Objective. Analysis of literature data of modern neurosurgical techniques in the treatment of lumbar disc herniation; clarification of the features of surgical tactics and results during microsurgical, endoscopic methods and laser thermoplastic of the intervertebral disk. Methods. A retrospective analysis of the results of conventional microdiscectomy (228 cases), laser disc decompression (22 observations) and percutaneos endoscopic discectomy (4 observations) for lumbar disc herniation from 2016 to 2018. The results of surgical treatment was assessed according to the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), modified MacNab criteria, and morphometric data of MRI and CT scans during the preoperative and postoperative periods, as well as 6 and 12 months after surgery. Results. The result of the study was a comparison of the literature data with those obtained in our clinic in the treatment of patients using all the indicated methods. On our material, we received confirmation of the feasibility and perspectivity of using minimally invasive methods in the treatment of lumbar disc herniation with low probability of recurrence and repeated treatment for pain. Also agree with the statement that the techniques have limited application, especially with instability in the VMS and multilevel lesion. Conclusion. Endoscopic discectomy, as well as laser disc decompression, are minimally invasive methods of treatment lumbar disc herniation, and have become an alternative to open lumbar microdiscectomy, as they allow minimizing surgical trauma, the effects of surgery, and quickly regress pain syndrome, contributing to early post-operative activation of the patient. A personalized approach in the treatment of lumbar disc herniation is based on the competent selection of patients and the clarification of a number of factors in determining.

Background. Arteriovenous malformations of the brain are a rare congenital vascular pathology. At the moment, the study of the venous component of arteriovenous malformations is a hot topic of many studies. Most authors believe that the angioarchitectural features of the venous link of arteriovenous malformations can have a significant impact on assessing the natural course of the pathology and determining the tactics of treating these patients. Objective. In our work, we conducted a assessment and compared the personalized features of venous drainage of arteriovenous malformations of the brain with the type of clinical course. Design and methods. We analyzed the results of a survey of 61 adult patients with arteriovenous malformations of the brain, observed in the neurosurgical department No. 3 of the RNSI n. a. prof. A. L. Polenov in the period from 2014 to 2021. Gender and age characteristics and neuroimaging data, as well as features of the venous outflow of arteriovenous malformations were analyzed. Groups of patients were composed according to the type of the course of the disease and a personalized analysis was carried out with the characteristics of the venous outflow, as well as their features. The male/female ratio was 1.5/1 (37/24). Patients under 45 years of age prevailed (77.1 %). By types of clinical course: hemorrhagic type — 18 cases (29.5 %); epileptic type — 24 patients (39.3 %); torpid type — 19 patients (31.2 %). Results. A correlation was found between the deep location of the body of the malformation, as well as drainage exclusively into the deep vein system, and the hemorrhagic type of course (p = 0.034), while the male gender and superficial localization of the malformation were more characteristic of the epileptic type (p = 0.01). The torpid flow type did not have significant relationships with the studied features. Conclusion. According to our data, an analysis of the personalized characteristics of venous drainage of cerebral arteriovenous malformations can help in assessing the clinical course, which will improve the treatment outcomes of these patients.

Toxoplasma gondii is a widespread parasitic infection, the activation of which is closely associated with the subsequent immune response. In HIV-infected patients, toxoplasmosis is one of the most common causes of brain damage, causing focal and cerebral symptoms, which can be difficult to diagnose, especially in cases where patients do not inform the doctor about HIV infection. The article presents clinical observations of patients with HIV-associated toxoplasmosis affecting the brain. Diagnostic difficulties arose due to the lack of reliable information about HIV infection in most patients. In the clinical picture, many patients had a multifocal brain lesion, which caused difficulties in recognizing the disease (metastases? encephalitis? Lymphoma?), and with an increase in hypertension-hypertension syndrome, an intracerebral tumor was assumed. To clarify the diagnosis, in case of detected volumetric brain lesions, surgical treatment was required, which was carried out in the volume of a stereotaxic biopsy in the compensated state of patients or emergency surgical intervention in decompensated patients to eliminate the dislocation syndrome.

Background. Identification of patients with a high risk of poor clinical outcome at early stages of intensive care of critical illness makes it possible to adjust the diagnostic and treatment process. Integral severity scoring systems are used for this purpose, which do not include either energy-protein metabolism or malnutrition (MN) parameters. The aim of this study was to determine the predictive value of MN markers for the risk of a poor clinical outcome in surgical (SG) and therapeutic (TG) group of intensive care units (ICU). Material and methods. During the period of 2012 to 2017, a single-center prospective cohort study based on mixed ICU was organized The patient’s critical illness severity was established by Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores. Nutritional indices: Nutritional Risk Index (NRI), Maastricht Index(MI), The Prognostic Nutritional Index (PNI)), and ND risk score: Nutritional Risk Screening 2002 (NRS-2002), Modified Nutrition Risk in the Critically Ill (mNUTRIC)), body mass index (BMI) were also calculated. Results. The best markers to predict the negative clinical outcome risk in the SG are NRI, mNUTRIC and NRS-2002, as well as patient’s age, while in the TG these are - NRS-2002 and mNUTRIC. Conclusion. NRI, mNUTRIC and NRS-2002 can be applied, as well as the traditional APACHE II and SOFA, in the clinical practice of a mixed ICU to predict a poor clinical outcome.

Blood pressure (BP) and its level are indicators of human health and the object of research in recent decades. However, not only elevated BP, but also reduced BP (acute and chronic) are one part of the J-shaped curve of increased risk of cardiovascular diseases [1, 2]. Nevertheless, the problem of arterial hypotension (AH) remains poorly understood today. The article discusses the diagnostic criteria of AH, its pathophysiological mechanisms and approaches to diagnosis and treatment.

Refractory arterial hypertension (RefHTN) is an extreme phenotype of resistant hypertension (RHTN), is associated with utmost poor clinical sequelae. True RHTN occurs in 10-15 % of treated patients. Up to half of them meet the definition of RefHTN, but another ~50 % are eventually diagnosed with ‘pseudo’-RHTN. Partial or complete non-adherence are among its the main causes. To date, there is no ‘gold’ standard to assess adherence. Directly observed therapy (DOT) is a promising non-invasive method to assess patient compliance. The wellknown abroad, DOT is not widely used in Russian clinical practice. In this short report we demonstrate a case of DOT in a patient with apparent RefHTN.

Recurrence of cerebral aneurysms after surgical treatment is an urgent medical and social problem, being a possible cause and a significant risk factor for intracranial hemorrhage, despite the primary total embolisation of the aneurysm. Timely risk assessment, diagnosis and personalized approach in the treatment of recurrent cerebral aneurysm can help improve the treatment outcomes of these patients.
Purpose: to describe a case of a personalized approach in endovascular treatment of recurrent aneurysm of the ophthalmic segment of the internal carotid artery after occlusion with detachable coils.
Assessment of the stability of aneurysm mbolisation in the long-term period after endovascular intervention on a cerebral aneurysm is an integral part of the treatment process in this type of cerebrovascular pathology. A personalized approach to the treatment of cerebral aneurysms, both primary and with signs of recurrence, makes it possible to improve the immediate and long-term results of treatment of patients with this type of cerebrovascular pathology. In some cases, one of the methods for solving this problem is the use of flow-diverting stents.

Arteriovenous malformations are one of the variants of congenital vascular malformations resulting from a defect in the development of the arterial and venous systems with the formation of direct messages between vessels of different diameters and shunting of blood with high velocity characteristics from the arterial to the venous part of the vascular system. Arteriovenous malformations are characterized by a wide variety of clinical manifestations and in some cases may be accompanied by severe circulatory disorders. Arteriovenous lung malformation (AVML) accounts for a small fraction of the AVM structure. The defect consists in the presence of arteriovenous anastomoses at the level of segmental, subsegmental and smaller vascular divisions. This article presents a case of detection of a rare malformation of arteriovenous malformation of the lower lobe of the right lung.

Behcet disease is autoimmune vasculitis with predominantly mucocutaneous manifestations; eye, gastrointestinal and nervous system involvement is also possible. Behcet disease is relatively rare in pediatric population.
This article presents the case of Behcet’s disease in a 17-year-old boy, with a usual delay in the diagnosis, the absence of internal organs involvement and successful first-line therapy (colchicine).