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Preservation of visual functions in patients with chiasmo-sellar region compression (CSRC) is possible with early diagnosis and surgical decompression., Purpose: To analyze the parameters of optical coherence tomography (OCT) and optical coherence tomography-angiography (OCTA) in patients with CSRC., Material and Methods: The study included 10 patients (20 eyes) with CSRC, 15 healthy volunteers (30 eyes). OCT, OCTA was performed on Cirrus HD-OCT 5000 AngioPlex™ (Carl Zeiss Meditec, U.S.A.) with AngioVue system., Results: Patients with CSRC were revealed to have decreased thickness of ILM-RPE in the nasal sector of outer circle ( p <0.001) and average mGCIPL - total and for all six sectors ( p <0.001), decreased RNFL in the inferior sector ( p =0.017); decreased superficial vessel density (SVD) and perfusion density in the inner and outer circle areas and in all sectors of the ETDRS grid ( p <0.001) except temporal; in the peripapillary area, decreased vessel perfusion density (VPD) in the inferior sector ( p =0.025), capillary flux index (CFI) in all sectors ( p <0.001; p =0.025 in the inferior sector). Informative diagnostic criteria included ILM-RPE in nasal sector of the outer circle (AUC=0.896); mGCIPL in the inferonasal sector (AUC=0.914), average (AUC=0.846), superior (AUC=0.829) and superonasal (AUC=0.846) sectors; average SVD (AUC=0.805) and SVD in the inner circle area (AUC=0.810); CFI in the inferior sector (AUC=0.806) with p <0.001., Conclusion: In CSRC, changes can be seen in OCT and OCTA parameters recorded in the macular and peripapillary regions before the changes in the central visual field. Informative diagnostic OCT and OCTA criteria can help diagnose the pathology early, expand the indications for decompression, and preserve the visual funcitons.

Aim: To analyze the efficacy of cytoflavin in the complex treatment of sleep disorders in asthenic syndrome., Material and Methods: One hundred patients with sleep disorders and asthenic syndrome of various etiology and severity were studied. The patients were divided into three groups depending on the type of therapy: the first group received intravenous infusions of cytoflavin for 10 days; the second group, in addition to cytoflavin, received per os melatonin (3 mg or 5 mg) at bedtime; the third group in addition to cytoflavin received per os zopiclone (7.5 mg) at bedtime., Results: On the 14th day of the study, a decrease in severity or complete relief of asthenia manifestations (according to the SHAS scale) and, accordingly, improvement or normalization of sleep in 97% of patients was found. At the same time, during polysomnographic study, the data obtained are characteristic for improving the quality of sleep phases mainly in the first and second groups of patients and, to a lesser extent, in the third group., Conclusion: Cytoflavin effectively suppresses the main manifestations of asthenic syndrome, including sleep disorders.

Gene mutations occur with high frequency in children with mental retardation. Standard diagnostic methods, such as TMS, Sanger's sequencing of individual genes, MLPA analysis of deletions, and investigation of methylation status in Martin-Bell syndrome are not informative in the majority of cases that hampered further diagnostic efforts. Massive parallel sequencing (MPS) allowed physicians to continue diagnostic search in previously undiagnosed cases and to find molecular causes of disease. MPS permits to discover a large number of new genes and understand the pathogenesis of mental retardation and brain development more deeply. It became possible to perform prenatal and pre-implantation diagnostics. However, big data generate big problems with their interpretation the genetic counselor faces with. This review reflects the advantages and disadvantages of MPS. Different variants of MPS, including gene panels, whole exome and whole genome sequencing as well as sequencing of trios, are described. In addition, the authors discuss the difficulties of interpretation of the results and recommendations for obtaining the most accurate results.

Purpose: To explore the possibilities of frameless navigation surgery in patients with posttraumatic defects and deformities of the orbit., Material and Methods: In order to develop frameless navigation technique for surgical treatment of posttraumatic defects and deformities of the orbit, examination and surgery were performed on 21 patients of the N.V. Sklifosovsky Research Institute of Emergency Medicine. Multi-slice spiral computed tomography was used for preoperative simulation and intraoperative control. Virtual layer-by-layer reconstruction of missing bone fragments and modeling of anatomical position of dislocated bone fragments in frontal, axial, and sagittal images were performed. Implant position control was done with pointer device of the navigation system., Results: Good functional (disappearance of diplopia in primary position of gaze) and cosmetic results were obtained in all patients. None developed complications in the postoperative period., Conclusions: The use of frameless navigation in surgical treatment of posttraumatic defects and deformities of the orbit allows to obtain good and stable functional and cosmetic results.

Objective: To study the possibilities of common ultrasound diagnostic methods in the evaluation of intracranial pressure (ICP) and central perfusion pressure (CPP) and to search for the ways of increasing the accuracy of these methods., Material and Methods: Thirty-eight patients, aged 28-66 years admitted to a neuroreanimation department of a hospital due to acute intracranial vascular and traumatic hemorrhages were examined. An instrumental study included transcranial dopplerography (TCDG) and digital echoencephalography. Accuracy of measurement was evaluated for ICP and CPP in clinical conditions., Results: The data obtained confirm the possibility of quantitative assessment of ICP and CPP using TCDG. We suggest a new formula for more precise calculation of CPP., Conclusion: The complex use of noninvasive ultrasound methods allow in most cases to measure with acceptable accuracy and assess the degree of intensity of ICP and CPP changes at the acute stage of intracranial hemorrhages.

Cranioorbital injuries (COI) are combined with brain trauma in 45-53% of patients and in 21--24% of cases require surgical treatment. Aim of this study was to evaluate the results of surgical treatment of patients with COI in acute period of traumatic brain injury (TBI). Among 4078 patients with TBI admitted to neurosurgical department of Sklifosovsky Institute of Emergency Medicine, 428 (10,5%) had COI. In acute period of TBI reconstructive procedures were performed in 158 (36,9%) cases. In 78 (49,4%) patients reconstructive surgical procedures were done within 48 hours after injury, in 35 (22,2%) of them simultaneously with neurosurgical operation. In 53 (33,5%) patients underwent surgical treatment in 1 week after trauma or later. Majority of procedures were reconstructive operations with reposition and rigid fixation of fractured bones using different implants. Overall mortality in patients with COIl was 5,3%, postoperative mortality--4,6%. Postoperatively position of the eyeball was restored totally or partially in 127 (97,7%), oculomotor disorders regressed in 132 (98,5%) patients. Obtained results of surgical treatment of COI in acute period of TBI demonstrate high effectiveness and safety of active surgical tactics. Application of modern diagnostic methods and interdisciplinary approach in management of COI in early period after trauma provide good functional and cosmetic results.

The article describes surgical treatment of a patient with traumatic brain injury combined with anterior fossa defect, CSF leak, bony fractures of superior and middle facial zones. Multidisciplinary surgical team including neurosurgeon, maxillofacial surgeon and ophthalmologist performed single-step operation which consisted of skull base defect closure, cranialization of frontal sinus and reconstruction of its anterior wall by titanium mesh, reposition and fixation of bony fragments of nasoorbital complex, maxilla, surgical fixation of occlusion by cortical screws. The surgery resulted in cessation of CSF leak, restoration of orbital geometry which lead to regression of diplopia and oculomotor disorders. Cosmetic defect was eliminated. This case report demonstrates high effectiveness of multidisciplinary approach in surgical treatment of complex craniofacial injuries.

An original method of impedancemetry designed by the authors and applied in 88 cases of cerebral edema caused by brain aneurysm rupture (n = 23), by acute hemorragic stroke of hypertensive type (n = 13) and craniocerebral injury (n = 52) is described. Diagnostic value of the method, its safety and convenience for clinical practice are demonstrated.