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Moyamoya angiopathy is a chronic progressive cerebrovascular disease characterized by stenosis and occlusion of the distal segments of the internal carotid arteries and/or proximal segments of the middle and anterior cerebral arteries, with a gradual compensatory restructuring of the cerebral circulation to the system of the external carotid arteries. Today, the main treatment method for Moyamoya angiopathy is surgical revascularization of the brain. A search and analysis of publications on the treatment of adult patients with Moyamoya angiopathy was carried out in the PubMed and Medscape databases over the past 10 years. We present a case of an adult female patient with a hemorrhagic form of Moyamoya angiopathy stage IV according to J. Suzuki, who underwent staged combined revascularization of both cerebral hemispheres. Surgical revascularization included the creation of a low-flow extra-intracranial shunt combined with a combination of indirect synangiosis. The combination of direct and indirect methods of surgical revascularization enables to achieve the development of an extensive network of collaterals and fully compensate for cerebral circulatory disorders both in the early and late postoperative periods, which is confirmed by instrumental diagnostic data. Combined revascularization is the most effective modern method of treating patients with Moyamoya angiopathy due to the complementary influence of direct and indirect components of revascularization.

Objective: To study microstructural abnormalities in epileptogenic focus and in mirror region by diffusion kurtosis (DK) MRI in patients with focal temporal lobe epilepsy., Material and Methods: The main group included 12 patients (mean age 35 [30.5; 39.0] years, 5 women) with a diagnosis of focal epilepsy in the right temporal lobe (r-TL). The control group consisted of 15 healthy volunteers (mean age 33 [29.0; 39.0] years, 5 women). In both groups all participants underwent clinical and neurologic assessments, EEG and video EEG monitoring, and MRI, including DK MRI., Evaluation of microstructural changes in the temporal lobes included the study of 10 DK parameters., Results: In the main group, focal motor/nonmotor or bilateral tonic-clonic seizures were observed in 9 and 11 patients. Ten (83%) patients had focal epileptic activity on routine EEG in the r-TL and 9 (75%) patients had MRI focal changes in the same lobe. There was a significant decrease in fractional (FA) and kurtosis anisotropy (KA), mean (MK), radial (RK), and axial kurtosis (AK), as well as in axonal water fraction (AWF) in the r-TL of patients with epilepsy compared to the control group. Besides, FA, KA, MK, RK, AK, and AWF parameters in the l-TL in the main group were significantly reduced compared to the l-TL in the controls. There was a significant association between the duration of epilepsy, axial and radial extra axonal diffusion as well as axonal diffusivity in the l-TL. No association was observed in the r-TL. In the control group, MK, AK, RK, and AWF positively correlated with age. No correlation between age and MK, AK, RK, and AWF was found in the main group., Conclusion: In patients with an epileptic focus in the r-TL, microstructural changes are observed not only in the area of the epileptic focus, but also in the affected temporal lobe as a whole, and also mirrored in the conditionally healthy temporal lobe. Altered microstructure in the mirror region may reflect changes secondary to bilateral tonic-clonic seizures or evolution to secondary epileptogenic zone. Assessment of DK MRI parameters may provide additional information about the epileptogenic focus and the extent of microstructural abnormalities.

Background: One-piece modified orbitozygomatic approach (OZA) is an extended version of the pterional approach that also includes orbital walls and frontal process of the zygomatic bone. For this craniotomy one burr hole must be placed in MacCarty keyhole and another - in the temporal region., Objective: To develop a technique of the one-piece modified OZA with single a burr hole in the alternative sphenoid ridge keyhole that allows access to orbit, anterior cranial fossa and middle cranial fossa and apply it intraoperatively., Methods: A single human head specimen was used. The dissection was performed using standard surgical instruments high-speed Stryker drill. Every stage of the approach was photographed. We also report a surgical case of a patient with orbital cavernous hemangioma that was resected using the described technique., Results: The technique of the one-piece modified OZA with a single burr hole in the alternative sphenoid ridge keyhole is described, and its advantages and limitations are analyzed. The technique is used to totally resect an orbital cavernous hemangioma with good functional and cosmetic result., Conclusion: Modified OZA with a single burr hole in the sphenoid ridge keyhole is possible and may be an alternative to the classic technique. The advantages of this variation are the placement of just one burr hole and the preservation of a larger portion of the orbital roof. The latter facilitates better bone reconstruction and better cosmetic outcome. Disadvantages are the difficulty of identifying the location of the sphenoid ridge keyhole and risk of damaging the dura., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objective: To present a case series analysis of surgical treatment of patients with secondary trigeminal neuralgia., Material and Methods: The treatment of 8 patients with secondary trigeminal neuralgia who underwent surgery since 2021 was analyzed. All records, neuroimaging archive, and follow-up observations were reviewed., Results: There were 5 patients with trigeminal neuralgia associated with multiple sclerosis; with neurosarcoidosis ( n =1); with tumor ( n =1); with unspecified degenerative disease ( n =1). The mean age was 61 years (from 48 to 73), the mean duration of disease was 7.2 years (from 5 to 13). Radiofrequency ablation (RF) was performed in 4 cases, balloon compression in 3 cases, tumor removal in 1 case. Relief of trigeminal neuralgia after surgery was observed in 7 patients, partial reduction in 1 patient. A complication was noted in a patient with neurosarcoidosis after RF with the appearance of dysesthesia, dry eye. The mean follow-up was 10 months (1 to 29). Pain recurrence occurred in 2 patients, one of them underwent the surgery twice., Conclusion: Surgical treatment of patients with secondary trigeminal neuralgia contributes to pain relief.

Idiopathic normotensive hydrocephalus (iNH) is a widespread disease in elderly patients. The effectiveness of iNG treatment and the subsequent quality of patients' lives directly depends on timely and early diagnosis. The criteria for diagnosing iNG that are used in neuroimaging can also be found in patients without clinical manifestations of this disease, and the widely used tap-test is an invasive technique with a rather low sensitivity. The need for early diagnosis and initiation of treatment before the development of irreversible damage to brain structures determines the relevance of the search for an accessible, minimally invasive, accurate and safe diagnostic method. The article presents a clinical observation of the use of phase-contrast MRI of cerebrospinal fluid (CSF) in a female patient with a positive response to the tap test with a quantitative analysis of changes in CSF flow parameters and ALVI and Evans indices depending on the time after CSF evacuation. Phase-contrast MRI of CSF with a quantitative assessment of CSF flow parameters in combination with an assessment of the ALVI index has the potential to increase the accuracy of diagnosing iNH and is of scientific interest for further research.

Back pain (BP) due to degenerative disc disease (DDD) is a severe, often disabling condition. The aim of this study was to determine the association between the expression level of proinflammatory cytokines (IL-1β, IL-6, and IL-17), angiogenesis markers (VEGF-A and CD31) in intervertebral disc (IVD) tissue and IVD degeneration in young people with discogenic BP. In patients who underwent discectomy for a disc herniation, a clinical examination, magnetic resonance imaging of the lumbar spine, histological and immunohistochemical analyses of these factors in IVD were performed in comparison with the parameters of healthy group samples (controls). Histology image analysis of IVD fragments of the DDD group detected zones of inflammatory infiltration, combined with vascularization, the presence of granulation tissue and clusters of chondrocytes in the tissue of nucleus pulposus (NP). Statistically significant increased expression of IL-1β, IL-6, IL-17, VEGF-A and CD31 was evident in the samples of the DDD group compared with the controls, that showed a strong correlation with the histological disc degeneration stage. Our results denote an immunoinflammatory potential of chondrocytes and demonstrates their altered morphogenetic properties, also NP cells may trigger the angiogenesis.

Background: Abnormal styloid processes cause dissection of supra-aortic arteries in some cases. In total, about 33 cases have been described in the world and national literature. However, there were no dissections associated with neurosurgery. At the same time, anomalies of styloid process may be an unidentified cause of many spontaneous dissections of brachiocephalic arteries., Objective: To analyze modern data on dissection of brachiocephalic arteries associated with anomalies of styloid process and describe dissection in a 44-year-old patient with deviated styloid processes after posterior cranial fossa surgery., Material and Methods: Searching for literature data was performed using the keywords "dissection of the cervicocerebral arteries", "dissection of the brachiocephalic arteries", "stylocarotid syndrome" and "Eagle syndrome" in the PubMed and Medscape databases. We also describe a patient hospitalized for microsurgical resection of cystic-solid hemangioblastoma of medulla oblongata who developed postoperative dissection of both internal carotid and vertebral arteries., Results: We found 1777 papers between 01/01/1900 and 01/18/2021. In most cases, ICA dissection was not a result of stylocarotid syndrome. There were 121 full-text Russian- or English-language articles. We selected 46 most relevant publications. Analyzing these papers, we found that small distance between the tops of styloid processes and internal carotid arteries can be a risk factor of dissection of brachiocephalic arteries in addition to styloid process elongation. Our patient was diagnosed with just such an anomaly., Conclusion: Anomalies of styloid processes can cause dangerous vascular complications. Therefore, the length and abnormal deviation of styloid process should be considered when planning intraoperative position of a patient associated with prolonged neck flexion.

The authors describe dynamic MRI and clinical data after non-invasive treatment of tremor in the upper extremity. Thalamotomy by high-intensity focused ultrasound under MR-guided navigation was performed. A 57-year-old patient with Parkinson's disease underwent treatment with focused ultrasound. MRI of the brain was performed 1 and 48 hours, 47 days, 3 and 6 months later. Features of natural course of focal brain changes after treatment, data of MR tractography necessary for correction of target zone are described. The authors conclude that MR changes are characterized by presence of a focus in the area of focused exposure. Peak severity is observed on the second day after procedure with subsequent regression. MR-based analysis of predictors is promising to forecast treatment outcomes.

Objective: To evaluate the results of endoscopy-assisted surgical treatment of patients with 'high' tortuosity of the ICA., Material and Methods: Endoscopy-assisted surgical reconstruction of high tortuosity of the ICA was made in 11 patients. All procedures were carried out at the Sklifosofsky Research Institute for Emergency Medicine (Moscow) and Republican clinical hospital of Kabardino-Balkaria (Nalchik) for the period from 01.01.18 to 31.12.18., Results: There were no intraoperative and postoperative complications (blood flow velocity increased by 66.2% after surgery). Neurological improvement after surgery was noted in all patients. Partial or complete regression of dizziness was observed in 5 (45.5%) patients. Tinnitus disappeared in 7 (63.6%) patients., Conclusion: Approach to the distal parts of ICA is traumatic, requires the use of additional techniques and considerable surgical experience. Endoscopic technique is valuable to reduce the risk of injury of soft tissues, neurovascular structures and improve functional outcomes.

Literature review is devoted to the role of frameless neuronavigation in surgery of distal aneurysms, cavernomas, arteriovenous malformations, Kimmerle's anomaly and revascularization surgeries. Visualization methods used in preoperative preparation of patients with vascular lesions compatible with frameless neuronavigation and the methods of intraoperative visualization as an addition to navigation are described.

A 30-year-old woman with giant fusiform aneurysm of the azygos anterior cerebral artery is reported. Clipping of the aneurysm followed by modeling of pericallosal artery was performed in 2017. However, further enlargement of the aneurysm has been observed for subsequent 2 years. The patient underwent redo surgery with excision of the aneurysm followed by «hemi-bonnet bypass» procedure (anastomosis between superficial temporal artery and anterior cerebral artery with radial artery as an interposition graft). Literature data on reconstructive surgery in the treatment of complex pericallosal artery aneurysms are reviewed.

Surgical revascularization of the brain is one of the most important trends in the development of neurosurgery. Restoration of adequate blood flow through pre- and intracerebral arteries promotes prevention and treatment of ischaemic lesions of the brain in various pathology. The present work was aimed at analysing the experience gained in performing revascularizing operations in patients with cerebral aneurysms at the department of neurosurgery. The authors analysed therapeutic outcomes in a total of 45 patients presenting with giant and complex aneurysms of cerebral arteries and treated from 2009 to 2014. Of the 45 patients with giant and complex aneurysms of cerebral arteries, 31 (68.8%) patients underwent open microsurgical interventions (including 10 patients with the use of different variants of revascularizing operation) and 14 (31.2%) patients were subjected to endovascular exclusion of the aneurysm from the blood flow. It was shown that performing revascularizing operations in patients with complex and giant aneurysms of cerebral arteries makes it possible to compensate circulation in the interested arterial basin and to obtain good functional results.