Background. Accurate calculation of the volume of subdural hematomas of traumatic, vascular, and other origins during diagnosis is complicated which leads to difficulties in selection of optimal tactics of neurosurgical treatment. Aim. To preform comparative analysis of accuracy of different methods of subdural hematoma volume calculations to increase the quality of evaluation of the results of radiological methods in selection of surgical tactics.Materials and methods. Data from preoperative computed tomography of 20 patients (15 men and 5 women between the ages of 20 and 60 years) with confirmed diagnosis of subdural hematoma who were examined and treated at the Neurosurgery Clinic of the Kirov Military Medical Academy were used. Four groups were formed based of the calculation method: two groups using formulas for volume of ellipsoid or convexo-concave lens (the shape most accurately representing the shape of subdural hematoma); electronic algorithm of volume calculation (Gamma MultiVox D2 software, Gammamed-Soft, Russia); control method (manual sectional calculation of areas of the formed structures with subsequent summation).Results. Deviations between the obtained values varied between +18 and -16 %. Deviations for calculations using ellipsoid volume formula were +46 and -19 %; using convexo-concave lens formula +38 and -35 %, respectively. Electronic calculation algorithm (Gamma MultiVox D2) showed the best accuracy compared to other methods including the control method.Conclusions. Comparative analysis of the accuracy of the studied methods of calculation of subdural hematoma volume showed that median results are statistically similar which allows for selection and use of these methods in accordance with the neurosurgeon's preferences.Study of the algorithm based on ellipsoid volume shows low specificity of this method, comparatively high deviations of the results from the true value with a trend toward overprediction.Calculation using volume of convexo-concave lens showed intermediate result if the shape of the hematoma corresponded to the ideal chape of a figure enclosed between two segments of a sphere. In cases where the shape did not correspond to the convexo-concave lens, both overprediction and underprediction of hematoma volume were observed.Calculations using the Gamma MultiVox D2 software showed the highest accuracy, lowest range of deviation from the control data, best versatility, independence from both the shape and location of the subdural hematoma, as well as selection of a section used in other algorithms for the measurements.It should be noted that accuracy of determination of subdural hematoma volume by the studied methods is directly proportional to time necessary for calculation.

Idiopathic normotensive hydrocephalus is one of the most common brain diseases in older people. The most urgent issue in the study of normotensive hydrocephalus is its differential diagnosis with other neurodegenerative and vascular pathologies of the brain. Currently, more studies have examined the concentration of biomarkers in the cerebrospinal fluid of patients with idiopathic normotensive hydrocephalus and other brain diseases to understand the pathophysiological processes in the pathogenesis of neurodegenerative diseases. The overwhelming majority of these studies have focused on the biomarkers of the cerebrospinal fluid in only one anatomical area: the ventricles of the brain or the lumbar subarachnoid space. However, only a few studies have conducted a comparative assessment of the composition and concentrations of biomarkers in ventricular and lumbar cerebrospinal fluid in the same patients. We believe that the difference in the content of biomarkers in different areas may be crucial in the choice of treatment methods for patients with idiopathic normotensive hydrocephalus. The lumbar cerebrospinal fluid is more pollutedthe content of nearly all biomarkers in the lumbar subarachnoid space is higher than that of the cerebrospinal fluid in the ventricles of the brain. Of the two most commonly used basic surgical techniques for the treatment of idiopathic normotensive hydrocephalus, ventriculoperitoneal and lumboperitoneal bypass surgery, preference is given to lumboperitoneal bypass surgery, which avoids complications associated with damage to the parenchyma of the brain and, most importantly, drains the dirtier cerebrospinal fluid with a higher concentration of proteins from the lumbar space. Instead of lumboperitoneal bypass surgery, we proposed a new combination of two surgical proceduresthe combination of endoscopic triventriculocysternostomy and ventriculoperitoneal bypass surgery. With such a combination, we believe that drainage of the cerebrospinal fluid from the ventricles and the subarachnoid space of the cisterns of the base of the brain will be more effective than the traditional ventriculoperitoneal shunting because the concentration of proteins involved in the progression of degenerative diseases of the brain will decrease more actively.

This study presents facial nerve neurotization, a common method of surgical treatment of facial muscle paralysis. In this surgical procedure, a trunk or some portions of individual fibers are sewn to an intact nerve-neurotizator to the injured facial nerve that can act as sublingual, masseteric, phrenic, accessory, glossopharyngeal nerves, as well as the descending branch of the sublingual nerve and anterior branches of the C2C3 cervical spinal nerves. Often, neurosurgeons combine various donor nerves and autotransplanting inserts for better results. The main stages of neurotization of the facial nerve includes isolation and transection of the facial nerve, isolation and transection of the trunk or separate fibers of the neurotizer, and nerve suturing in an end-to-end or end-to-side fashion. Facial cross-plasty, the most innovative method of facial nerve neurotization, should be carefully performed, during which an anastomosis is performed between the damaged and intact facial nerves using autotransplantation inserts from the calf nerve or from a free muscle graft, including a tender muscle and an anterior branch of the locking nerve. Recovery of facial nerve function and regression of characteristic symptoms takes time and specialized recovery treatment. Generally, among the lesions of the cranial nerves, injuries and diseases of the facial nerve rank first and are one of the most common pathologies of the peripheral nervous system. The clinical picture of facial nerve injuries in various origins is quite monotonous and manifested by persistent paralysis or paresis of the facial muscles. Various highly effective techniques are aimed at restoring the function of the facial nerve and facial muscles. Many conservative and operative methods of treating facial nerve neuropathy have been presented in the modern medical literature. However, all methods of facial nerve neurotization have several disadvantages, and the leading ones are the inability to achieve 100% efficiency and development of one degree or another neurological deficit.

Pathologies of the facial nerve are one of the most common types of pathology of the peripheral nervous system. In the structure of lesions of the cranial nerves, this pathology occupies the first place. The clinical picture of facial nerve damage of various genesis is rather monotonous and manifests itself as persistent paresis or paralysis of the facial muscles. The literature describes a large number of different highly effective techniques aimed at restoring the function of the facial nerve and mimic muscles, examples of which are numerous conservative and surgical methods for the treatment of facial nerve neuropathy. The review presents the most common method of mimic muscles paralysis surgical treatment facial nerve neurotization. The essence of this surgical intervention is in suturing to the affected facial nerve the trunk or a portion of individual fibers of the intact nerve-neurotic, which can be the hypoglossal, masticatory, phrenic, accessory, glossopharyngeal nerves, as well as the descending branch of the hypoglossal nerve and the anterior branches of the C2C3 cervical nerves. Currently, options for the combined use of various donor nerves and autoextensions are gaining popularity among neurosurgeons, due to more favorable results in restoring the function of the facial nerve, as well as with an individual approach to each patient. The main stages of neurotization of the facial nerve include the isolation and intersection of the facial nerve, the isolation and intersection of the trunk or individual fibers of the neurotizer, the execution of the suture of the nerve in the end to end or end to side method. Particular attention should be paid to the most innovative method of facial nerve neurotization facial nerve cross-plasty, during which an anastomosis between the damaged and intact facial nerves using autotransplants from the gastrocnemius nerve or a free muscle graft, including the tender muscle and the anterior branch of the obturator nerve is performed. The process of restoring facial nerve function and regressing characteristic symptoms takes a long period of time and requires specialized restorative treatment.

The adhesion of the Tahokomb hemostatic plate of Takeda (Japan) to the solid cerebral membrane prostheses from materials of various origins was experimentally investigated to determine which of them the implants under study best provide tachocomb fixation and contribute to the prevention of postoperative liquorrhea and infectious complications resulting from leaks in the subdural space. It was found that the greatest adhesion of tachocomb was revealed to xenogenic prostheses having collagen in their composition, which characterizes them as optimal prostheses for plasticizing defects of the solid cerebral membrane from the point of view of sealing the subdural space. Intermediate values were observed in the study of prostheses of combined origin, and the lowest adhesion of tachocomb was observed with respect to synthetic prostheses. Of some interest are new composite substitutes for the hard brain (NeoDura, Medprin), created as a mix of synthetic and organic materials. The surface texture of these solid cerebral membrane analogues approaches collagen implants in characteristics, and is similar to the structure of the native solid cerebral membrane. Based on the data obtained, we can talk about the priority use of solid braincase prostheses based on animal collagen - not only due to the high adhesion parameters of tachocomb to them, but also due to other qualities: resorbability, facilitating the deposition of recipient fibroblast materials on the surface.