Background: Carotid-cavernous fistulas (CCFs) are abnormal connections between the carotid artery and/or its branches and the cavernous sinus, potentially resulting in significant complications, including visual impairment and neurological deficits. Timely diagnosis and appropriate therapeutic intervention are critical to minimizing the risk of adverse outcomes. Over the years, endovascular techniques have become the preferred method for treating CCFs, offering high success rates with fewer complications. This study aims to study the clinical and radiological outcomes of patients with CCFs treated with endovascular approaches, and to identify key prognostic factors associated with treatment efficacy and symptomatic resolution.Methods: A retrospective analysis was conducted of patients diagnosed with carotid-cavernous fistulas (CCFs) and treated at the National Center for Neurosurgery in Astana, Kazakhstan, between 2008 and 2024. A total of 71 patients underwent endovascular embolization using either transarterial or transvenous techniques. According to the Barrow classification, type A CCF were observed in 62 patients (87.3%), type D in 7 patients (9.9%), and types B and C in 1 patient each (1.4%). Collected data included patient demographics, type of embolic materials utilized, number of procedures performed, treatment approach, and corresponding radiological and clinical outcomes.Results: Among the 71 patients included in the study, 80.3% achieved complete clinical resolution, 15.5% demonstrated partial improvement, and 4.2% experienced no clinical benefit. The mean age was 35.7 ± 12.9 years, with 71.8% males. Clinical outcomes were significantly associated with complete occlusion following the initial intervention (p < 0.001), with 96% of these patients achieving full symptom resolution. Imaging follow-up was available in all patients, with complete occlusion confirmed in 65 cases (91.5%) on MRI at 6 months. Other variables, including distal internal carotid artery flow (p = 0.145), number of interventions (p = 0.838), treatment approach (p = 0.529), and type of embolic agent employed (p = 0.778), did not demonstrate a statistically significant association with clinical outcomes.Conclusion: Endovascular embolization is a safe and effective first-line treatment modality for CCFs. Both transarterial and transvenous approaches offer comparable rates of clinical success. Achieving complete occlusion is a critical determinant of favorable clinical outcomes and is associated with a reduced risk of treatment-related complications.

Background: Microvascular decompression (MVD) remains the primary surgical treatment for trigeminal neuralgia due to its positive postoperative results. This study aims to evaluate the outcomes of patients with primary trigeminal neuralgia who underwent MVD. Additionally, the paper offers a detailed explanation of the surgical methodology of MVD employed at the neurosurgical hospital in Kazakhstan.Methods: The study involved 165 medical records of patients with trigeminal neuralgia who underwent MVD between 2018 and 2020. Out of these 165 patients, 90 (54.55%) were included in the final analysis and were further evaluated using the Barrow Neurological Institute pain intensity score. Various variables were analyzed, including age, sex, affected side, dermatomes, offending vessel, and surgical intervention type. Moreover, the surgical technique employed at the hospital was described.Results: The average follow-up period after the MVD procedure was 32.78 ± 9.91 months. The results indicated that out of the 90 patients, 80 (88.89%) achieved a good outcome as evidenced by BNI scores I and II. It was observed that patients with affected maxillary dermatomas and those with affected ophthalmic + maxillary dermatomas were more likely to experience fair + poor postsurgery BNI scores. On the other hand, patients with neurovascular conflicts involving the maxillary + mandibular dermatomas demonstrated good BNI scores (p = 0.01).Conclusions: The outcomes of MVD in patients with primary trigeminal neuralgia showed good BNI scores within this study population. The outcome depended on the affected dermatome of the trigeminal nerve with the vessel. Additionally, patient positioning, intraoperative management including small skin incisions, minimal craniotomy, and precise closure of the dura, as well as intraoperative neurolysis, may contribute to achieving good clinical and satisfactory post-surgery aesthetic outcomes.

Background: Deep brain stimulation (DBS) is an effective treatment for movement disorders, but its long-term efficacy may be undermined by hardware complications such as lead fractures. These complications increase healthcare costs and necessitate surgical revisions. The frequency, timing, and clinical factors associated with lead fractures remain poorly understood. Objective: This study aimed to determine the incidence, timing, and clinical factors associated with lead fractures in a large cohort of DBS patients over a 10-year period. Methods: This retrospective study analyzed data from 325 patients who underwent bilateral DBS implantation at the National Centre for Neurosurgery from 2013 to 2023. The analysis specifically focused on 17 patients who experienced lead fractures during the long-term follow-up period. Results: Among the 325 patients, lead fractures were identified in 17 patients (5.23%), affecting 18 electrodes. The majority of cases involved patients with Parkinson’s disease (76.5%) or dystonia (23.5%), with an average age of 59.17 ± 8.77 years. Nearly all patients with lead fractures had a history of trauma. Additionally, two cases were associated with active engagement in sports, particularly activities involving movements like pulling up on a horizontal bar, while Twiddler’s Syndrome was identified in two other cases. All electrode fractures required surgical revision. Conclusions: Lead fractures, while rare, remain a significant complication in DBS systems. Precise surgical techniques, early detection, and advancements in DBS hardware design may help to mitigate this risk. Future innovations, such as durable leads or wireless systems, may improve long-term outcomes in DBS therapy for movement disorders.

(1) Background: This report describes the surgical management of a case of concurrent AVM with the involvement of dural arteries and moyamoya syndrome. Given the infrequency of this combination, there is currently no established management strategy available. (2) Case Description: A 49-year-old male patient with multiple symptoms including headaches, tinnitus, and visual impairment diagnosed with the coexistence of an arteriovenous malformation with the involvement of dural arteries and moyamoya syndrome was admitted to the national tertiary hospital. The patient underwent surgical management through embolization of the AVM from the afferents of the dural arteries, which has resulted in positive clinical outcomes. However, this approach may not be suitable for all cases, and a multidisciplinary team approach may be required to develop an individualized treatment strategy. (3) Conclusion: The contradictory nature of the treatment approaches in cases of combined AVM with the involvement of dural arteries and MMD highlights the complex nature of this condition and the need for further research to identify the most effective treatment strategies.

BACKGROUNDː Pediatric posterior fossa tumors are the significant cause of morbidity and mortality in children and adolescents. This study aimed to investigate the characteristics of the patient population and report the experience in managing and treating children with these tumors, as well as their survival outcomes in Kazakhstan. METHODSː This retrospective study analysed data from the archives of the Pediatric Neurosurgery Department and included 214 pediatric patients with PFT in the period from January 2015 to December 2020. RESULTSː The study included 214 patients with a mean age of 7.29 ± 4.26 years. The most common tumor pathology observed in this study was medulloblastoma (33.18%). Grade I tumors showed a notable median survival of 56.64 months (95% CI, 53.93-59.35), surpassing Grade II tumors at 50.38 months (95% CI, 40.57-60.2). Grade III and IV tumors had median survivals of 38.64 months (95% CI, 31.11-46.17) and 38.76 months (95% CI, 33.96-43.56). Multivariate analysis using Cox regression model revealed significant predictors of overall survival. Grade III-IV tumors (RR = 0.577, 95% CI 0.462-0.720, p = 0.000), delayed resection (RR = 0.950, 95% CI 0.717-1.104, p = 0.000), and brainstem tumors (RR = 2.454, 95% CI 1.791-5.751, p = 0.000) had poorer survival. Tumor volume, age, and adjuvant chemotherapy were not significant predictors of 5-year survival (p > 0.05). CONCLUSIONSː The study found similar death rates in children with pilocytic astrocytoma compared to other population studies. Regrettably, the 5-year survival rate for medulloblastoma and ependymoma indicates a poorer outcome compared to previous reports.

Background: Falcotentorial meningioma is a rare tumor of pineal region, arising from the dural folds where the tentorium and falx meet. Due to the deep location and near closeness to significant neurovascular structures, gross-total tumor resection in this area can be complicated. Pineal meningiomas can be resected using a variety of approaches; however, all these approaches are associated with a significant risk of postoperative complications. Case Description: A 50-year-old female patient who presented with several headaches and visual field defect and diagnosed with pineal region tumor is discussed in the case report. Patient was successfully managed surgically by combined supracerebellar infratentorial and right occipital interhemispheric approach. Cerebrospinal fluid circulation was restored after surgery and neurological defects were regressed. Conclusion: Our case shows that it is possible to completely remove giant falcotentorial meningiomas with minimal brain retraction, preserve the straight sinus and vein of Galen, and prevent neurological impairments by combining two approaches.