В статье описан наиболее распространенный тип сосудистых аномалий спинного мозга-спинальные дуральные артеровенозные фистулы (СДАВФ). На долю СДАВФ приходится 60-80% сосудистых аномалий спинного мозга. Причины образования СДАВФ, особенности их гемодинамики и классификация остаются предметом дискуссий. СДАВФ формируются в ткани твердой мозговой оболочки, на дорзальной поверхности корешковых манжеток. Патогенез неврологических расстройств при СДАВФ определил название возникающего на их фоне поражения спинного мозга-«венозная гипертензионная миелопатия». В типичных случаях в дебюте СДАВФ в нижних конечностях отмечаются боль и парестезии, расстройство чувствительности (чаще в дистальных отделах) и двигательные нарушения в форме нижнего вялого парапареза. До установления диагноза проходит в среднем от 12 до 44 мес. На момент установления диагноза, помимо двигательных и чувствительных расстройств, у больных выявляются сфинктерные нарушения и сексуальная дисфункция. Большинство пациентов к этому времени уже имеют инвалидность вследствие неврологических проявлений. В статье представлены история изучения СДАВФ, существующие классификации артериовенозных мальформаций и фистул, клинические проявления венозной гипертензионной миелопатии при СДАВФ, данные нейровизуализационных исследований, а также варианты лечения. Ключевые слова: артериовенозная мальформация спинного мозга; спинальная дуральная артериовенозная фистула; клинические проявления; диагностика; лечение.

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The study objective is to report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head and to discuss diagnostic methods and neurosurgical treatment. Materials and methods. We report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head in a female patient. The patient was treated in the Neurology Clinic of I.M. Sechenov First Moscow State Medical University. We analyzed clinical manifestations and compared them with the data described in research literature. Results. Upon admission, the patient complained of pain in the anterolateral surface of the right shin and in the dorsum of the foot during walking. At rest, the patient experienced no pain. We observed no motor or sensory disorders typical of nerve root disorders at the level of L5. Lasegue’s test was negative. The patient had a positive Tinel’s sign in the area of the right fibular head. In order to clarify the diagnosis, we performed a repeated extension test in the right ankle joint and it was positive. The patient underwent surgery that included peroneal nerve decompression and neurolysis at the level of the fibular head. In the postoperative period, the patient had complete pain relief. Conclusion. Due to the difficulties in the diagnostics of dynamic neuropathy of the common peroneal nerve, this disease is often mistaken for radiculopathy at the level of L5. Thorough clinical examination, testing for Tinel’s sign in the area of the fibular head, and repeated extension test in the ankle joint ensure the correct diagnosis and reduce the frequency of ineffective surgeries on the lumbar spine. Surgical decompression of the common peroneal nerve at the level of the fibular head with obligatory opening of the entrance to the nerve canal is an effective method of treatment in such patients.

The study objective is to describe a case of ossified pseudomeningocele after spinal surgery and to develop an optimal treatment strategy for this disorder.Materials and methods. We report a case of ossified pseudomeningocele developed after the removal of an intradural neurinoma in the lumbar spine in a female patient treated in the Clinic for Nervous Diseases, University Clinical Hospital No. 3 of the I.M. Sechenov First Moscow State Medical University in 2017. We also reviewed research literature describing this pathological condition.Results. Upon admission, the patient was diagnosed with paresis of the left foot occurring in ankle joint dorsiflexion (score 4), absence of the Achilles reflex on the left side, and hypoesthesia of two first toes of the left foot. Magnetic resonance imaging revealed a postoperative cyst of irregular shape located in soft tissues at the level of L vertebral body and compressing the dural sac. The patients underwent surgery that included separation of the pseudomeningocele cavity from the dural sac and placement of an external lumbar drainage. In the postoperative period, we observed a complete regression of neurological symptoms.Conclusion. Since ossified pseudomeningocele in the lumbar spine is extremely rare, an optimal treatment strategy has not been developed so far. We believe that maximum possible excision of the cyst wall and anastomotic sealing with a muscular or fat flap with biological glue followed by flap fixation from the extradural space is a simple and robust method of decompression and separation of the anastomosis. To eliminate the cavity in soft tissue of the paravertebral space, we recommend reconstruction of epidural fat with additional sealing using biological glue. To prevent anastomosis recurrence, we recommend placing an external lumbar drainage.

The objective is to report 3 cases of intraneural cyst (ganglion) of the peroneal nerve and compare our own findings with the data from scientific literature.Case reports. Three patients with intraneural ganglions of the common peroneal nerve were treated in the Department of Neurosurgery, A.Ya. Kozhevnikov Clinic of Nervous Diseases, I.M. Sechenov First Moscow State Medical University between 2013 and 2019. All patients underwent extensive dissection of the cyst wall, evacuation of secretion; 2 of them had ligation of the articular nerve branch, while in one patient, the articular branch was not revealed. Complete nerve recovery was registered in all cases.Conclusion. We believe that ganglion dissection using microsurgical techniques with surgical microscope is a safe and noncomplex procedure; therefore, the avoidance of this manipulation seems unjustified.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to the publication of their data.