Introduction. The dramatic increase in the cost of treating patients with spinal cord injury is associated with the currently accepted active surgical tactics, as well as the use of new technologies, more expensive implants. Currently, a standardized method for calculating the costs of treating patients has not been developed, which may in the future lead to an incorrect assessment of the economic effectiveness of a particular treatment strategy.Aim. To assess the cost of diagnosis and treatment of patients with spinal injury of the thoracic and / or lumbar spine in a multidisciplinary emergency hospital.Materials and methods. The study was carried out in the Clinic of Emergency Neurosurgery of the N. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department during 2018–2021. A working group was formed from the doctors of the neurosurgical department. Further, a model of the therapeutic and diagnostic process was compiled with a reflection of all its characteristics: 1) compilation of a mo dified operogram, 2) transformation of the operogram into a technological map, 3) comparison of the obtained characteristics of the process of diagnosis and treatment of patients with spinal injury with actual data, correction.Results. The operogram included 136 steps of the process from the moment of admission of a patient with spinal injury to the emergency department to the moment of discharge (surgery is the 77th step), and also reflected the interactions of 38 participants in the process and took into account the variety of possible methods and tactics of treatment, taking into account the average frequency of their use. Based on the developed process model, a technological map was prepared, which combined quantitative parameters for all key resource characteristics of the process.Conclusions. Hospital costs for the treatment of a patient with isolated complicated spinal injury at the level of the thoracic and lumbar spine in a specialized hospital amount to 600,652.41 rubles. Out of the total amount of expenses, surgical intervention costs amount to 48.7 %.

The study objective is to evaluate feasibility and effectiveness of decompressive craniectomy (DC) for treatment оf supratentorial hypertensive intracerebral hematomas (ICH).Materials and methods. Between 1996 to 2019, 97 patients with supratentorial hypertensive ICHs underwent surgical treatment. DC was performed in 50 patients (primary - in 41, secondary - in 9). Putaminal hematomas were diagnosed in 30 patients, subcortical - in 20. The comparison group consisted of 47 patients, of which 20 had osteoplastic craniotomy (OPC) with microsurgical removal of ICH, and 27 had endoscopic aspiration (EA). The performed DCa were treated as unjustified (decreased brain dislocation without prolapse of the brain substance into the trepanation defect), ineffective (preservation of brain dislocation and absence of prolapse of the brain substance into the trepanation defect, as well as small size of the trepanation hole) and effective (prolapse of the brain substance into the trepanation defect and regression of transverse brain dislocation).Results. DC was effective only in 22 (44 %) patients (13 - primary, 9 - secondary). Among patients with subcortical ICH, mortality rate after DC was equal to that after OPC and EA. Among patients with putaminal ICH, the mortality rate after DC was significantly higher than after OPC and EA. Among the patients who underwent primary EA and delayed DC (due to recurrent ICH), postoperative mortality rate was significantly higher than among the patients who underwent repeated EA of recurrent ICH. However, there were no fatal outcomes among patients who underwent delayed DC due to increased edema and transverse dislocation of the brain without recurrent ICH.Conclusion. In the surgical treatment of supratentorial hypertensive ICH, decompressive effect of DC was achieved only in 44 % of patients. Open removal of putaminal hematomas in combination with DC was unjustified, mortality rate was 66 %. Primary DC with removal of ICH is indicated in patients with subcortical hematomas with a volume >50 cm3 , with transverse dislocation >7 mm, deep deafness or sopor. Delayed DC, regardless of the location of ICH, is recommended in case of increased edema and transverse dislocation of the brain in patients without recurrent hemorrhage.

Background. The comparison of external ventricular drainage and endoscopic surgery in patients with intraventricular hemorrhages is carried out.The aim of the study is to perform comparative analysis of external ventricular drainage and endoscopic surgery results in patients with intraventricular hemorrhage.Materials and methods. A retrospective analysis was performed in 29 patients with intraventricular hemorrhage who underwent surgery at the N. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, and the Yaroslavl Regional Clinical Hospital. Endoscopic surgery for intraventricular hemorrhage was performed in 15 cases (treatment group), and in 3 cases endoscopic removal was accompanied by external ventricular drainage. External ventricular drainage without endoscopic surgery was performed in 14 cases (control group), and in 3 of these cases local fibrinolysis was also performed. In the treatment group, mean age was 59.6 ± 16.7 years, level of consciousness per the Glasgow Coma Scale prior to surgery was 9.9 ± 3.3, severity of intraventricular hemorrhage per the Graeb Scale was 7.3 ± 2.5. In the control group, mean age was 52.8 ± 9.6 years, level of consciousness per the Glasgow Coma Scale prior to surgery was 10.7 ± 3.2, severity of intraventricular hemorrhage per the Graeb Scale was 5.0 ± 2.6. Outcomes were assessed on the 30th day after hemorrhage using the modified Rankin Scale.Results. Endoscopic method allows to effectively remove clots from the lateral and III ventricles, decreasing the volume of intraventricular hemorrhage from 7.3 ± 2.5 to 3.9 ± 2.5 points per the Graeb Scale. Comparative analysis showed no difference in hydrocephalus resolution in the treatment and control groups. There were no intracranial infectious complications in the treatment group, but in the control group bacterial meningitis was diagnosed in 2 (14.3 %) of the 14 patients. Favorable outcome (score 0–2 per the modified Rankin Scale) was observed in 40.0 % of patients in the treatment group and 28.6 % in the control group. Mortality was 13.3 % in the treatment group and 57.1 % in the control group (χ2 = 8.6, p <0.01).Conclusion. Endoscopic surgery is an effective and safe method for intraventricular hemorrhage management and third ventriculostomy for occlusive hydrocephalus resolution, allowing to achieve better functional results and decrease mortality in patients with nontraumatic intraventricular hemorrhage.

Aim: to present the experience of using the technique of endoscopic aspiration (EA) of lateral intracerebral hematomas (ICH) through the mini-supraorbital approach. Material and methods. From 2019 to 2021 at the Sklifosovsky Institute for Emergency Medicine, 12 patients with lateral ICH underwent EA of the ICH using a mini-supraorbital approach. There were 7 men (58.3 %) and 5 women (41.7 %). The mean age of the patients was 53.2±6.8 years. According to the Glasgow Coma Scale (GCS), the level of consciousness during hospitalization corresponded to 15 points in 4 (33.3 %) patients, and 11‑14 points — in 8 (66.7 %) patients. The average volume of lateral ICH was 45.3±17.4 cm3 (from 28 to 84 cm3). The average duration of the surgical intervention was within 4.2±2.1 days. The operations were performed using STORZ endoscopic equipment. Ventriculoscopes and Gaab trocars were used in 3 cases, and transparent endoscopic ports with a diameter of 8 mm and 4 mm endoscopes were applied in 9 cases. The operations were performed under the control of BrainLab frameless neuronavigation. Results. The average duration of operations was 93±18 minutes. EA through the mini-supraorbital approach provides the removal from 51 to 91 % of the intracerebral hematoma volume, 73.3±16.6 % on average. There were no complications during the operation associated with the use of the approach. The outcomes were of 0‑2 in 2 (16.7 %) patients, 3‑5 — in 8 (66.7 %), and 6 — in 2 (16.7 %) patients according to the modified Rankin Scale. Conclusion. Supraorbital approach allows efficient removal of lateral ICH. The close passage of the access trajectory to the base of the anterior cranial fossa is not an obstacle and does not reduce the radicality of blood clots removal from the ICH cavity. However, the lateral ICH removal through the supraorbital approach requires the use of frameless navigation during the entire main stage of the operation, and instead of a metal trocar, it is recommended to use a transparent endoscopic port.