Background. In modern neurosurgery, preference is given to less invasive procedures. A classic example is switching from standard surgical approaches to keyhole approaches, in particular transition from pterional to minipterional approach. In turn, addition of extradural resection of the anterior clinoid process to the minipterional approach significantly expands the range of its indications.Method. The paper analyses the stages and main features of microsurgical clipping of carotid-ophthalmic aneurysms through the minipterional approach with extradural anterior clinoidectomy in patients operated in the Federal Centre of Neurosurgery (Tyumen, Russia) by professor Sufianov.Conclusion. The technique described in this research is a safe surgical approach, which demonstrates the efficacy of adding some skull base surgery elements to keyhole approaches. This type of craniotomy could become a method of choice for many neurosurgical conditions.

Aim. To identify predictors of surgical outcomes in patients with drug-resistant temporal lobe epilepsy in a multivariate model.Materials and methods. Aretrospective study included 69 patients with drug-resistant temporal lobe epilepsy who underwent microsurgical anterior temporal lobectomy. The study included 31 (45%) men and 38 (55%) women. The median age was 28 (21; 36). Surgical treatment outcomes were assessed at 6, 12, 36, and 60 months after surgical intervention according to the Engel Epilepsy Surgery Outcome Scale. Logistic regression equations were calculated, a ROC curve was constructed, and odds ratio (OR) with 95% confidence interval (CI), sensitivity, specificity, area under the ROC curve (AUC) were calculated.Results. In all assessed time periods, 88.3–93.0% of patients had outcomes consistent with Engel classes I and II. The distribution of patients by outcome classes did not change statistically significantly over the entire follow-up period. There were the following predictors of high efficacy of surgical treatment at 6 months after surgery: relatively shorter duration of active disease course (OR 0.719, 95%, CI: 0.437–0.966, p < 0.05), absence of status epilepticus (OR 0.048, 95% CI: 0.002–0.472, p < 0.05), absence of subdominant foci of irritative activity (OR 0.123, 95% CI: 0.012–0.845, p < 0.01), presence of mesial temporal sclerosis (OR 1008, 95% CI: 21.59–1310851, p < 0.01), a relatively longer resection margin on the temporal lobe (OR 637.32, 95% CI: 5.43–1960062, p < 0.05), lateralization of epileptogenic zone in subdominant hemisphere (OR 0.103, 95% CI 0.004–0.937, p = 0.0532). AUC was 0.957 (0.917–0.997), p < 0.0001; sensitivity 87.5%, and specificity 82.8%.Conclusion. Independent predictors of the efficacy of microsurgical anterior temporal lobectomy in patients with drug-resistant temporal lobe epilepsy are the following: shorter duration of active disease course, absence of status epilepticus in the history, absence of subdominant foci, presence of mesial temporal sclerosis, a relatively longer resection margin on the temporal lobe, and lateralization of the epileptogenic zone in the temporal lobe of the subdominant hemisphere.

Aim to measure and compare the vertical and horizontal angles of attack on different intracranial surgical targets provided by the transzygomatic, modified orbitozygomatic and classic two-piece orbitozygomatic approaches, to determine the most optimal approaches to different surgical targets. Material and methods. The study was conducted on 8 sides of en bloc specimens of human head and neck. The marking was performed with BrainLAB Kolibri navigational station (Germany) to highlight the surgical landmarks and measure the angles. The dissection was started macroscopically with standard instruments and photographic fixation of every stage of the approach. The craniotomy was performed with Stryker high speed drill (USA). After that, the microscopic stage was carried out with the ZEISS OPMI Vario/S88 surgical microscope (Germany). On each side, the following steps were completed: soft tissues dissection, cutting the zygomatic arch, fronto-temporal craniotomy, orbitozygomatic osteotomy, opening of the dura mater and dissection of structures of the cranial base, measurement of angles of attack with their apex located on skull base structures Results. The angles of attack on different intracranial surgical targets were measured and compared for two-piece orbitozygomatic, modified orbitozygomatic and transzygomatic approaches. Conclusion. The two-piece orbitozygomatic craniotomy is the most universal and optimal to approach the basilar artery bifurcation and lesions located in both anterior and middle cranial fossae. However, to minimize the surgical trauma and the risks of complications when exposing exclusively anterior cranial fossa, the modified orbitozygomatic approach is more adequate. When the lesion is small and located exclusively in middle cranial fossa, performing the transzygomatic approach is recommended.

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Objective. To analyze the technique of traction bipolar coagulation dissection (strip technique), to assess its effectiveness and safety in surgery for removal of lumbosacral lipomas of various types. Material and Methods.The study involved 39 patients (the follow-up period was 1 year) operated on for removal of lumbosacral lipoma using the method of traction bipolar coagulation dissection. The 3D models of lumbosacral lipomas before and after surgery were created based on neuroimaging data, the neurological status before and after surgery was assessed using the SBNS scale, and the results of intraoperative neurophysiological monitoring were analyzed. Results.A decrease in the volume of lumbosacral lipomas by 95.0 % was achieved in all patients, the volume after surgery was less than 1 cm 3 (p < 0.01). Positive dynamics of neurologic status according to the SBNS scale was observed in 94.9 % of patients (p < 0.01). Motor evoked potentials remained unchanged throughout surgery in most patients. No false negative results of intraoperative neurophysiological monitoring were obtained. Conclusion.Traction bipolar coagulation dissection is an effective and safe method of surgical treatment of lumbosacral lipomas allowing the safest and most complete removal of lipomatous tissue, as well as improving the functional state of patients.