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Clinical guidelines are topical systematically developed provisions designed to help the doctor make a decision about a treatment approach in certain clinical situations; they provide information on conducting diagnostic and screening tests, the amount of medical and surgical care, and other aspects of clinical practice. Vestibular schwannomas account for 8% of all intracranial lesions, up to 30% of posterior cranial fossa tumors, and 85% of cerebellopontine angle tumors. The incidence rate of acoustic neuromas is approximately 1 case per 100000 population per year. The paper addresses the issues of classification, diagnosis, and treatment of acoustic neuromas. The guidelines discuss in detail the key aspects of formulation of clinical diagnosis, classification features, definition of the indications for surgical or radiation treatment, and principles of expectant treatment in vestibular schwannomas. The article pays particular attention to surgical treatment of acoustic neuromas and describes the criteria for choosing a surgical approach, use of modern surgical equipment, and stages of tumor resection. On the basis of the accepted clinical classification, we propose the algorithms of action depending on the disease stage, pathological process dynamics, patient's age, and clinical manifestations. The key points of the clinical guidelines rely on evidence-based criteria. The work is intended for neurosurgery practitioners.

Prolactinomas account for about 40% of all pituitary adenomas. The main treatment for prolactinomas is undoubtedly therapy with dopamine agonists (DAs). However, prolonged conservative treatment (for many years or even throughout life) that is necessary for permanent control of the disease makes some patients refuse pharmacological treatment for various reasons. In addition, not all prolactinomas respond to DAs therapy. Sometimes, the patient is not able to continue treatment because of the severity of side effects. Along with tumor resistance to therapy and patient intolerance of DAs, complications (liquorrhea, hemorrhage in the tumor) may occur during conservative treatment. In these cases, surgery is necessary. The paper analyzes the modern literature on various treatment options for prolactin-secreting pituitary adenomas and defines the indications for surgical treatment.

Unlabelled: Hyponatremia is a relatively frequent and serious complication in patients with various neurosurgical pathologies., Objective: This study is aimed at assessing the incidence of hyponatremia in neurosurgical patients depending on the pathology., Material and Methods: This paper presents a retrospective analysis 39 479 cases of patients operated on at the Burdenko Neurosurgical Institute from 2008 to 2014., Results: A total of 785 hyponatremic patients with Na level lower than 130 mmol/l (2% of all operated patients) were identified. Mortality in patients with hyponatremia was 14.3%, which is tenfold higher compared to the rest of population of patients without hyponatremia who were operated on during the same period. In adults, hyponatremia most frequently occurred after resection of craniopharyngiomas (11%) and as a result of acute cerebrovascular accident (22%). In children, it occurred after resection of craniopharyngiomas (10%), astrocytomas (7%), ependymomas (24%), and germ cell tumors (10.5%)., Conclusion: This study, which was mainly statistical one, was not aimed at detailed investigation of hyponatremia in different groups of neurosurgical patients. We only tried to draw the attention of various experts to those categories of patients, where focused and in-depth developments are more than important. Obviously, already gained international experience should be taken into account for this, Purpose: Therefore, this article presents the literature data on the etiology and pathogenesis of hyponatremia. We describe the details of the various classifications of hyponatremia, its clinical symptoms, diagnosis, and treatments, primarily based on the recommendations of the last European consensus of various specialists (2014).

The paper reports two clinical cases observed with a time lag of four years. In both cases, there were severe clinical symptoms of intracranial hypertension before the surgery. Prompt full-scale resuscitation was required in both cases due to asystole that developed immediately after induction of anesthesia and tracheal intubation. In one case, cardiac activity was successfully recovered by complex resuscitation with the emergency drainage of the cerebral ventricles. The possible causes of complications and preventive measures were discussed.

This paper presents in brief the data on epidemiology, classification, diagnostics, and current tendencies in the surgical treatment of cholesteatoma of the pyramid of the temporal bone. A clinical case of diagnostics and the surgical treatment ofpetrous apex cholesteatomainthe temporal bone is described.

In this paper, we present a review of current literature on the application of intraoperative fluorescence diagnosis and fluorescence spectroscopy using 5-aminolevulinic acid in surgery for various types of brain tumors, both alone and in combination with other neuroimaging methods. Authors' extensive experience with these methods allowed them to develop a set of clinical guidelines for the use of intraoperative fluorescence diagnosis and fluorescence spectroscopy in surgery of brain tumors.

In this paper, we describe the possibility of using a bone-mounted miniature robot based on the experience of different surgeries performed in 77 patients divided into four groups according to the general pathology (degenerative stenosis of the vertebral canal, fractures of vertebral bodies, spondylolisthesis, hemangiomas, and tumors). All the patients underwent surgical intervention using Spine Assist Mazor, such as stabilization using the Go-Lif system, transpedicular systems, vertebroplasty, and vertebral body biopsy. The new method and the technology of stabilizing surgeries using Spine Assist Mazor allow one to perform preoperative virtual planning based on CT images and to identify an ideal and safe trajectory of placing screws or needles for vertebroplasty or biopsy.

Fluorescent diagnosis was first proposed in the early XX century and has been used in neurosurgery for about 15 years. The method relies on selective accumulation of strongly fluorescent protoporphyrin IX in tumor cells. Over the past years, the method of intraoperative fluorescence diagnosis has occupied its niche in many neurosurgical clinics around the world and is now used for fast intraoperative diagnosis in brain tumor surgery. However, the efficiency of fluorescent intraoperative diagnosis using 5-aminolevulinic acid is 80-90% and 58.8% for surgery of Grade III-IV and I-II gliomas, respectively. One of the methods to improve the efficiency of fluorescent diagnosis is to use vector systems for delivering fluorescent drugs into the tumor. This paper reports the results of an experimental study of systems for delivering fluorescent agents (protoporphyrin IX, Alexa 488, Alexa 660) using connexin-43 antibodies in rats with transplanted C6 glioma.

The paper presents the experience of application of single-photon emission computed tomography (SPECT) and CT in neurosurgery. Combination of these two techniques in the single system provides higher precision of both methods. The novel technique allows assessment of tumor spread in the brain, differential diagnosis of tumor regrowth and radiation-induced necrosis, evaluation of cerebral perfusion in epilepsy, traumatic brain injury (TBI), and diagnostics of secondary CNS lesions. Examples of primary diagnosis, dynamic follow-up and differential diagnosis of cerebral neoplasms, localization of epileptogenic foci in planning of surgery, prediction of outcome after TBI and evaluation of spread of metastatic skeletal involvement and further application of acquire data are presented.

The paper presents modified treatment protocols for spinal trauma and degenerative disease--transpedicular screw fixation based upon biomechanical adjustment and spinal dura opening. Both methods help to improve results of surgical treatment and decrease complication rate.

The paper summarizes the results of surgical treatment of patients with thalamic tumors of different topographic variants. Since 1985 till 2010 127 patients were operated, 147 direct surgical interventions were performed. Repeated surgeries were required due to partial resection of a tumor or recurrence. In most cases resection of tumors was performed via transcallosal (48%) and occipital interhemispheric (29%) approaches. Less common approaches included transcortical (frontal, temporal, parietal) (14%), pterional through lateral and basal parts of Sylvian fissure (6%) and subtentorial supracerebellar (3%). Selection of approach is based on topographic features of tumor within thalamus, direction of its growth and relations with adjacent structures (internal capsule, brainstem, hypothalamus, ventricular system). Each approach has its own advantages and drawbacks which are highlighted in the paper.

Development of national and international registers for the most socially significant diseases is an important problem of contemporary medicine. Importance and priority of vertebrological register is explained by relatively young age of spinal neurosurgery as specialty, in which many questions concerning indications and optimal methods of treatment remain unsolved, and accumulated experience is quite limited. Nevertheless, vertebrology is on the way from opinions of certain experts to evidence-based scientific proofs. This transition needs generally accepted and convenient instruments for assessment of outcomes of treatment and procedures which should be presented by national vertebrological register. Aims of its development include accumulation of clinically valuable resources and knowledge in vertebrology by means of organization of society of interested professionals and patients. The paper discusses architecture, contents and importance of development of Russian vertebrological register targeted on neurosurgeons, orthopaedic surgeons, vertebrologists and other specialists dealing with this problem. Foreign vertebrological registers are analyzed, their advantages and disadvantages are summarized, requirements for inclusion of criteria in the register are investigated.

In the paper we describe a rare case of intraventricular recurrence of melanoma metastasis treated by endoscope-assisted surgery. Total resection was performed using microsurgical approach with endoscopic assistance. Full regression of neurological deficit, physical rehabilitation and recurrence-free 6-month follow-up was achieved in this case.

The paper analyses the series of 220 observations of patients with cranial chordomas operated in Burdenko Neusurgical Institute (Moscow, Russia) since 1984 till 2007. Tumors were localized in sellar region (34.1%), clival region (32.3%), craniovertebral junction (27.3%); craniofacial chordomas were observed in 5.9% of cases, ectopias (without any connection with clivus and sphenoocipital junction)--in 0.5%. In most cases transnasal, retrosigmoid and pterional approaches were used for excision of the tumor. The paper emphasizes the problem of selection of surgical tactics, early and delayed postoperative results. 5-year survival rate was 62%, 10-year survival--47%.

Benign gliomas are slowly growing primary brain tumors with prolonged natural course and tendency to malignization. Selection of methods of treatment of patients with good quality of life is being discussed. 'Conservative' as well as active surgical tactics are supported. The paper describes results of treatment of 19 patients with benign supratentorial gliomas. Follow-up period varied from 4 months to 17 years. Aspects of volume evolution and surgical excision of tumor are highlighted.

The paper analyzes the advantages and disadvantages of using locoregional anesthesia (LRA) modes (a combination of local anesthesia and regional blockade) in neurosurgical patients with intracranial, spine, and spinal cord occlusive cerebrovascular disease and lesions during transnasosphenoidal interventions. LRA is now an effective and frequently indispensable component of anesthetic management during neurosurgical interventions.

Trochlear neurinomas are extremely rare. This paper presents 2 cases of surgically treated trochlear neurinomas. In the first case, the tumor occupied the lateral part of the tentorial notch was removed via retromastoidal approach. In the other case, neurinoma was located in the posterior parts of the tentorial notch and removed via paramedian subtentorial supracerebellar approach.

The paper presents the results of clinical evaluation of combined prevention of leg deep vein thrombosis and pulmonary thromboembolism in 130 neurosurgical patients undergoing intracranial interventions for brain tumors. Combined prevention comprises mechanical (compression knitted wear + periodic pneumatic leg compression by a special device) and pharmacological (subcutaneous injection of low molecular-weight heparins on postoperative day 2, followed by the daily administration of acetylsalicylic acid from the moment of a patient's activation) treatments. The study has indicated that this preventive procedure is effective and at the same time safe against the development of intracranial hemorrhagic complications.

The paper deals with the new application of the well-known surgical technique laminoplasty that is not commonly used to remove giant intramedullary tumors in pediatric patients. The basic stages of the operations and the nuances of their performance are described in the step-by-step fashion. Real photos of each stage are designed to furnish insights into the specific features of surgical techniques.

The paper analyzes the results of treatment for various diseases of the vertebral column, by applying endoscopic technologies. Group 1 included 5 patients with cervical hernias appeared as cervical radiculopathy. Group 2 comprised patients with diseases of the thoracic vertebral column, including 8 patients with discal hernias, 6 with primary or metastatic lesions of the thoracic vertebrae, 2 with sympathalgia, and 5 with uncomplicated thoracic vertebral body fractures. Group 3 consisted of 86 patients with lumbosacral hernias, of whom 33 patients were endoscopically operated on and the remaining 53 patients made up a control group and were microsurgically operated on. The clinical findings were analyzed by using the current scales and questionnaires to make an objective assessment of subjective index, such as pain syndrome. A preliminary comparison of endoscopic and microscopic surgical treatments for diseases and lesions of the vertebral column demonstrate the noticeable advantages of endoscopic technology. Further development of neuroendoscopy in spinal neurosurgical care is expected to substantially enhance the efficiency of treatment due to the lower traumaticity rates of surgical interventions. Furthermore, mastering endoscopictechniques in surgery of bone tumors, but also spinal cord extra- and intramedullary neoplasms is promising, as considered by the authors.

The study was conducted at the Academician N. N. Burdenko Institute of Neurosurgery, Moscow, in 1999 to 2006. The paper presents the results of stepwise surgical treatment in 84 patients with chronic cerebral ischemia, caused by multiple stenotic and occlusive lesions of the brachiocephalic arteries, who underwent 183 reparative operations. Six major groups of patients with various combinations of lesions of major cerebral arteries were identified. An attempt was made to create an algorithm of the optimum stepwise surgical treatment policy in the identified groups of patients on the basis of the site, degree, and nature of stenotic lesions, by taking into account the cerebral hemodynamics and collateral circulation at all stages of surgical treatment. At the same time, changes in the degree of neurological deficit as one of the major determinants of the results of surgical treatment could be evaluated. The study has demonstrated that the chosen tactics of employing series arterial reconstructions in multiple stenotic and occlusive lesions of major cerebral arteries is an effective treatment option in patients with chronic cerebral ischemia.

Background: Radical surgery for intramedullary spinal cord tumors (IMSCT) is currently accepted as a first-line treatment. At the same time most papers concerning this problem show that surgical results depend on the preoperative neurological status of a patient. Many authors consider that the functional status of a patient with severe neurological deficit does not change for the better., Materials and Methods: In 2002-2006, at the Academician N. N. Burdenko Research Institute of Neurosurgery, the author operated on 63 patients diagnosed as having IMSCT as evidenced by magnetic resonance imaging (MRI). Among them, there were 29 patients with severe preoperative neurological deficit (3-4 scores by the McCormick scale (MCS)). Thirteen (45%) tumors were totally removed; in the remaining patients with diffuse tumors, tumor removal was subtotal (more than 80% of a tumor being removed, as confirmed by MRI scans). There were neither neurological status deteriorations, nor fatal outcomes. Nineteen patients were found to have functional improvement by 1-3 MCS scores. Out of them, 15 (52%) patients became completely independent in their everyday activities due to surgery., Conclusions: In this series of patients with IMSCT and severe preoperative neurological deficit, tumor removal led to functional improvement in the patient and his independence in everyday life in 52% of cases. Radical surgery for localized IMSCT does not deteriorate the patients' functional status.

The paper presents experience with surgical and combined treatment of 197 patients with malignant tumors involving the skull base and extracranially originating. The authors have defined indications for and contraindications to different types of surgical treatment, developed methods for radical and palliative tumor removal, which are based on a comprehensive approach considering the basic principles of oncology and neurosurgery. Assessing the immediate and long-term results of surgical treatment by mathematical statistical methods could reveal the major factors influencing survival rates in patients after surgery and the duration of a relapse-free period.

The paper describes a relatively rare clinical case of stepwise surgical treatment in a patient with concomitant cerebrovascular pathology: thrombosis of the left internal carotid artery + critical stenosis of the right internal carotid artery + arteriovenous malformation of the right occipital lobe. The patient underwent open right carotid endarterectomy left extra-intracranial microvascular anastomotic application, and histoacryl endovascular embolization of the major afferents and arteriovenous malformation stroma in the stepwise fashion. Management policy, possible complications, and ways of their prevention in these patients are discussed.

The paper considers surgical treatment of patients with partially thrombotic giant and fusiform aneurysms of the posterior cerebral arteries (PCA), which is a challenge of cerebrovascular neurosurgery. Giant, fusiform aneurysms are clinically manifested themselves as a mass effect in 80% of cases and as spontaneous subarachnoidal hemorrhage in 20%. Due to their vicinity of the brain stem, giant aneurysms of PCA in any clinical course present a real threat to a patient's life. A case of clipping of partially thrombotic giant aneurysm of PCA by means of tunnel clips to form the wall of a vessel from an apron cut from the aneurysmal wall is considered in detail. Surgical treatment of partially thrombotic giant and fusiform aneurysms is identified as an individual problem of cerebrovascular neurosurgery, which awaits a sophisticated study in order to define an adequate surgical treatment.

The paper analyzes the experience gained in using a molecular resonance coagulator in 145 patients with tumors of the base of the skull and brain. The Vesalius NEUROsurgery N1 molecular resonance apparatus is an innovational bipolar device that is specially designed for neurosurgical application,(operations on the brain). Due to the fact that the temperature at the site of a cut does not exceed 45-50 degrees C, the apparatus has the minimum effect on tissues, nerves, nerve ending, and blood vessels, permitting a surgeon to make interventions into sophisticated anatomic formations. The apparatus operates in the modes "cut" and "coagulation" that enable operations to be performed on particularly minor and fine structures. While working on brain tissues, it is particularly important that there is no thermal injury, tissue charring, or sticking effect due to low working temperatures. The possibility of concurrently making hemostasis and tissue dissection reduces the time of an operation and considerably decreases the extent of blood loss. The clinical case given in this paper demonstrates the universality of the Vesalius NEUROsurgery N1 molecular resonance apparatus used in an infiltrative tumor of the bases of the skull. One forceps operated in different modes may provide sparing coagulation of minor cortical arteries, reduce the volume of a tumor through its bloodless dissection, arrest bleeding from the hyperostosis (wax sticking effect), prepare nerves in the upper lid slit and cavernous sinus. The Vesalius NEUROsurgery N1 molecular resonance surgical apparatus is recommended for neurosurgical care to perform brain operations requiring great caution in handling the tissues being operated on.

The paper describes the surgical technique of laminotomy. The basic stages of the operation and nuances of its performance are provided so that the readers can easily understand. Real photos of each surgical stage are useful for neurosurgeons dealing with intramedullary tumors.

The paper presents the results of treatment in 15 cases with non-acoustic parastemal schwannomas, which amounts to 4.3% in this histological subgroup. Among them, there were 7 (2.0%) patients with trigeminal tumors, 5 (1.4%) with facial nerve schwannomas, 3 (0.9%) with schwannomas, which were localized in the jugular foramen. In 4 (57.1%) cases, trigeminal schwannomas were localized in the posterior fossa and in (3.42.9) cases, they spread into the infra- and supratentorial areas. Tumors of the jugular foramen spread extracranially in 2 (66.7%). Their diagnosis was based on clinical intrascopic (computed tomographic and magnetic resonance imaging) data. All the cases had sings of acousticofacial disorders. For tumor removal, the suboccipital retrosygmoid approach was used in 12 cases and combined approaches were applied in 3 cases, including 2 (13.3%) patients in whom schwannomas were removed via two- or three-stage interventions. The anatomic integrity of the cranial nerves adjacent to a tumor was preserved in all the cases. After surgery, their mild or moderate dysfunction that did not lower life quality was observed in most cases. Liquorea and meningitis were seen in 1 (6.7%) case after removal of an extracranial component of trigeminal schwannoma. Radical tumor resection was made in 93.3% of cases. Tumor recurrence was observed in 1 (6.7%) case. There were no fatal cases in a group of the patients operated on. Larger tumors that induce severe deformation of the brain stem should be removed in two steps; this makes it possible to rule out their rapid redislocation that deteriorates the course of an early postoperative period.

Malignant pineal tumors (PT) tend to metastasize. In rare cases, this process is provoked by surgery. This paper describes four cases of iatrogenic metastasis of PT. Metastasis occurred: a) along the surgical approach path after tumor removal in 2 cases; b) along the biopsy cannula path; and c) along the ventriculoperitoneal catheter into the abdomen. The sources of metastases were pineoblastoma (n = 1), malignant teratoma (n = 1), germinoma (n = 1), and malignant germ-cell tumor of unknown genesis (n = 1). To prevent this complication due to high-grade PT, such as malignant germ-cell tumors and pineoblastomas, radiation of the whole brain, besides the sites of a tumor should be performed and, in some cases, in combination with chemotherapy.

Benign pituitary tumors or adenomas are highly common, occasionally inclined to infiltrate the adjacent structures, the cavernous sinus in particular. Despite the fact that drug and radiation therapy are at present widely used treatments, surgical procedures remain highly topical. Different modifications of two basic surgical methods (transcranial intradural and transsphenoidal) that fail to completely remove a tumor from the cavernous sinus in most cases are mostly frequently used as before. Attempts to improve surgical procedures and introduction of current technologies have led to the emergence of an extradural method for tumor removal from the cavernous sinus and to the introduction of endoscopic monitoring during transsphenoidal operations. A strategy of two-stage removal of pituitary tumors has simultaneously been developed. The paper presents the results of surgical treatment of 297 patients with pituitary adenomas growing into the cavernous sinus, by using currently available procedures: transsphenoidal, transcranial intradural, and intra-extradural, and two-stage ones. The findings have confirmed that transsphenoidal removal of pituitary adenomas is the safest method. However, this method has a number of limitations in cases with tumor being grown into the cavernous sinus especially when there is a medial displacement of the intracavernous segment of the internal carotid artery. Moreover, secondary tumor nodes that may be removed by transcranial intradural access are a contraindication to its use. With this, attempts to remove a tumor from the cavernous sinus fail to ensure the desired completeness of removal from the cavernous sinus. The application of an intra-extradural access is the most adequate procedure for tumor removal from the cavernous sinus. The two-stage removal is the most adequate procedure in cases of simultaneously significant spread of a tumor intracranially and into the structures of the base of the skull.

The paper gives a clinical example of embolization of the vascular network of carotid paraganglioma with subsequent en-block tumor removal with bifurcation of the common carotid artery and with recovery of great blood flow along the internal carotid artery through alloprosthesis of the latter. The positive effects of a combination of endovascular embolization of the vascular network of the tumor with its subsequent removal are noted. Indications for endovascular embolization and its procedure, intraoperative evaluation of cerebral collateral circulation are discussed. Those for carotid repair during en-block removal of carotid paraganglioma with bifurcation of the common carotid artery are considered.

The paper describes two types of resection of primary and metastatic spinal tumors via a posterolateral approach: by curettage and en-block resection. The outcomes of treatment in 15 patients operated on by curettage and 2 patients undergone en-block resection are analyzed. Postoperative pain relief was noted in 100% of the patients. Six (55%) patients who had not been able to move became outpatient after surgery. There was a neurological improvement in 5 (29%) patients, i.e. they were at a higher stage by the Frankel scale. The above results show that removal of spinal tumors via posteriomedian access with lateral extension by curettage or en-block resection might be effective in surgically treating this pathology. Choice of a type of surgery (carcinological or palliative) primarily depends on the histological nature of a tumor, on the degree of neurological deterioration, on the extent and site of a tumorous process, and on the expected survival of a patient.

Mini-invasive techniques have been increasingly used in lumbar surgery in the past decade, most commonly during operations on the intervertebral disks. However, mini-invasive interventions may be used as a modified traditional approach to treating more serious and challenging pathology, such as tumors of the lumbar vertebrae, metastatic disease, as well as lumbar fractures of different origin. In the literature, there are only several papers on the mini-invasive anterolateral retroperitoneal approach (ALMIRA) to corpectomy with repair of the lumbar spine. This paper deals with the autopsy of 15 cadavers (aged 55-83 years) and 5 blocks of the lumbar spine. The approach is described with illustrations being given. All the results are analyzed and shown in a table. Fifteen corpectomies of L2, L3, and L4 vertebrae were performed by ALMURA, using a self-retaining retractor. The duration of a procedure from skin incision to complete preparation of a spinal specimen for retractor's attachment averaged 50 min (30-70 min). The corpses were rotated in the axial plane at 45, 35, and 25 degrees for corpectomy of L2, L3, L4, respectively. The procedure was easier-to-use when convex binding of the spine was performed after the approach and before insertion of a retractor, in obese cases in particular. Damage to the peritoneum occurred in 5 cases, that to the ascending lumbar vein took place in 4 (during L4 corpectomy) and m. psoas in 2 cases, both in a cachectic cadaver. In the authors' opinion, the method is effective, but before applying it in the clinical theater, spinal surgeons should be well trained under experimental conditions.

The paper analyzes the authors' experience in treating 16 patients with neurinomas and neurofibromas of the jugular foramen. A tumor was located intracranially (Type A) in 1 case, at the level of the base of the skull (Type B) in 7 cases, extracranially (type C) in 3 cases, and extra- and intracranially (Type D) in 5. All the patients were operated on. One-stage removal was performed in 15 patients, in 1 case a tumor was removed in 2 steps. By taking into account differences in the site of the tumors, the authors used the following accesses: retrosigmoid, supracondyllar, extreme lateral transcondylar, retroauricular transtemporal, extended retroauricular transtemporal, lateral cervical. While planning accesses, it is necessary to bear in mind not only the direction of growth of these tumors, but also the pathways of collateral venous blood flow.

The paper analyzes the outcomes of intravascular treatment in 87 patients with cerebral aneurysms with separable a balloon catheter with a valve device. In the cold and hemorrhagic periods, mortality rates were 6.4 and 40%, respectively. The postoperative follow-ups lasted 1 to 17 years (mean 7.7 years). Recurrent subarachnoidal hemorrhage (SAH) was noted in 6.5% of cases, with not earlier than 4.5 years after intervention. The remaining patients (even with partial aneurysmal occlusion) had no recurrent SAH.

The paper presents outcomes of treatment of patients with arteriovenous malformations (AVM) of the spinal cord by using endovascular techniques in 171 patients. There were a total of 364 occluded afferent vessels involved in the blood supply to and development of AVM. A classification of spinal cord AVM is presented. Methods for occlusion were described in relation to the type AVM. Malformations were thrombosed with polyvinyl acetate (PVA) emboli in 129 patients; balloon occlusion of afferent vessels was performed in 6, as described by F. A. Serbinenko; histoacryl glue was applied in 27 cases. A combined method of occlusion of afferent vessels was used with PVA emboli and balloons in 9 patients. The clinical picture of spinal cord AVM was outlined. Emphasis is laid on diagnostic methods, such as selective angiography and magnetic resonance imaging, as well as on their role in postoperative control studies, in determining the degree of thrombosis, the presence of ischemic events, and subarachnoidal space patency. Endovascular treatment used in patients with AVM at different levels of the spinal cord alleviated neurological symptoms in 155 (91%) patients. There was no improvement in 12 (7%) patients. Complications at angiography and embolization were observed with deteriorated neurological symptoms in 4 (2%) cases. Further development and improvement of endovascular treatments in patients with spinal cord will be promising if new intervention technologies are introduced in clinical practice.

The paper summarizes five-year experience with mechanically detachable microspirals for embolization of 62 arterial aneurysms in 59 patients. The complications and technical problems associated with both the specific features of this technology and anatomic types of the structure of vessels and aneurysms are described. Methods for the prevention and treatment of these complications are proposed.

The paper summarizes the outcomes of endovascular treatment of 42 patients (19 males and 23 females) aged 24 to 68 years who had cerebrovascular aneurysms, 7 of them were operated on in the acute phase of subarachnoidal hemorrhage. There were small [n = 27 (61.4%)], large [n = 14 (31.8%)], and giant [n = 3 (6.8%)] aneurysms. According to their site, aneurysms were found in the internal carotid [n = 22 (50%)], the middle cerebral artery [n = 2 (4.5%)], the anterior cerebral artery-anterior communicating artery [n = 10 (22.7%)], the basilar artery [n = 9 (20.5%)], and the vertebral artery [n = 1 (2.3%)]. MDS tungsten and platinum miscospirals (Balt, France) were employed for aneurysmal occlusion. Twenty seven (61.4%) aneurysms were totally and subtotally closed by means of microspirals. Partial occlusion of the aneurysmal cavity was achieved in 12 (27.2%) cases. There were poor results associated with spiral migration into the carrying vessel in 5 patients: an increase in aneurysmal volumes occurred in 3 patients and in 2 patients with partially occluded giant aneurysms within up to a year. Three patients died. Angiographical control was exercised in 12 patients at months 6 to 18. The analysis of long-term results indicated that the aneurysms initially totally closed failed to be recanalized later on (8 patients). With subtotal or partial occlusion, there was a change in the position of spiral coils in the aneurysmal cavity, namely, their displacement to the bottom and an increase in the dimension of a functioning aneurysmal part (2 patients). The use of microspirals for occlusion of cerebrovascular aneurysms is a low-traumatic and effective treatment. The best results were obtained with the occlusion of small and large aneurysms with their well-defined neck.

The paper outlines some issues of nontraumatic nasal liquorrhea. The authors state that in the vast majority of cases, liquorrhea occurs along the passage of olfactory filaments through the perforated lamina. Their morphological studies provide indirect evidence for this statement. Encephalomeningocele through the perforated lamina of the ethmoid bone or Turkish saddle is much more infrequent cause of liquorrhea. The authors have developed 2 methods of surgical treatment: 1) endonasal closure of a fistula and 2) its intracranial closure. With mode 1, the nasal mucosa in the upper nasal passage and roof is destroyed and muscle tamponade is made. This method was used to operate on 66 patients. Liquorrhea recovered in 13 patients. It is less traumatic and less expensive and less effective. With method 2, trepanation is made in the frontal region, the dura mater is dissected, the olfactory bulb is destroyed and the site of the perforated lamina is tamponed with a muscle tissue piece. A total of 23 patients were operated on, a good result was achieved in 22 patients of them. Subsequently liquorrhea did not restore in any case. The method is more traumatic, but more effective. With method 3, if liquorrhea occurs through the Turkish saddle, the procedure to close a fistula corresponds to endonasal plasty, only the site of fistular destruction is the sphenoid sinus. The tip of an aspirator is inserted through the aperture of the sinus, its mucosa is destroyed, thereafter it is tamponed with a muscle flap. Three patients were operated on. Liquorrhea ceased.

The paper presents a stepwise surgical technique of transcervical craniospinal posterolateral approach to the bulky processes of the craniovertebral region and the historical background. The access was modulated on cadavers (the head-neck region) in the project of a surgical intervention. In 1995-1998, clinical tests were made in 11 patients, 6 of whom had ventral craniospinal meningiomas, 2 cases had sand watch neuromas of the C2 root with extradural growth and 3 cases presented sand watch neurofibroma at the C1-C levels. The advantages and disadvantages of the approach are described.