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The number of victims with difficult defects of the skull bones, which should restore the integrity of the skull is growing annually, both in connection with the increase in severe traumatic brain injury (TBI), and in connection with the expansion of indications for decompressive craniotomy not only in traumatic brain injury, but also vascular disease, neuro-Oncology for the relief of hypertension-dislocation syndrome. Cranioplasty at the stage of early rehabilitation of patients after decopressive craniotomy is an important condition for effective rehabilitation measures. Currently, titanium, polyether ethyl ketone (PEEK), polymethyl methacrylate (PMMA) and hydroxyapatite are actively used as the material for the implant. Unfortunately, none of the synthetic materials used meet the conditions of the perfect implant by 100%. CAD/CAM 3D printing technologies are used to achieve absolute accuracy of the implant that replicates the missing part of the patients skull bone, which is especially important in the presence of extensive and complex defects. The use of this technology at the preoperative stage directly in the medical institution where the cranioplasty will be performed avoids additional logistics, reduces the time from the patients admission to the hospital before the operation and reduces the cost of manufacturing implants, making them more accessible to healthcare institutions. also, the absence of the need for intraoperative implant adjustment significantly reduces the operation time, reduces the risk of infectious complications and complications associated with prolonged general anesthesia. The favorable course of the postoperative period allows you to resume rehabilitation activities on the third or fourth day after cranioplasty.

Background. Along with the measures to restore the basic body functions and prevent secondary brain injury, one of the key areas of modern rehabilitation is nutritional and metabolic support. Aims: to improve the results of the treatment of the patients by optimizing the system of nutritional and metabolic rehabilitation using enteral, parenteral, combined parenteral-enteral nutrition methods, who are undergoing rehabilitation after recovering from Coma resulting from injuries and diseases of the central nervous system. Methods. In a prospective cohort study, the results of the study and complex treatment of 113 patients after recovering from Coma as a result of brain injury of various etiologies who were undergoing rehabilitation in the period from 2017 to 2019 in the FNRC RR were analyzed. Results. Indirect calorimetry has proven to be the most accurate method for creating an effective and adequate program of nutritional and metabolic support in patients in chronic critical conditions who recovers from the coma. In patients who recovers from the coma, due to the excessive process of hypercatabolism, increasing protein requirements: the average protein requirements for a patient who recovers from the coma are 1.261.5 g of protein per kg/weight. Conducting optimal nutritional support for patients recovering from Coma involves determining the functional state of the gastrointestinal tract. To build an effective and adequate program of nutritional and metabolic support where accurate determination of energy needs is of great importance. Conclusions. The indirect calorimetry method is a valuable tool for assessing energy needs, although without taking into account the functionality of the gastrointestinal tract and other factors affecting body compositions, it may not be sufficient to prescribe optimal nutritional support in patients after recovering from Comatose.

Justification. One of the forms of systemic angioreticulomatosis is the combination of a tumor (angioreticuloma) of the cerebellum with retinal angioma (the so-called Hippel-Lindau disease). With this hereditary disease, the general condition of patients and the prognosis depend on concomitant tumor diseases. Including for a comprehensive diagnosis of this syndrome, radiation research methods are used. Description of the clinical case. A young patient with Hippel-Lindau disease and a number of neurological disorders was enrolled in a course of treatment and rehabilitation measures at the Federal Center for Pharmacy of the Republic of Poland. At the hospitalization stage in the previous hospital, she underwent microsurgical removal of an intracerebral tumor. During the examination, possible long-term postoperative complications were excluded, however, kidney and pancreas lesions were detected. As a result of the adjusted course of rehabilitation, the patient showed positive dynamics (in particular, an increase in functional and somatic status). Conclusion. In Hippel-Lindau disease, as one of the forms of multiple angioreticulomatosis, cerebellar angioreticuloma and retinal angioma can be combined with lesions of other internal organs. Therefore, a comprehensive diagnosis of this category of patients is necessary. Timely identification of foci of Hippel-Lindau disease, complications after previous treatment allows you to choose the necessary amount of therapeutic and rehabilitation measures, which in the future can improve the patient’s quality of life and prognosis.