Removal of large and giant vestibular schwannomas is associated with the risk of paresis of facial muscles. The probability of anatomical damage to the facial nerve is 10.3–14.0%. Treatment of mimic muscle paralysis is one of the most difficult problems in reconstructive surgery. In this study, the results of neurotization of the facial nerve by masticatory were evaluated in 4 patients after its damage during the removal of large and giant vestibular schwannomas. Neurotization was carried out 10–14 days after tumor removal. With direct neurotization of the facial nerve by masticatory in all patients, it was possible to achieve the function of mimic muscles, corresponding to grade II–III according to the House–Brackmann scale. The use of an autoinsert from the greater ear nerve led to a worse result (House–Brackmann IV).

Objective: To assess the frequency of ruptures of very small cerebral aneurysms, features of the perioperative period and outcomes, in comparison with the rupture of ordinarily sized aneurysms.Material and methods: A comparative analysis of the group of patients with ruptured cerebral miliary aneurysms (n = 18) and the group of patients with ruptured cerebral aneurysms of regular size (n = 308) was carried out. All patients underwent open surgery in the first 3 days after the rupture (osteoplastic craniotomy, microsurgical aneurysm clipping). We compared gender, age of patients, severity of the patient’s condition at the moment of admission, severity of subarachnoid hemorrhage, location of aneurysms, aspect ratio, duration of the operation, frequency of intraoperative ruptures, postoperative mortality.Results: It was found that miliary aneurysm rupture occurs in 5.5% of all patients with cerebral aneurysm rupture. The most common cases of rupture of very small aneurysms were in women (77.7%), with a mean age of 50.8 years. Aneurysms of the anterior communicating artery (66.6%) with a narrow neck (average aspect ratio – 2.1) were the most common. Patients with rupture of very small aneurysms were 7.9% more likely to be admitted in a state of subcompensation or decompensation (Hunt-Hess IV–V), they had massive subarachnoid hemorrhage (Fisher III) 19.6% more often than with ruptured aneurysms of regular size. On average, operations in cases of very small aneurysms lasted 30 minutes less than clipping of ordinary aneurysms, but were complicated by intraoperative rupture twice as often (38.8% and 16.5%, respectively). Postoperative mortality in the group of patients with ruptured miliary aneurysms was 5.7% higher than in patients with ruptured aneurysms of regular size.Conclusion: Rupture of cerebral miliary aneurysms is relatively rare. Women of 50–60 years old with very small aneurysms of the anterior communicating artery with a narrow neck constitute the main group of such patients. Massive subarachnoid hemorrhage and severe condition of patients on admission are more common with miliary aneurysms than with ordinarily sized aneurysms. The small size of the aneurysm and the work near the rupture determine the more frequent contact intraoperative rupture when the neck is exposed as compared to operations on larger aneurysms, which negatively affects the treatment outcomes in this group of patients.

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Tumors of the base of the posterior cranial fossa are among the most difficult for surgical treatment in neurosurgery. Numerous studies are being conducted on the factors that determine clinical manifestations and treatment outcomes. The aim of the study was to study the linear and angular parameters of the posterior cranial fossa in patients with extracerebral neoplasms and to evaluate their effect on the results of surgical treatment. Craniometric study of linear and angular parameters of the posterior cranial fossa was performed in 115 patients with sub-tentorial extracerebral tumors. A computer program was used to determine the longitudinal, transverse and height diameters of the head, the length, width and height of the posterior cranial fossa, the sagittal diameter of the foramen magnum, the length of the clivus, the length of the posterior part of the skull base, the basilar angle, the Boogard’s angle, the posterior angle of the base of the skull, angle of the cerebellar mantle, angle of inclination of the clivus, angle of inclination of the scales of the occipital bone and angle of convergence of the pyramids of the temporal bones. These parameters were determined on magnetic resonance tomograms in the sagittal projection on the median section and in the axial projection, on the section passing at the level of the internal auditory canals. The main group consisted of 15 patients who developed vascular complications after surgery, the second comparison group included 100 patients with uncomplicated postoperative course. The predominant head shapes according to the transverse-longitudinal index in both groups were brachycephalic (53.3 and 54%, respectively). There was no acrocephaly (high and narrow head forms) among patients with complications, while in the control group this type was registered in 12% of cases. Certain craniometric prerequisites for a complicated course of the postoperative period have been identified, allowing a more selective approach to the tactics of treating these patients. The risk group includes patients with large values ​​of the basilar angle and the angle of inclination of the scales of the occipital bone, having a narrower and elongated shape of the posterior cranial fossa.