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AIM: to assess effectiveness of mimic muscles rehabilitation after cross neuroplastics using accessory nerve (AN) by neurological scales estimating functional outcome. MATERIAL AND METHODS: During 1998-2010 20 patients underwent cross neuroplastics of facial nerve (FN) by a main trunk of AN. The average follow-up was 4.65 years (1-10 years). At baseline all patients had total function loss of FN after excision of acoustic neuroma. The interval between function loss and surgery was 1-6 months (4.7 months in average). Patients were within age range 37-73 years (51.8 years in average). Each patient was accessed by clinical scales House-Brackmann Facial Grading Systems (HB) and Yanagihara system (YS) for estimation of the extent of mimic paresis. Sunnybrook Facial Grading scale (SFG) was used to assess facial symmetry and synkineses. Self-assessment questionnaire Facial Disability Index (FDI) was also used. Original questionnaire, Shoulder Disability Index (SDI), including 4 questions was used for self-assessment of a denervated shoulder segment (maximum 100 degrees). RESULTS: 4 patients (20%) recovered up to HB II, 11 (55%) - up to HB III and 5 (25%) - up to HB IV-V. Average degree by YS was 27.5±4.06, average SFG was 71.1±9.38. Average degree by self-assessment (FDI) was 143.75± 22,82, and average SDI was 69.06± 22.16. All acquired data was statistically analyzed and compared. Strong correlation (r= -0.72, p< 0.001) was found between magnitudes of HB, YS and SFG after surgery, and between total FDI and SDI (r=0.56, p<0.001). CONCLUSION: Results of cross neuroplastics of FN using AN are compatible with those in other neuroplastic techniques and improve patients' quality of life. This procedure is acceptable for rehabilitation of FN function after surgery of skull base. The main problem of assessment of mimic muscles is subjectivism, that is why clinical scales and self-assessment questionnaires have to be used. After cross neuroplastics denervated segment of shoulder should be assessed by the specialized scale.

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PURPOSE: The study was conducted to analyze different criteria for lumbar discectomy success rate. MATERIAL AND METHODS: 493 patients were evaluated by five-component visual-analogue pain scale, Oswestry index, ability to perform normal daily activity and work, satisfaction with surgery results and Watkins scale. RESULTS: Good and excellent results of surgery correspond with good functional outcome. Generally, values reflecting good outcome could also be used as successful surgery criteria, although 10 to 20% of those patients still have pain complaints and/or are not satisfied with their postoperative functional and economic status. CONCLUSION: None of the abovementioned criteria has proved to be absolute prognostic factor. Combination of different predictive values might be useful in lumbar disc surgery outcome anticipation.

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The study was performed for development of more precise criteria for assessment of pain using five-component visual analogue scale. Pain status was studied in 493 patients who underwent lumbar spinal nerve root decompression. Pain scale included the following parameters: pain at the moment, usual pain, maximal pain, minimal pain and overall pain score which was calculated as an average quantity of the previous four parameters. Overall pain score is a more precise criterion for evaluation of postoperative pain status in patients with degenerative lumbar spine disease.

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BACKGROUND: Aim of the study was to assess results of treatment and quality of life of patients with hemifacial spasm (HFS) after microvascular decompression and to analyze intraoperative data in surgical revision of intracranial portion of facial nerve. MATERIALS AND METHODS: The study included 30 patients with HFS who underwent microvascular decompression. Duration of symptoms varied between 1 and 30 years (mean--6.7 years). Typical manifestation of spasm was observed in 28 cases, atypical--in 22. Severity of HS and its influence on everyday activity were assessed using 5-grade scale (by E. Tan), and surgical results--according to degree of clinical improvement combined with evaluation of quality of life using scale HFS-7. RESULTS. Most frequent type of conflict observed in the series was contact between facial nerve and AICA (64.4%). Compression of facial nerve root entry zone was revealed in vast majority of cases (93.3%), and in 2 patients (6.7%) site of compression was distal to the root entry zone. In a female patient with secondary HFS due to the tumor relations of neurovascular structures were altered and their displacement produced conflict between AICA loop and facial nerve. In our series hearing depression of different severity was observed in 16.7% of patients. This disorder is persistent and does not regress in the follow-up period. All other symptoms of cranial nerve dysfunction are amenable to resolve within 1-2 months. CONCLUSION: Microvascular decompression of facial nerve is pathogenetically feasible and effective method of treatment of HFS. It allows achievement of consistent regression of symptoms and improvement of quality of life of patients with HFS.

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Examining responses of the local immune system of the brain in neurocancer patients suggests that the immune system is involved in the neuroimmune interaction of both physiological and pathological conditions in the central nervous system (CNS). The setting off the local immune system of the brain is of functional nature, similar to functional analogy with the local system of the mucosae. By functional analogy, the aggregate of immune responses in the nervous tissue and cerebrospinal fluid should be called local and the system that includes these responses should named the local immune system of the brain. Due to the fact that nervous, endocrine, and immune regulatory pathways intersect in the CNS (hypothalamus), it is expedient to call this aggregate of defensive factors and mechanisms in CNS more broadly--the neuroimmune system.

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On the basis of a complex analysis of surgical treatment of 52 patients with degenerative diseases of the lumbosacral part of the spine complicated by the formation of compressive reticulopathies main states were established responsible for the worse quality of life of this category of patients. Different forms of vertebrogenic radiculopathies were determined according to the morphological substrate of compression. The methods of diagnosing the spinal diseases at the lumbosacral level were estimated and the diagnostic algorithms for different variants of degenerative lesions were developed. Rational schemes of surgical correction are proposed according to the established groups of vertebrogenic lumbosacral radiculopathies. Special attention is given to prophylactics of recurrences of the pain syndrome and postoperative instability of the spine.

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This paper presents the information on the early period of an explosive head trauma and trauma to the auditory system. Different types of hearing impairment, the staging of the pathological process were determined along with various immunological and biochemical changes occurring in this group of patients. The results of the study call for necessity of the early ENT observation of all patients in whom an explosive trauma is suspected.

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The wide use of the mine-explosive weapon in modern military conflicts is accompanied by high specific weight of mine-explosive traumas (MET), which achieve 30-40% of all traumas. In the departments of the hospital in 21.3-35.8% of the wounded with MET accompanying defeat of acoustical system with probable subsequent development of neurosensory hypoacusis and invalidism of the injured is established. It defines necessity of early ENT-inspections of all injured with such traumas. Steady up to 1-6 months reduction of hearing is accompanied by biochemical infringements of a cerebrospinal liquid.

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The cerebrospinal fluid was investigated in 16 patients with chronic cerebral ischemia. Reactions of the local immune system of the liquor was shown to change by the autoimmune type. Medical efficiency of cerebrospinal fluid sorption was proved and it can be considered a method of detoxication aimed at breaking the pathogenetic chain: formation of abundance of the autoantibodies--increased amount of the circulating immunocomplexes--damage of the cell membranes--discharge of deep antigens--appearance of a new generation of autoantibodies. Using cerebrospinal fluid sorption as a test for the detection of latent functional reserves of the neurons not changed irreversibly in the zone of reduced perfusion of the cerebral tissue is thought to be a perspective method.

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Biochemical reactions of the liquor were investigated in 68 patients with gunshot wounds of the skull and brain and in closed treatment of the brain wound. The reactivity of biochemical system plays a certain role in the development of infectious complications. In dead people the developing pathogenetical biochemical syndromes having a sanogenic role of clearance from antigens of the injured tissues turn pathogenesis into thanatogenesis.

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An analysis of immunobiochemical indices of the cerebrospinal fluid has shown possibilities to establish objective mechanisms of injuries of the brain by explosions. Biochemical manifestations of the cytolysis syndrome can be taken as symptoms of primary injury of the brain under conditions of burst polytrauma since increased activity of cytoplasmic and mitochondrial enzymes in the liquor is directly proportional to the brain trauma degree. The primary injury of the brain is characterized by a specific immune response: increased concentration of IgG, IgA in the liquor with the increased circulation of immune complexes.

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Specific features in the immunological status of 49 wounded with explosion injuries of neurosurgical profile are as follows: in light injuries--it is hyperergic character of the immune system and its inadequacy to the injuries of a middle degree it is a distinct parallelism between the dynamics of the immune status indices and the functional state of the CNS depending on the severity of the injury-an extremely flabby with the inhibiting of main immunological indices at a low but permanent level.

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The paper shows the formation of immunopathological syndromes in the cerebrospinal fluid in the victims with gunshot wounds in relation to the policy and outcome of treatment. Suturing the dura mater during a primary surgical treatment should be regarded as a protective process to limit antigen release, the development of immunological paralysis and autoimmunization. Deaths are caused by the neurogenic immune dysfunction induced by the inadequate functioning of the psychoneuroimmunoendocrine connections of the whole body.

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The selection of neurosurgical minor wounded during casualty staging has a number of specific features. First of all it is caused by objective difficulties in the diagnosis of wounds and traumas of nervous system. Patients who have even minimal traumas of soft tissues of head or bone structures of skull could have intracranial injuries which could be treated only at the stage of tertiary medical care. These patients can be evacuated to the hospital for minor wounded if they have no confirmation on intracranial injuries.

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The work analyzes preliminary results of a complex method of treatment of severe ischemic alterations of the brain. Certain parameters of the immune system, its phagocytic link in particular, were studied along with clinico-physiological indices of the functional state of the brain. It was shown that efficient surgical revascularization of the ischemic zones reinforced by electrostimulation at the early postoperative period allowed to substantially restore the motor and speech functions even in cases of critical lesions. Higher indices of functional activity of the phagocytic link of the immune system were noted.

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