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Objective: To evaluate the results of diagnosis and treatment of patients with cerebrovascular diseases (CVD) using modern technologies Methods: The results of the diagnosis and treatment of 105 patients with CVD for the period from January 2018 to May 2022 were evaluated. The age of the patients ranged from 10 to 75 years. The Glasgow Coma (GCS) and Hunt-Hess (HHS) Scales were used to assess the severity of the disease. In patients with arteriovenous malformation (AVM), the Spetzler-Martin grading scale was used to determine the size, location, and drainage into the deep cerebral veins. The Fisher scale was used in all cases of subarachnoid hemorrhage (SAH). Additional research methods included computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA). Results: Of the 105 patients, operations were performed in 55, the remaining 50 patients underwent conservative treatment (due to refusal of surgery). The main reasons for the development of non-traumatic intracranial hematomas (NICH) were: hypertension – in 30 (28.5%) cases, arterial aneurysm (AA) – in 12 (11.4%) cases, AVM – in 20 (19.5%) cases and other causes in 8 (7.6%) patients. Out of 38 (69.1%) patients operated on during the acute period, 5 (9.1%) underwent surgery during the first 5 days, while 12 (21.8%) – were operated on within 10-14 days. The following interventions were performed: external ventricular drainage – 10, removal of blood clots from the basal cisterns – 1, clipping of vessels – 7, and decompressive craniotomy – 37. In the group of operated patients, mortality was 9.1% (5 patients); mortality in the conservative treatment group constituted 40% (20 patients). Conclusion: The wider use of modern and highly informative imaging methods resulted in increased detection of asymptomatic AVMs and AA. This, in turn, contributed to the application of adequate treatment techniques in a relatively safe period of the disease, thereby reducing the frequency of deaths and serious complications.

The parapharyngeal space is a complex structure, being narrow and difficult for surgical approach. Surgical treatment is the main treatment for parapharyngeal space (PPS) tumors, it is performed on the basis of information obtained from imaging methods (computed tomography (CT) and magnetic resonance imaging (MRI)). Objective – to investigate the effectiveness of advanced visualization of radiological research methods in the diagnosis of the parapharyngeal space tumors in order to select the necessary tactics of surgical treatment. This retrospective study included 43 patients who underwent surgery for primary parapharyngeal space tumors from 2010 to 2021. 32 patients were treated in previous 10 years, 11 – patients who underwent examination and surgical treatment over the past 2 years with advanced methods of MRI and CT to select a safe surgical approach. Patients of the 2nd group underwent advanced MRI and CT studies in order to choose the correct method of surgical approach and prevent postoperative complications and recurrence. The histological conclusion in 90.1% of the operated patients confirmed the preliminary data of MRI perfusion regarding the probable histological structure of the neoplasm. Due to a comprehensive preoperative study, in 81.8% of patients in this group transoral approach was used. Our experience confirms the necessity for a thorough preoperative diagnostic procedure that should take advantage of imaging modalities (CT, MRI), especially new techniques (MRI-perfusion and diffusion weighted imaging). [ABSTRACT FROM AUTHOR]

The analysis of medical histories of 129 patients aged 20 to 59 years, who suffered acute cerebrovascular disorders (AСVD) of the ischemic type (IT), and participated in ATO-JFO was carried out. Anomalies of cerebral arteries were found in all of them. A significant role of hypoplasia of the right posterior cerebral artery, aplasia of the posterior connective, left anterior cerebral and anterior connective, as well as pathological S-shaped tortuosity of the internal carotid artery, hypoplasia of the vertebral arteries and their combinations in the development of acute cerebrovascular disorders in ATO members was established.

The article reviews etiology and pathogenesis, clinical manifestations and diagnosis of the renovascular disease. Main non-invasive diagnostic methods – functional tests and diagnostic images – are discussed. Much attention has been paid to methods of ultrasound diagnosis, value of magnetic resonance angiography and computed tomography angiography in the diagnosis of renovascular disease, their advantages, disadvantages, indications and perspectives for usage, taking into account indications for revascularization and assessment of the treatment efficacy. Problems and complications of the diagnostic methods are discussed as well.

The aim of this study was a comparison of diagnostic efficacy of non contrast enhanced MR-angiography (MRA) and CT-angiography (CTA) with digital subtraction angiography (DSA) in patients with atherosclerotic lesions of internal carotid arteries. We examined 70 patients with stenosis of carotid arteries. A stenosis degree of more than 50% (assessed by DSA) was considered as hemodynamically significant. Besides neurological survey the examination of extracranial arteries was performed, whichincluded MRA, CTA and DSA. In each case we analysed a plane on which a degree of a stenosis was assessed as maximum. To characterize each modality we evaluated sensitivity, specificity and positive predictive value. A coincidence rate for CTA and DSA was 95%, for MRA and DSA 89%. We can conclude that CTA and MRA can be use for an appropriate evaluation of stenosis of interna carotid arteries.

The Foix-Alajouanine syndrome was originally reported by these authors in 1926, as rapidly progressive vasculitis on the background of a viral infection. The pathology was represented by the huge, more than 10 times, dilation either of the lumen, or the walls of the spinal vessels, either of the arteries, or the veins. There were no signs of thrombosis, no malformations. Massive necrosis was observed in the spinal cord. Though plenty of observations of the syndrome were reported over the past 100 years, most of them deal with arteriovenous malformations and/or thrombosis, which had not been revealed originally. We present the case of spinal viral vasculitis detected by means of spinal MR-angiography. The undoubted viral etiology of vasculitis allows us to attribute this observation to Foix-Alajouanine syndrome.

Motor neuron diseases (MND) include two main forms - amyotrophic lateral sclerosis (ALS) and spinal muscular atrophy (SMA). A certain part of these diseases is hereditary, while etiology of sporadic cases remains unknown. Both entities are known to develop because of motoneurons damage. Difference between them lies in the state of the descending pyramidal pathways. The pyramidal pathways in SMA are intact, as brain pyramidal neurons are not affected, thus pathology of SMA is restricted to anterior horns of spinal cord. Meanwhile, most forms of ALS arise due to loss of both cerebral and spinal motoneurons, which, in addition to anterior horn lesion, leads to pyramidal descending pathways damage either in brain or in spinal cord. While pathological distinction between these two entities is clear and definite, the clinical difference remains obscure. We present the case of 41-year old patient with MND, in whom spinal MR tractography has revealed lateral columns to be intact that proves the utility of spinal MR tractography in differential diagnosis between ALS and SMA. Given that ischemic diseases of the spinal cord often occur with a clinical picture of MND, we also examined this patient using spinal MRI angiography, revealing a pronounced narrowing and tortuosity of the spinal arteries, complicated by occlusion of the right twelve intercostal artery.

There are different views on the nature of cerebral palsy, but no one has been accepted commonly. Since, every new observation of this disorder based on thorough clinical examination could convert the obscurity into clear and simple conception. We report the case of 4-year-old boy with lower paraplegia and speech retardation. The tonus was increased bilaterally in gastrocnemius muscles and thigh adductors. The muscle tonus was decreased in iliopsous. Electrophysiological examination revealed signs of decreased excitability of motoneurons at the level L 2 - S 2. MRI has confirmed lesions of spinal cord at that level in addition to injury at thoracic level and brain lesions. MRI spinal angiography has detected tortuous anterior spinal artery. The boy benefited from the electrophoresis with theophylllinum, applied on lower thoracic and first lumbar vertebrae with improvement of his legs motor skills. Our presentation testifies to involvement of spinal cord and benefits from therapy applied on spine and, thus, confirms the initial description of cerebral palsy in 1853 made by English surgeon James Little.

The characteristics of development of vascular lines are important for development and improvement of of surgical treatment, decreasing risk of complications and development of personalized approach to treatment of patients. The purpose of the study is to reveal prevalence of different variants of development of common carotid artery bifurcation and to assess their significance for clinical medicine. The sample included 70 volunteers of average age 43.4 ± 10.7 years. The 3D reconstructions of MRI data 1.5 T Brivo 355 were evaluated. The observation data was grouped and processed using software Microsoft Excel 2007 and IBM SPSS Statistics 20. To summarize the data, 5 main variants of location of great vessels were identified. The most rare types of development and course of carotid arteries in bifurcation area were variants "II" and "III" (8.2% of all observations). The most common development options were "I" (51.4%) and "IV" (31.4%). The variants "I" and "IV" were determined relatively evenly.The variants "II" and "III" were found on the right in 60% and 66.7% correspondingly and "V" option was found on the left in 61.5%. The typical options of location of carotid arteries near the bifurcation (variants "I" and "IV"), 82.8% in total. The cases of ventral position of external carotid artery (variants "II" and "V") were established in 12.9%. The variant III was found in 4.3% of all cases. The distribution of vascular development options depending on the gender of patients was investigated. The study did not reveal significantly pronounced deviations in distribution of variants of vascular development, taking into account the age factor. The mentioned data permits to judge with confidence about necessity of developing personalized treatment of diseases of carotid arteries, considering their anatomical features of development in bifurcation area.

The use of catheterization cerebral angiography (CCA) to assess collateral blood flow through an indirect anastomosis is traumatic for children, uses a high radiation dose, and requires anesthetic care in most cases., Aim: we aimed to compare the capabilities of triplex ultrasound (TU) of vessels, magnetic resonance angiography (MRA), computed tomography angiography (CTA), and CCA in assessing the competence of indirect cerebral revascularization (ICR) in children., Material and Methods: ICR was performed in 18 children in 24 hemispheres (24 operations). The results were evaluated by Matsushima classification-based comparison of the data of preoperative and postoperative clinical examinations, TU of the superficial temporal artery, magnetic resonance imaging (MRI) and computed tomography (CT) of vessels, and selective cerebral angiography., Results: After surgery, improvements in the neurological and neuropsychological status were assessed. Matsushima grade A collaterals were found in 12 (50%) cases, grade B collaterals were present in 3 (13%) cases, grade C collaterals were present in 7 (29%) cases, and grade D collaterals were detected in 1 (4%) case; in 1 (4%) case, the superficial temporal artery was not enhanced. MR angiography visualized 18 (75%) indirect anastomoses, CT angiography revealed 4 indirect anastomoses, and TU visualized 4 indirect anastomoses. Comparison of preoperative and postoperative TU data for the superficial temporal artery revealed significant changes in blood flow in the form of increased rate indices and a decreased resistance index; mean values of indices for each angiographic class of revascularization and significant differences in pre- and postoperative observations were calculated., Conclusion: Examination of ICR competence using CCA is necessary in the presence of persistent clinical signs of chronic cerebral circulatory insufficiency, absence of increased blood flow and decreased peripheral resistance in the superficial temporal artery, and lack of anastomosis according to MRA. The most optimal techniques for postoperative examination are MRA with perfusion and diffusion maps and TU.

The article describes a case of successful surgical treatment of an 81-year-old male patient with symptomatic occlusion of the internal carotid artery that led to severe impairment of cerebral hemodynamics and was accompanied by severe gait and equilibrium disorders. Given the patient's age and his positive medical history, he underwent surgery for the creation of an extracranial-intracranial microvascular anastomosis under regional anesthesia, with spontaneous breathing and a baseline level of consciousness being maintained. In the postoperative period, the patient achieved a marked clinical effect in the form of complete regression of syncopal conditions and gait disorders associated with recovery of cerebral perfusion in the right MCA territory. The article discusses the indications for surgical treatment and the technical details of surgery for the creation of an extracranial-intracranial microvascular anastomosis under regional anesthesia.

Because of the spread to different anatomical regions, craniofacial tumors (CFTs) usually receive blood supply from several arterial systems, and CFT removal is often accompanied by abundant blood loss., Purpose: The study purpose was to develop an algorithm of diagnostic angiography for planning surgical treatment of CFT patients., Material and Methods: Complex preoperative angiography was performed in 72 patients with craniofacial tumors, aged 10 to 78 years (mean age, 45.5 years), who underwent surgical treatment at the Burdenko Neurosurgical Institute in the period from 2012 to 2015. At the first stage, blood supply to tumors was quantified using SCT perfusion. Then, depending on an assessed degree of tumor vascularization, direct angiography or modern minimally invasive angiographic techniques (3D TOF HR MR angiography, SCT angiography) were applied., Results: In 12 cases of hypervascular tumors, accessible afferents were preoperatively embolized through the external carotid artery, which was accompanied by an increase in the blood supply to tumors via alternative routes of the external and internal carotid arteries. The obtained data were used to plan the surgical approach. A comparative analysis of the SCT perfusion data and the expression level of endothelial markers in histological specimens revealed no significant correlation., Conclusion: The study demonstrated the importance of a comprehensive assessment of the blood supply to CFTs in planning of the surgical treatment and enabled the development of algorithms for preoperative angiographic diagnosis, depending on the baseline clinical and radiological data.

The aim of the study was to assess the results of surgical treatment in 74 patients with extensive arteriovenous angiodisplasia in the head and neck area. All patients underwent complex examination including ultrasound, CT and MRI with contrast and selective carotid angiography. The lesions excision was performed after endovascular embolization and soft tissue defects were restored by various methods selected according to prevalent vascular lesion type (arterial, arteriovenous, venous, capillary) and blood flow values (high flow, low flow, mixed). Good and satisfactory esthetic results were seen in 95.2% of cases, lesion relapse was detected in 4.8% of cases by 12-18 months follow-up. Endovascular embolization proved to decrease the intraoperative bleeding risk, prevent lesion relapse and minimize the size of the lesion improving the results of radical treatment. Local flap reconstruction usually results in good esthetic results. By local soft tissue deficiency distant free flaps or microsurgical complex flaps may be used.

Aim: To investigate changes in cerebral perfusion in patients with unilateral internal carotid artery occlusion before and after surgical revascularization of the brain, depending on the clinical efficacy of surgical treatment., Material and Methods: The study included 60 patients with unilateral ICA occlusions who underwent placement of an extra-intracranial microvascular anastomosis (EICMA). All patients underwent a CT perfusion study before and after cerebral revascularization. In addition, the degree of neurological deficit was evaluated before surgery and during follow-up (3 and 8-10 months) using the NIHSS score., Results: All patients were divided into 3 groups, depending on the results of surgical treatment: objective improvement (43 patients), no changes (14 patients), and worsening of clinical symptoms (3 patients). In each group, the absolute and relative perfusion parameters (MTT, CBV, and CBF) were analyzed to identify the perfusion criteria for the EICMA efficacy. A significant relationship between the clinical efficacy of EICMA and a baseline perfusion deficit and its change after anastomosis placement was found., Conclusion: Placement of EICMA is effective treatment for patients with symptomatic ICA occlusions and an increase in the blood transit time in the hemisphere ipsilateral to occlusion by more than 40% compared to that in the opposite side provided that perfusion is recovered in more than one area of the MCA territory (in accordance with the ASPECTS scale).

Moyamoya disease in children is a rarely diagnosed entity. Frequent headache is the first symptom of the disease. Headache associated with moya-moya disease (HAMD) is a separated entity reported in the literature. Variants of onset, a spectrum of primary diagnoses and diagnosis verification rate of moyamoya disease in 7 children are presented. A clinical case of moya-moya disease in a 9-year boy, who was primarily diagnosed with migraine with aura, is reported. The results presented by the authors as well as literature data indicate the necessity of using magnetic-resonance angiography in children with headache attacks and focal neurologic symptoms to identify this progressive vascular pathology and timely recommend a surgical treatment.

Authors describe a 7-year-old boy, who developed a severe right-sided hemiparesis, aphasia, seizure, and confusion state during sport games. There was no headache. Allergic dermatitis in the past medical history and influenza vaccination 2 weeks before stroke were recorded. On the 12th day of disease, MRI of the brain revealed an acute infarction in the territory of left anterior and middle cerebral arteries with hemorrhagic transformation. MPA (15 day) showed occlusion of the left ACA and MCA. HR-MRI T1_db_fs weighted imaging (36 day) found intramural hematoma (IMH) in ACA and MCA with marked stenosis of the lumen. After 3 months, HR-MRI/MRA showed the complete regression of IMH, recanalization of the arterial lumen, prolonged irregular MCA stenosis. Neurological deficit regressed significantly.

Unlabelled: The study is devoted to the use of a minimally invasive method of SCT perfusion for the differential diagnosis of sellar and pаrаsellar tumors. Given a wide differential diagnostic range of tumors occurring in this area, the tumor perfusion indicators were used as an auxiliary diagnostic criterion., Material and Methods: The study analyzed outcomes in 115 patients with various tumors of the sellar area who underwent surgery or biopsy for histological verification of the diagnosis., Results: The statistically significant differences were obtained for certain groups of tumors based on the values of hemodynamic parameters (p<0.05) that enable, with a high confidence, making a conclusion on the histologic type of most tumors., Conclusion: These findings demonstrated that SCT perfusion is a highly informative method of the preoperative differential diagnosis of these tumors. The sensitivity and specificity of SCT perfusion in the study were 100% and 81.2%, respectively.

Objective: To substantiate the reasonability and duration of angiographic follow-up of patients operated on for cerebral aneurysms to rule out de novo aneurysm formation., Material and Methods: The results of angiographic examination (cerebral angiography and SCT angiography) of 43 patients with cerebral aneurysms operated on at the Burdenko Neurosurgical Institute in 1995-2012 are analyzed. The follow-up duration varied from 1 to 14 years after surgery (mean duration, 5 years). Patients' age ranged from 14 to 56 years., Results: Control angiographic examination showed that de novo aneurysms were formed in 7 (16.2%) patients. A total of 8 de novo aneurysms were detected (in one case there were two aneurysms formed). All aneurysms, both the previously operated and the de novo ones, were located in the anterior part of the circle of Willis. De novo aneurysms were clipped in 5 cases; the cavity of the de novo aneurysm was occluded with spirals in one case. One patient with a small aneurysm of the middle cerebral artery refused surgery. Neither lethal nor unfavorable outcomes were recorded., Conclusions: The patient groups with the high risk of de novo aneurysm formation are as follows: 1) young smokers with hypertension; 2) patients who developed clinical signs of the disease when being young; 3) patients subjected to proximal exclusion of the main artery; and 4) patients with multiple and familial forms of the pathology. Dynamic angiographic follow-up (SCT angiography or magnetic resonance angiography) for 1-3 years is recommended for these patients.

The thoracic outlet syndrome is characterized by a variety of clinical signs due to multiple causes resulting in compression of a neurovascular bundle in a relatively narrow anatomical space. Despite the frequently encountered clinical symptoms, inadequate attention is paid to their analysis, and their diagnostic and surgical aspects require a modern approach. The study included 46 patients. The main clinical sign is a persistent pain syndrome of the cervico-occipital localization that affects the shoulder girdle, suprascapular and infrascapular regions and spreads to the arm in combination with trophic, sensory and vascular disorders. SCT angiography of the superior thoracic outlet structures has been used as a priority instrumental method of research. The macro- and micro factors of compression are the main cause for the development of neurological symptoms, and their removal is the main task of surgical treatment. Surgical approaches were planned depending on the nature and extent of injury. 36 patients underwent 42 surgical interventions. The proper assessment of the neurological status in combination with modern paraclinical diagnostic methods and selection of an adequate surgical approach provided satisfactory outcomes in 33 cases.

Unlabelled: Despite the obvious progress in modern neurosurgery, surgery for glial tumors of the insular lobe is often associated with a high risk of postoperative neurological deficit, which is primarily caused by damage to perforating arteries of the M1 segment of the middle cerebral artery., Objective: The work is aimed at evaluating the effectiveness of high resolution time-of-flight (3D-TOF) MR angiography in imaging of medial and lateral lenticulostriate arteries and determining their relationship to tumor edge in patients with gliomas of the insula., Material and Methods: 3D-TOF MR angiography data were analyzed in 20 patients with primarily diagnosed cerebral gliomas involving the insula. All patients underwent non-contrast enhanced 3D-TOF MR angiography. In 6 cases, 3D-TOF MRA was performed before and after contrast enhancement., Results: 3D-TOF angiography before intravenous contrast injection was capable of visualizing the medial lenticulostriate arteries in 19 patients (95% of all cases) and lateral lenticulostriate arteries in 18 patients (90% of all cases). Contrast-enhanced 3D-TOF angiography allows for better visualization of both the proximal and distal segments of lenticulostriate arteries. Three variants of relationship between the tumor and lenticulostriate arteries were identified. Variant I: the tumor grew over the arteries without their displacement in 2 cases (10% of the total number of observations); variant II: the tumor caused medial displacement of arteries without growing over them in 11 cases (55% of the total number of observations); variant III: the tumor partially grew over and displaced arteries in 2 cases (10%). In 25% of cases (5 patients), tumor was poorly visualized on 3D-TOF MR angiograms because their signal characteristics did not differ from those of the medulla (tumor tissue was T1 isointense). As a result, it was impossible to determine the relationship between the tumor and lenticulostriate arteries., Conclusion: High spatial resolution time-of-flight MR angiography can be recommended for preoperative imaging of lenticulostriate arteries to plan the extent of neurosurgical resection in patients with glial tumors of the insular lobe.

The authors have experience in organ-preserving operations for spleen rupture with the splenic artery ligation in 156 casualties. They consider that such operations let to preserve the spleen, to avoid the postoperative rebleeding and ischemia of pancreas tail and body. Also it is accompanied by the low indications of lethality and postoperative complications. The authors consider that this operation is alternative to splenectomy and other techniques of organ-preserving operations in case of spleen trauma.

Pericranial sinus (Sinus pericranii - SP) is a rare pathology of the extra-intracranial cerebral venous system. However, SP is not just an additional transosseous canal that connects the extra- and intracranial venous systems. This "emissary vein" connects the intracranial sinus and the variceally extended thin-walled veins localized on the outer surface of the skull where blood flows fun in opposite directions. We present a literature review and two case reports of patients with pericranial sinus who underwent surgical treatment. We discuss the problems related to etiology, clinical signs, diagnosis, and surgical treatment of the anomaly.

Moyamoya syndrome is a rare chronic progressive disease of brain vessels in which certain arteries in the brain are constricted. During the disease a collateral circulation develops around the blocked vessels to compensate for the blockage, and on angiography these collateral vessels have the appearance of a "puff of smoke". Moyamoya syndrome is extremely rare disease, especially outside of Japan We describe a clinical case of a 27-year-old patient from Tomsk with Moyamoya disease. The clinical features are an acute stroke in the right middle cerebral artery with dysarthria and paralysis of VII and XII cranial nerves. The diagnosis of moyamoya is suggested by MRI-angiogram results in accordance to the diagnostic criteria.

The article analyzes magnetic resonance angiography and computed tomography angiography for diagnosis of blood vessels in the brain. 215 patients with brain meningiomas were examined in 2006-2013 years. Among them 206 adults: 90 (43,3%) men, 119 (56,7%) weman from 19 to 76 years (mean age - 51,4 yrs) and 6 children (4 boys, 2 girls) from 6 to 16 years (mean age - 12 yrs). Adult patients with atypical and malignant meningiomas were 13,6%, children - 0,4%. All patients underwent MR-angiography (100%), CT angiography - 122 (56.7%). Based on the article data, it's obvious, that malignant meningiomas are characterized by a rather specific vasculature. Contrast-enhanced CT angiography makes possible to examine blood vessels, get sliced visualization of their images and, with the help of computer processing of the obtained data, to make a 3D image of the vascular system, to detect morphological and functional changes of brain blood vessels. From the informative point of view contrast-enhanced CT angiography dramatically changes digital angiography. MR tomography gives possibility to make a complete evaluation the brain vasculature in different parts, including small-caliber arteries and veins. The advantage of MRI examination is that it gives the possibility to manifest not only anatomical, but also functional characteristics of blood circulation. In case of localization of meningiomas close to main arterial and veins it's necessary to perform both non-contrast and contrast-enhanced MR angiography, because this method gives us the proper information about the damage of blood vessels and their involvement in the process. MR angiography makes possible to diagnose the involvement of arterial or venous vasculature in the tumor process, dislocation and extravasal compression of arterial branches, the degree of venous sinus damage and evaluation of draining collateral branches, thus enables us to provide prophylaxis of intra and postoperative hemorrhagic and ischemic complications.

In article covers theoretical preconditions for the hypothesis about helical (spiral or swirling) blood flow in cardiovascular system followed by its experimental corroboration. The role of the modern blood flow visualization methods--such as Color Doppler ultrasound and magnetic-resonance angiography--in registration and investigation of the regularities of the given phenomenon is described. The data describing the known parameters of helical blood flow--such as direction of the rotation and its quantitative parameters in large arteries--are given. The main hypotheses for flow screw mechanisms are considered from the point of view of cardiovascular system structural organization. Biological role of helical blood flow is discussed, in respect of which there are diametrically opposed points of view, which consider it as a physiological phenomenon on one side, and as a patogenetic factor of atherosclerosis development on the other.

Implications of an protein-energy malnutrition are diagnosed for patients with a dysplasia of a connecting tissue more often than in population (in 69.9% of cases). One of mechanisms is depression of a volume abdominal blood flow against the structural changes of vascular system associated with a dysplasia of a connecting tissue.

Sixty-two year old man was admitted to the department of neurosurgery after stroke episode. CT-scan revealed non-traumatic, non-hypertensive intracerebral hemorrhage in the left temporal lobe; cerebral amyloid angiopathy was suspected. Initially, according to Boston criteria, intracerebral hematoma was interpreted as a result of a "probable" cerebral amyloid angiopathy. Surgical evacuation of the hematoma lead to the partial recourse of speech and cognitive deficit. Four weeks after stroke onset and 3 weeks after surgery CT was performed, which revealed intracerebral hematoma in the right parietal lobe; this fact let to diagnose "probable" cerebral amyloid angiopathy. The second hematoma was evacuated, and surgical treatment together with medical therapy improved patient's quality of life. Treatment strategy for the intracerebral hematomas resulting from cerebral amyloid angiopathy has not been justified yet, which requires further investigations.

Radiation treatment techniques are essential in complex management of selected neurooncological, neurovascular and functional brain pathology. Stereotactic radiotherapy provides sufficient damage to the target (tumor, AVM, functional structures) with minimal impact on surrounding brain tissue. Development of stereotactic methods with X-ray guidance lead to expansion of indications for irradiation of intracranial and extracranial lesions. This paper represents the first experience of treating patients with AVMs using CyberKnife system in Russia. The technique of stereotactic radiotherapy (SRT) and radiosurgery (SRS) is described in details, as well as indications for SRT and SRS in different regiment of fractionation, possibilities of planning systems, with additional emphasis on specific complications, radiation-induced reactions and capabilities of neurovisualization methods in evaluation of radiation-induced damage of brain tissue.

The article summarizes the experience of diagnostics in 60 patients with large face and neck angiodysplasia. Compression test, cytology, Doppler ultrasound with color Doppler mapping, X-ray computed tomography and angiography with intravenous contrast, magnetic resonance imaging with angiography and selective carotid angiography of branches of external carotid arteries were used for adequate diagnostics. The efficiency of a multidisciplinary approach in diagnosis and treatment of extensive face and neck angiodysplasias is shown in the study.

To present the clinical case of successful extracranial-intracranial (EC-IC) high-flow bypass performance. Patient, female, 51 years old, was suffered from giant cavernous aneurysm of right internal carotid artery (ICA), presented with mass effect. The EC-IC high-flow bypass using radial artery was performed between M2 segment of right middle cerebral artery and right external carotid artery. Bypass patency was confirmed by intraoperative dopplerography, postoperative digital subtraction angiography and by ultrasound examination of anasthomosis. Patient was discharged in 3 weeks after operation in satisfactory condition. The EC-IC high-flow bypass is one of effective method for cavernous aneurysm treatment, allowing excluding aneurysm from cerebral blood flow and decreasing its mass effect.

We studied 1387 patients with different forms of syphilis for neurological deficiency. Thirty patients had vascular neurosyphilis. Two cases are described in detail. A 40-year-old man had recurring episodes of acute disturbance of the cerebral blood flow and progressive cognitive disorders. A 32-year-old patient presented with progressive dementia, hallucinatory symptoms and minor multifocal neurological changes. The diagnosis of neurosyphilis was verified by CSF-test results. The diagnosis of cerebral vasculitis was proved by the data of magnetic resonance imaging (MRI), magnetic resonance (MR) angiography, ophthalmological methods, and duplex scanning of brachiocephalic arteries, transcranial duplex scanning. Diagnostic criteria of syphilitic cerebral vasculitis were defined and presented.

The study was aimed at improving surgical policy in management of patients presenting with pathological tortuosity of the internal carotid artery. The study comprised a total of 105 patients with pathological kinking of the internal carotid artery undergoing a total of 117 reconstructive operations. In order to determine the indications for the operation the patients were subjected to triplex scanning, transcranial Dopplerography and monitoring of blood flow in the median cerebral artery, contrast-enhanced computed tomography or magnetic resonance tomography. Depending upon the degree of intimal proliferation in the area of the maximal bend («septal tortuosity»), the patients were divided into two groups: group I - pathological kinking of the internal carotid artery without intimal proliferation - 75 patients, Group II - pathological kinking with intimal proliferation - 30 patients. The indications for the operation were determined depending upon the degree of cerebrovascular insufficiency, haemodynamical significance of pathological tortuosity, the presence of intimal proliferation in the zone of the maximal bend - «septal tortuosity». An operation of choice for Group I patients was resection of the internal carotid artery with redressation and reimplantation into the own bed, and all Group II patients underwent resection of the area of kinking of the internal carotid artery with an end-to-end anastomosis in order to remove the septal portion. Immediately after the operation 85% of patients were found to have their cardiovascular insufficiency symptoms relieved and all patients showed improved haemodynamic parameters (p<0.01). Neither postoperative strokes nor lethal outcomes were registered.

Presented herein is a clinical case report concerning surgical treatment of arterial insufficiency of the upper limb having developed on the background of thrombosis in an 85-year-old male patient. The cope of the operation was subclavian-brachial bypass grafting. Cephalic vein (v. cephlalica) was used as a graft in "in situ" position. The patient was examined 11 months after the operation, with the shunt functioning well.

To illustrate the present-day possibilities in treatment of aortic dissection we describe herein a clinical case report concerning successful prosthetic repair of a gigantic aneurysm of the infrarenal portion of the aorta with the Gore Excluder using an endovascular surgical approach in a patient running high risk associated with difficult anatomy of the abdominal portion of the aorta, iliac arteries, and accompanying diseases (left lung cancer, CAD, critical stenosis of the RCA. This was followed by balloon angioplasty with stenting of the RCA with Lekton stents with a good angiographic result. EVAR has become an alternative to the conventional open surgery with lower risk of complications, shorter hospital stay, and decreased mortality rate, which was confirmed by the findings of international studies.

Retinal vessel occlusion and eye haemodynamics damage is described in moya-moya disease, a rare occlusive cerebrovascular condition characterized by progressing stenosis and occlusion of cerebral arteries with collateral development in basal vascular system. Data concerning neuroophthalmological features, diagnostic and treatment methods are presented. Necessity of MR-tomography and MR-angiography in ischemic retinal damage is emphasized.

Retrospective analysis of treatment outcomes of 89 patients with GIAs, treated in Sklifosovsky Emergency Care Institute from 01.01.1992 till 30.11.2010, was performed. 67 patients were operated on, among them open surgery was conducted for 49 patients, endovascular embolisation - 18 patients. Severity of patients' condition was assessed according to Hunt - Hess (H-H) scale, level of consciousness - Glasgow Coma Scale (GCS), treatment outcomes - Glasgow Outcomes Scale (GOS). Hemorrhage due to GIA rupture was seen at у 64 (72,0%) patients, mass lesion signs - at 18 (20,2%), embolic events - at 3 (3,4%) and GIA without any symptoms - at 4 (4,4%) patients. Good and excellent outcomes were at 79,1% operated patients, total lethality among operated patients was 13,4%. Lethality among non-operated patients was 47,4%. Conservative treatment of patients with GIAs has low perspectives. Open and endovascular operative interventions are the high-risk surgery but they allow decreasing the lethality and morbidity rate among these patients compared with conservative treatment.

The study included 76 patients with ischemic stroke in the carotid system (56 patients) and in the vertebrobasilar system (20 patients). The magnetic resonance angiography (MRA) revealed congenital anomalies of Willis circle in 31 patients. These anomalies were stratified as follows: back trifurcation of the internal carotid artery (ICA) (19 patients), anterior trifurcation of the ICA (4 patients), the combination of anterior trifurcation of the one of ICA and posterior trifurcation of the other ICA (4 patients), double back trifurcation of ICA (2 patients), the normal structure of the circle of Willis (45 patients). Patients with anomalies of the circle of Willis scored significantly higher on the Neurological deficit scale NIH-NINDS. Despite the lack of significant differences in the size of lesions in 2 groups, the foci in patients with the abnormalities of the circle of Willis were frequently localized in adjacent blood supply zones. The signs of vascular encephalopathy were seen as well. The data obtained suggest that the presence of anomalies in the circle of Willis is a risk factor, together with in the additional adversities, including iatrogenic factor, for the development of hemodynamic ischemic stroke.

Range of methods for diagnostics of extracranial arterial stenosis includes both untrasonic techniques (transcranial Doppler study, duplex sonography, which are not only screening methods, but also used in surgery as well) and high-tech imaging methods--spiral CT scans and MR angiography with visualization of structural changes in vascular wall, quantitative and functional assessment of blood flow in vessels. Aim of this study was to determine the effective of non-invasive diagnostic techniques--MR angiography (MRA), including phase-contrast MRA (PCMRA), and spiral CT angiography (SCTA) in identification and comprehensive assessment of stenosis of internal carotid artery and comparison of capabilities of these methods with gold standard--direct angiography.

Diffuse hyperplasia of choroid plexuses of lateral ventricles is extremely rare entity which is characterized by diffusely increased size of choroid plexuses along the entire choroid fissure and CSF hypersecretion. This disease, initially described by Davis in 1924, may be fallaciously diagnosed as bilateral choroidpapillomas. We present a case of diffuse hyperplasia of choroid plexuses of lateral ventricles in a female infant.

The authors share herein their experience with hybrid surgical interventions for multilevel lesions of the brachiocephalic arteries (stenting and an open operation) in a total of eleven patients presenting with cerebrovascular insufficiency. Our first experience gained in performing hybrid operations confirmed a possibility of correcting tandem stenoses of the brachiocephalic arteries from the standard approach to the common carotid artery bifurcation. No intraoperative complications were encountered. Hybrid interventions made it possible to reliably correct multiple arterial stenoses, necessitating neither additional bypass grafting nor prosthetic repair.

The paper deals with the topical issues of diagnosis of aortic aneurysms and with the current possibilities of treating this pathology. It presents epidemiological data, assessment of the risk of aortic rupture, a patient management regimen according to screening results, and information on the new miniinvasive aortic aneurysm treatment--endovascular replacement using self-expandable stent-grafts.