The overall incidence of symptomatic lumbar spinal stenosis is about 1015% among persons aged 5070 years. Due to the aging of the population, the incidence of this pathology is constantly growing. The desire of older patients to preserve their quality of life and their functional abilities, along with the improvement of surgical techniques, leads to an increase in the number of surgical interventions for lumbar stenosis. This publication describes the classification of spinal canal stenosis. The clinical picture of this disease has been studied in detail. A special attention is paid to such diagnostic methods as computed tomography (CT), radiography, CT-myelography, magnetic resonance imaging (MRI). Various methods of surgical treatment decompression and decompression-stabilization are described in detail.. The efficiency of various types of decompression operations are 7280%, the results of surgery not differing statistically between the types of decompression (hemilaminectomy, interlaminectomy). Decompression-stabilization operations are used for progressive degenerative spinal deformity, destabilization after the surgical treatment, and disruption of the vertebral-pelvic relations. Currently, the following types of stabilization are used in the lumbar stenosis surgery: ALIF, PLIF, PLF, TLIF, XLIF, OLIF, and transpedicular fixation. The rate of complications in the stabilizing interventions is 27.6%; after decompression operations 9.7%. The frequency of revision operations is also higher after stabilization 10.3%, while after decompression it is 6.5%, which makes us cautious about these types of interventions. Systems of interosseous fixation are also used in the treatment of lumbar stenosis. In the 14 years of followup after interosseous fixation and decompression in 142 patients, 30 (21.1%) patients underwent revision interventions, with chronic pain (38.5%) and disc herniation (42.3%) being the main indication for repeated surgery in 26 of them.

The technique of deep brain stimulation is used to treat patients with various diseases of the central nervous system who are not amenable to conservative therapy, while open interventions in them are associated with a high risk of complications. In the review, we evaluate the efficiency of the deep stimulation of different regions of the brain in some pharmacoresistant forms of diseases.

Background. The incidence of trigeminal neuralgia (TN) is 15 per 100,000 people per year. The effectiveness of the existing conservative methods of therapy does not exceed 50%. At the same time, the use of carbamazepine doubles the frequency of depressive conditions, and by 40% increases the incidence of suicidal thoughts. Microvascular decompression (MVD) of the trigeminal root is a"gold standard" treatment for patients with facial pain, however, due to the lack of awareness of the disease, not all the patients receive the adequate therapy timely. Aims: to evaluate the long-term results of video endoscopy-assisted microvascular decompression in the treatment of patients with classical trigeminal neuralgia (cNTN) with paroxysmal facial pain. Methods. In the period from 2014 to 2019, 62 patients were operated for classic NTN and paroxysmal facial pain. The average period from the onset of pain syndrome to surgery was 5 years (from 2 months to 15 years). All the patients in the preoperative period underwent conservative therapy (carbamazepine, gabapentin, pregabalin), which was not accompanied by significant pain reduction. Two (3%) patients had previously undergone a radiosurgical treatment using the Gamma Knife device, and 7 (11%) patients had an analgesic blockade without an effect at other hospitals. The maximum pain intensity upon the admission to the hospital, according to the visual analogue scale (VAS,) was 10 points, according to the BNI (Barrow Neurological Institute) pain syndrome scale V. All the patients underwent MVD of the trigeminal nerve root using Teflon, and video endoscopic assistance during surgery was used in 9 patients . The average follow-up period after the surgery was 3.4 1.7 years (from 1 to 5 years). Results. In all (100%) the patients, the pain was completely relieved after the surgery (BNI I). Excellent and good results after MVD within 5 years were achieved in 97% of patients (BNI III). Facial hypesthesia, not causing discomfort and anxiety (BNI II), developed in 5 (8.1%) patients. The use of video endoscopy made it possible to identify the vessels compressing the trigeminal nerve root with a minimal traction of the cerebellum and cranial nerves. The development of cerebellar edema and ischemia occurred in one (1.6%) patient operated without the application of video endoscopy. Conclusion. The MVD method with video endoscopy is effective in the treatment of patients with cNTN with paroxysmal pain syndrome.

Дегенеративно-дистрофические заболевания позвоночника являются основной причиной временной нетрудоспособности лиц молодого возраста. Количество проведенных микродискэктомий (МДЭ) во всем мире увеличивается с каждым годом. По данным разных авторов, частота рецидива грыжи межпозвонкового диска (МПД) составляет 5-26%. Цель работы - выявить факторы риска развития рецидивов МПД. Материал и методы. Проведен анализ современных источников литературы, представленной в базах данных PubMed, eLibrary, КиберЛенинка и Cochrane. Результаты. Рецидивные грыжи МПД являются причиной сохраняющегося болевого синдрома, неврологической симптоматики и потери трудоспособности. Научные изыскания по данной тематике в настоящее время привлекают все большее внимание вертебрологов и нейрохирургов. В работе приведены взгляды различных исследователей на понятие «рецидив» и методы диагностики данной патологии. Подробно изложены и обсуждены факторы риска развития рецидивов модифицируемых и немодифицируемых грыж МПД. В статье основное внимание уделено методам интраоперационной и послеоперационной профилактики развития рецидива грыжи МПД. Описаны механические способы закрытия дефектов фиброзного кольца после МДЭ. Заключение. Причины рецидивных грыж МПД и потенциальные варианты их профилактики по сей день изучаются в современной вертебрологии. Спинальные хирурги приводят взаимопротиворечивую информацию о зависимости частоты рецидивов от пола, индекса массы тела, возраста, высоты МПД, степени дегенерации МПД, курения, техники МДЭ и травматического анамнеза. Среди методов профилактики рецидива чаще обсуждаются рекомендации по корсетотерапии, коррекции образа жизни, отказу от вредных привычек, нормализация массы тела и регулярные физические...

Хирургическое лечение пациентов с нейрохирургической патологией, сочетающейся с инфекцией COVID-19