained. The degree of immunogenicity of donor cells with syngeneic and allogeneic bone marrow transplantation based on the microspectral fluorescence method was evaluated. Within the framework of the experiment a low degree of immunogenicity of donor cells with syngeneic and allogeneic transplantation is shown. Importantly, allogeneic bone marrow transplantation did not cause any reduction in the mean life span of mice. These data and the results of our previous studies, demonstrating the mean life span increased by 34% with syngeneic transplantation in line C57BL/6 EGFP+, allow for developing different methods of cell therapy with no risk of fatal consequences of the immunological incompatibility between donor and recipient.

In this paper the experimental results of bone marrow transplantation from C57BL/6-Tg(ACTB-EGFP)1Osb/J transgenic mice into C57BL/6 mice subjected to 5-fluorouracil treatment are represented. It has been shown that EGFP+ cells engraftment in bone marrow, spleen and thymus of host mice after 5-Fu treatment significantly increased. More long-term engraftment was recorded after transplantation between closely related donors and 5-fluorouracil treatment hosts. We have also obtained data on differences in the dynamics of EGFP+ cells engraftment in host investigated organs. To assess the effect of the donor's bone marrow cells on the host immune system, functional activity of the synthetic apparatus (synthetic activity) of cells in bone marrow, spleen, thymus and blood have been investigated with fluorescence microspectral method. The results obtained allow of improving techniques for bone marrow transplantation without host irradiation in order to minimize the adverse effects.

In this paper the method of life span extension of multicellular organisms (human) using the reservation of stem cells followed by autotransplantation has been proposed. As the efficiency of this method results from the information theory of ageing, it is important to verify it experimentally testing the basic concepts of the theory. Taking it into consideration, the experiment on the bone marrow transplantation to old mice from young closely-related donors of the inbred line was carried out. It has been shown, that transplanted animals exhibited a survival advantage, a mean life span increased by 34% as compared to the control. This result not only demonstrates the efficiency of the proposed method for life span extension of multicellular organisms, but also confirms the basis of the information theory of ageing.

The method of lifespan extension that is a practical application of the informational theory of aging is proposed. In this theory, the degradation (error accumulation) of the genetic information in cells is considered a main cause of aging. According to it, our method is based on the transplantation of genetically identical (or similar) stem cells with the lower number of genomic errors to the old recipients. For humans and large mammals, this method can be realized by cryopreservation of their own stem cells, taken in a young age, for the later autologous transplantation in old age. To test this method experimentally, we chose laboratory animals of relatively short lifespan (mouse). Because it is difficult to isolate the required amount of the stem cells (e.g., bone marrow) without significant damage for animals, we used the bone marrow transplantation from sacrificed inbred young donors. It is shown that the lifespan extension of recipients depends on level of their genetic similarity (syngeneity) with donors. We have achieved the lifespan increase of the experimental mice by 34% when the transplantation of the bone marrow with high level of genetic similarity was used.

In this article the method for studying 3-dimensional (stereological) characteristics of interactions of biological micro objects with nanoparticles on a basis of morphodensitometry analysis of standard 2-dimensional images of cytological and histological specimens is proposed. The performance of the task of determining the distance from registered nanoparticle to the center of the nucleus of the cell is described in detail. It is shown that using specific nanoparticles the results obtained may find application in science and diagnostics. Furthermore, it is possible to employ these results in nanotoxicology, in particular for determination of quantity characteristics of translocation of nanoparticles of different types in biological structures.

During the period of 2010-2012, 33 patients with cerebellopontine angle tumors were operated on at the Burdenko Neurosurgical Institute (Moscow, Russia) using different types of endoscopic assistance. All patients were operated on via the retrosigmoid suboccipital approach in semi-sitting and prone positions. 30° and 70° endoscopes were used during the surgery. Endoscopic assistance allowed us to increase the completeness of tumor removal and to reduce the risk of postoperative complications by retaining the anatomic integrity of cranial nerves and vascular structures in the base of the posterior cranial fossa. These benefits made it possible to maintain and improve quality of life in patients with CPA tumors in the postoperative period.

to describe the main topographic and anatomical features of the clival region and its adjacent structures for improvement and optimization of the extended endoscopic endonasal posterior (transclival) approach for resection of tumors of the clival region and ventral posterior cranial fossa.We performed a craniometric study of 125 human skulls and a topographic anatomical study of heads of 25 cadavers, the arterial and venous bed of which was stained with colored silicone (the staining technique was developed by the authors) to visualize bed features and individual variability. Currently, we have clinical material from more than 120 surgical patients with various skull base tumors of the clival region and ventral posterior cranial fossa (chordomas, pituitary adenomas, meningiomas, cholesteatomas, etc.) who were operated on using the endoscopic transclival approach.We present the main anatomical landmarks and parameters of some anatomical structures that are required for performing the endoscopic endonasal posterior approach. The anatomical landmarks, such as the intradural openings of the abducens and glossopharyngeal nerves, may be used to arbitrarily divide the clival region into the superior, middle, and inferior thirds. The anatomical landmarks important for the surgeon, which are detected during a topographic anatomical study of the skull base, facilitate identification of the boundaries between the different clival portions and the C1 segments of the internal carotid arteries. The superior, middle, and inferior transclival approaches provide an access to the ventral surface of the upper, middle, and lower neurovascular complexes in the posterior cranial fossa.The endoscopic transclival approach may be used to access midline tumors of the posterior cranial fossa. The approach is an alternative to transcranial approaches in surgical treatment of clival region lesions. This approach provides results comparable (and sometimes better) to those of the transcranial and transfacial approaches.Цель исследования - представить основные топографоанатомические особенности области ската и пограничных с ним образований с целью возможного усовершенствования и оптимизации эндоскопического эндоназального заднего расширенного (транскливального) доступа при удалении опухолей области ската и вентральных отделов задней черепной ямки. Материал и методы. Проведено краниометрическое исследование на 125 человеческих черепах, топографоанатомическое исследование на головах 25 кадаверов, артериальное и венозное русло которых окрашено цветным силиконом, по разработанной нами методике, для визуализации его особенностей и индивидуальной вариабельности. В настоящее время мы располагаем клиническим материалом оперативного лечения более 120 пациентов с различными опухолями основания черепа, локализующихся в области ската и вентральных отделах задней черепной ямки (хордомы, аденомы гипофиза, менингиомы, холестеатомы и др.), которые были оперированы с использованием эндоскопического транскливального доступа. Результаты. Представлены основные анатомические ориентиры, параметры ряда анатомических образований, необходимые для выполнения эндоскопического эндоназального заднего расширенного доступа. Используя такие анатомические ориентиры, как интрадуральные отверстия отводящих и языкоглоточных нервов, область ската можно условно разделить на верхнюю, среднюю и нижнюю трети. Важные для хирурга анатомические ориентиры, обнаруживаемые при топографо-анатомическом исследовании основания черепа, способствуют определению границ между различными отделами ската и С1-отделами внутренних сонных артерий. Верхний, средний и нижний транскливальный доступы обеспечивают подход к вентральной поверхности верхнего, среднего и нижнего нейроваскулярных комплексов задней черепной ямки. Заключение. Эндоскопический транскливальный доступ может быть применен для осуществления подхода к срединно расположенным опухолям области задней черепной ямки. Он является альтернативным по отношению к транскраниальным доступам при хирургическом лечении патологических образований области ската. Результаты применения этого доступа сопоставимы с результатами транскраниальных и трансфациальных доступов, а в ряде случаев превосходят их.