Morton’s neuroma is a  disease that  remains in  the  structure of  nosologies, which are  diagnosed and  treated by  neurosurgeons. It has  been known for  a  long time, while in  the  domestic literature there are  isolated works on  this topic, while in  the  foreign literature there  are a  suffi cient number of  publications on  this topic. The  aim of this article is  to  systematize knowledge on  this pathology, approaches to the diagnosis and surgical treatment options for Morton’s neuroma. The paper presents the anatomy and epidemiology of Morton’s neuroma, discusses diagnostic methods and modern options for its surgical treatment, and complications of surgeries.

Introduction. Until recently, surgical treatment of sphenopetroclival tumors was considered impossible. With the advancement of microsurgery and the emergence of new technologies, tumors in this area have become amenable to  surgical treatment. However, surgical treatment of tumors in  this area remains one of  the most challenging areas of  skull base surgery due  to  the  proximity of  important vascular and neurovascular structures.
The  aim. To  describe and  analyze treatment outcomes and  surgical complications associated with the anterior transpetrosal and infratemporal approaches in surgery for sphenopetroclival tumors.
Materials and methods. The study group included 13 patients (8 women and 5 men; mean age 55 years) with  sphenopetroclival tumors, operated  on using the  anterior transpetrosal and  infratemporal approaches. Patients were divided into two groups. Group 1 consisted of 7 patients (4 women, 3 men) with  sphenopetroclival tumors who  were operated  on using an  anterior transpetrosal approach. Group 2 included 6 patients (4 women, 2 men) with sphenopetroclival tumors who were operated on using an infratemporal approach.
Results. In the group 1, total resection was achieved in 1 patient, subtotal resection  – in 5 patients, and partial resection – in 1 patient with chondrosarcoma. In the group 2, total resection was achieved in 2 patients, subtotal resection – in 3 patients, and partial resection – in 1 patient with sphenopetroclival meningioma.
Conclusion. Surgical treatment of sphenopetroclival tumors remains one of the most challenging areas of skull base surgery. Various lateral and posterior approaches, or combinations of these approaches, are  used for  resection of  tumors in  this location. These diff erent approaches have both advantages and  disadvantages. Understanding the  technical nuances and  anatomical basis of  each approach is crucial for choosing the optimal approach.

Myasthenia gravis is the most common pathology from the group of neuromuscular synapse diseases. An urgent issue remains the development of a decrease in muscle mass in patients with this disease due to limited physical activity, steroid myopathy, senile sarcopenia, and a number of other factors.
The aim of the study. To identify diff erences in body composition parameters in patients with myasthenia gravis and healthy individuals using bioimpedance measurement.
Materials and methods. The prospective study included 40 patients with myasthenia gravis and 30 people in the control group (healthy volunteers) who underwent anthropometry and analysis of body composition using bioimpedance research.
Results. Patients with  myasthenia gravis showed a  higher body mass index (26.4  ±  5.2 versus 23.9 ±  4.1  kg/m2; p =  0.045), however, the  prevalence of  obesity in  both groups had no  statistically signifi cant diff erences and amounted to 11.1 % among patients with myasthenia gravis and 9.3 % in the control group (p = 0.82). At the same time, the percentage of fat mass was signifi cantly higher in patients with myasthenia gravis: 32.4 ±  6.8 versus 26.1 ±  5.2 % (p = 0.008), and  the proportion of people with excess fat mass was 57.1 % in the main group and 26.1 % in the control group (p = 0.031). In addition, in patients with myasthenia gravis, lean body weight, active cell mass and its proportion in body composition were statistically signifi cantly lower than in the control group: 55.4 ± 6.2 versus 58.7 ± 5.1 kg, 24.1 ± 5.8 versus 28.6 ± 4.7 kg and 44.8 ± 4.3 versus 49.1 ± 3.5 %, respectively. A reduced proportion of active cell mass (less than 50 % in women and less than 53 % in men) was detected in 68 % of patients with myasthenia gravis and only in 20 % of the control group. Similarly, a reduced proportion of musculoskeletal mass – less than 40 % in women and less than 45 % in men – was observed in 54 % of patients with myasthenia gravis versus 13 % in the control group. Bone mineral mass is lower in patients with myasthenia gravis: 2.21 versus 2.53 kg in the control, that is, 0.32 ± 0.19 kg less (p = 0.02). In 32% of patients, bone mineral mass values were lower than the conditional norm (2.0 kg), although this diff erence did not reach the level of statistical signifi cance (p = 0.052).
Conclusion. According to  the  bioimpedance study, patients with myasthenia gravis, compared with healthy volunteers in  the  control group, showed higher body mass index and  fat mass, combined with a decrease in lean, active cellular and musculoskeletal mass, as well as bone mineral mass.

The aim. To present the fi rst results of intraoperative microneurography of the trigeminal root in patients with classic trigeminal neuralgia and  to  assess the  relationship between recorded electrical activity and pain regression or persistence after microvascular decompression.
Materials and methods. The study included 13 patients with classic trigeminal neuralgia who underwent microvascular decompression (MVD) and 4 patients with posterior cranial fossa tumors (control group). Patients were divided into three groups: Group 1 – MVD with tactile stimulation (n = 9); Group 2 – MVD without stimulation (n = 4); Group 3 – control group with tactile stimulation (n = 4). Electrical activity of the nerve root was recorded before and after decompression. Pain assessment was performed using the Visual Analog Scale and the BNI scale.
Results. In all patients of Group 1, deep tactile stimulation evoked electrical activity of the trigeminal root before surgery, whereas superfi cial stimulation was not accompanied by recordable activity. After MVD, a signifi cant reduction in electrical activity was observed in 67 % of cases (6 out of 9), which correlated with pain regression. In  three patients with persistent pain (Group  1), electrical activity was  also recorded after surgery. In Group 2, no spontaneous ectopic activity was detected. In the control group, no electrical activity characteristic of classic trigeminal neuralgia was found. The signal-to-background amplitude ratio in patients with persistent pain after surgery was signifi cantly greater than 1 compared to the pain regression group (p = 0.003).
Conclusion. Intraoperative microneurography allows the  detection of  pathological electrical activity of the trigeminal root in patients with classic trigeminal neuralgia, which correlates with the presence of pain and its regression after surgical intervention. The proposed parameter – the ratio of electrical activity amplitude to  background – may  be considered a  potential criterion for  the  eff ectiveness of decompression, but requires further study in an expanded cohort.

Giant cell arteritis (GCA), previously known as temporal arteritis, is a chronic  immunemediated   infl ammatory disease with acute onset, representing the most common form of systemic vasculitis in patients over 50 years of age. The disease signifi cantly impacts quality of life and can lead to severe complications, including  irreversible  vision loss. Due to the diagnostic complexity of GCA and the need for  morphological  verifi cation of the diagnosis, the use of radiological  imaging methods is of particular importance. The application of a standardized, unifi ed MRI protocol improves diagnostic accuracy, confi rms the clinical diagnosis, and provides navigation for biopsy of the aff ected arterial segment.

Introduction. Conducting intraoperative neurophysiological monitoring in pregnant patients presents a complex challenge, as planning its protocol and choosing the anesthetic management requires consideration not only of the impact on the stability and reproducibility of the recorded neurophysiological parameters but also the specifi cs of pregnancy physiology and potential risks to the fetus. However, information regarding its use and safety is extremely scarce and requires further study.
Case description. This article presents a clinical case of a 29-year-old patient who underwent surgery at the Neurosurgery Department of the Irkutsk Order of the Badge of Honor Regional Clinical Hospital at 29 weeks of gestation for an intradural tumor of the cauda equina nerve roots (ependymoma G2) at the L2–L3 vertebral level, with the use of intraoperative neurophysiological monitoring (IONM). Anesthetic management included combined endotracheal anesthesia in conjunction with an erector spinae plane block. The IONM protocol included recording of somatosensory evoked potentials from the lower extremities, free-run electromyography, and stimulated electromyography. During direct stimulation of the nerve root intimately adhered to the tumor, M-responses were obtained from the left lower leg muscles; the nerve root was preserved, and the tumor was mobilized and removed en bloc. No new neurological defi cit was observed in the early postoperative period; at the time of discharge, the condition of both the mother and the fetus was satisfactory.
Conclusion. Thus, the use of IONM in pregnant patients with neurosurgical pathology improves the neurological outcome of the disease and is safe for both the mother and the fetus.

Introduction. Angioleiomyoma is a benign tumor arising from the smooth muscle layer of the vascular wall. These neoplasms can cause pain and mimic other pathologies, creating diffi culties in preoperative diagnosis, especially when located in the hand.
Aim. To present a clinical case of hand angioleiomyoma, demonstrate the challenges of diff erential diagnosis with neuromas, and evaluate the eff ectiveness of microsurgical treatment with vascular reconstruction.
Case description. A 62-year-old female patient presented with a 5-year history of intense pain in the fourth interdigital space of the left hand. Preoperative diagnostics, including ultrasound and magnetic resonance imaging, suggested a neuroma of the proper digital nerve. However, intraoperatively, a vascular mass arising from the wall of the common palmar digital artery was identifi ed. Microsurgical excision of the mass was performed with resection of the involved arterial segment and restoration of blood fl ow via an end-to-end anastomosis. Histological examination confi rmed the diagnosis of angioleiomyoma. In the postoperative period, signifi cant regression of pain was achieved.
Discussion. This clinical case highlights the necessity of including vascular neoplasms in the diff erential diagnosis of painful hand masses. Our case confi rms the eff ectiveness and successful outcome of microsurgical treatment of hand angioleiomyoma with subsequent restoration of vascular integrity by means of an end-to-end microsurgical anastomosis.

Introduction. Abnormalities of the circle of Willis can be associated with the development of cerebrovascular pathology.
Description of cases. This article presents an extremely rare clinical observation of a patient with bilateral agenesis of the internal carotid arteries who suff ered an ischemic stroke in the vertebrobasilar territory due to dissection and occlusion of one of the vertebral arteries.
Discussion and conclusion. Based on the presented case and a few scientifi c publications, the possible pathogenetic link between bilateral internal carotid artery agenesis and the development of cerebrovascular disorders is discussed.

Introduction. Vertebrobasilar dolichoectasia (VBD) is a rare vascular disorder characterized by abnormal elongation, tortuosity, and dilatation of the vertebral and basilar arteries. Its etiology remains incompletely understood. The reported prevalence ranges from 0.05 to 5.8 %. Clinically, VBD most often manifests asischemic stroke, compression of  the  cranial nerves and  brainstem, and,  less frequently, as intracranial hemorrhage and hydrocephalus. The prognosis depends on the clinical presentation and the degree of arterial dilatation within the vertebrobasilar system.
The aim. To present a clinical case of surgical management of symptomatic compression of the trigeminal and facial nerve roots caused by vertebrobasilar dolichoectasia using a subtemporal transtentorial approach.
Clinical case description. Patient A., a 61-year-old man, was admitted with complaints of serial episodes of pain in the left half of the face radiating to the mandible, accompanied by paroxysmal spasm of the left facial muscles. He had been taking carbamazepine with only temporary effect. Magnetic resonance imaging, computed tomography (CT), and CT angiography revealed an S-shaped course of the right vertebral artery in its intracranial segment with deviation to the left. The confl uence of the vertebral arteries was located in the region of the left cerebellopontine angle. Signs of neurovascular confl ict involving the left trigeminal and facial nerves with the displaced left vertebral artery were identifi ed. A temporo- occipital craniotomy was performed, followed by microvascular decompression of the left trigeminal and facial nerves. In the postoperative period, the neurological status showed no increase in focal defi - cits; the pain syndrome and hemifacial spasm resolved.
Discussion. Currently, there  are no  universally accepted guidelines for  the  management of  patients with VBD. Treatment is symptomatic and aims to correct cerebrovascular disturbances and compression syndromes that develop upon manifestation of VBD. In cases of neurovascular conflict, conservative management represents the first line of therapy. The role of microvascular decompression in VBD-induced neurovascular confl ct remains a subject of debate.