Among elderly patients, normal pressure hydrocephalus (NPH) is a socially significant and as yet unresolved problem in modern medicine. Its diagnosis is signifi cantly complicated by the similarity of its clinical manifestations to those of neurodegenerative and vascular diseases (vascular dementia, Alzheimer’s disease, progressive supranuclear palsy).

The aim. To present the neuroradiological markers commonly associated with normal pressure hydrocephalus, as well as the current radiological scale for assessing the probability of NPH (Radscale), its advantages, and disadvantages. This scale allows for the standardization of the assessment of radiological signs when NPH is suspected and can be used as a diagnostic screening tool.

Background. It is currently generally accepted that rehabilitation is an integral part of comprehensive multiple sclerosis (MS) therapy. However, data on the effi  cacy and safety of MS rehabilitation during relapses are limited. Given that recovery after relapse occurs in half of cases, a search for non-pharmacological strategies is necessary.

Materials and methods. The study included 32 patients with relapsed MS (2–7 points on EDSS (Expanded Disability Status Scale)). Patients in control Group 2 (14 patients) received high-dose pulse therapy with glucocorticoids only. Group 1 (18 patients) received motor rehabilitation in addition to pulse therapy. To assess the efficacy and safety of early rehabilitation during a relapse, standardized scales (FSS (Fatigue Severity Scale), FIS (Fatigue Impact Scale), Borg Scale, 6-minute walk test, Borg Balance Scale, and 9-peg test) were used before treatment and upon discharge. Patients were assessed using the EDSS upon admission, discharge, and 3–4 months later.

Results. After treatment, statistically significant diff erences were observed between the groups, with Group 1 demonstrating superiority over the control group on the following scales: the emotional subscale of the FIS (p = 0.045), the 6-minute walk test (p = 0.045), the EDSS (p = 0.018), and the rehabilitation routing scale (p = 0.025). Statistically significant differences emerged between the groups on the EDSS 3–4 months after treatment, indicating better recovery in Group 1, which received physical rehabilitation in addition to pulse therapy (p = 0.02).

Discussion. Physical rehabilitation during an MS relapse during pulse therapy is safe and eff ective when the principles of load dosing and prevention of overheating are followed.

Postoperative facial nerve paralysis is the most frequently detected complication in surgery of tumors of the cerebellar bridge angle.

The aim of the study. To carry out a retrospective assessment of the long-term results of trigeminal neurotization of the facial nerve, taking into account the timing of reinnervation.

Methods. In the period from 2013 to 2020, 67 patients underwent surgical treatment, within a period of 1 to 13 months after the detection of facial nerve paralysis. In almost all cases, facial nerve paralysis was the result of surgical treatment of tumors of cerebello-pontine angle (66 patients), in one case, paralysis developed as a result of traumatic injury. The function of the facial nerve was evaluated both in the preoperative period and in the catamnesis. The House – Brackmann (HB) scale and electromyography were used for this purpose. The catamnesis lasted from 15 to 98 months.

Results. In 61 patients, functional restoration ofthefacial nerve wasobserved from grade6 tograde3 or 4 HB (91 %). Patients operated on early after the development of facial paralysis showed better postoperative recovery (Spearman’s r = 0.3; p = 0.038).

Conclusion. The results of surgical treatment indicate that early reinnervation in patients with facial paralysis demonstrates a significant regression of facial paralysis without the development of additional complications.

The availability of an objective, instrumental intraoperative method for assessing the eff ectiveness of microvascular decompression (MVD) in classical trigeminal neuralgia (cTN) is undoubtedly indispensable in modern neurosurgery.

The aim. To study the applicability of the ZLR method for intraoperative identification of the causative vessel and assessment of the completeness of trigeminal nerve root decompression in classical trigeminal neuralgia.

Materials and methods. A prospective study was conducted involving 10 patients with cTN. During MVD, a ZLR monitoring protocol was used, including stimulation of vessels in the neurovascular confl ict zone with a bipolar concentric electrode in the range of 0.1–2.5 mA, as well as recording of the masseter muscle responses (ZLR, ZL-response) before and after MVD. Postoperative pain regression was clinically assessed.

Results. In 90 % of cases, the causative vessel was the superior cerebellar artery (SCA). The arterial stimulation threshold before MVD was 0.4 ± 0.22 mA, after MVD – 1.5 ± 0.49 mA (p < 0.05). After decompression, there was no response to arterial stimulation up to 2.5 mA in 54.5 % of cases. Venous stimulation required higher parameters (1.3 ± 0.61 mA before MVD), and in most cases, there was no response from the target muscle either before or after decompression. Postoperatively, pain completely regressed in 90 % of cases; however, in one case, partial persistence of facial pain was noted, which completely regressed with conservative therapy.

Conclusion. Given the obtained stimulation threshold parameters, the ZL response method allows for intraoperative verifi cation of the causative arterial vessel and assessment of the effectiveness of microvascular decompression, as evidenced by favorable clinical outcomes. The role of venous compression requires further study. Further research is needed to evaluate the prognostic signifi cance of this method, as well as the role of venous compression.

Thearticle describes aclinical case ofsuccessful treatment ofapatient with primary brain echinococcosis (microsurgical removal + drug therapy). It presents key epidemiological data on the disease, current approaches to treating echinococcosis of the central nervous system, as well as potential complications and clinical outcomes. 

Introduction. An epidermoid cyst, also known as a “pearly tumor” or cholesteatoma, is a rare, slowgrowing benign neoplasm. Giant epidermoid cysts with extra-intracranial growth are extremely rare, with only a few dozen cases of giant epidermoid cysts with extra-intracranial extension described in the available literature.

Aim of the study. To present a clinical observation and analyze the literature.

Case report. A 57-year-old woman with a history of head trauma (at age 20) had been experiencing periodic right-sided headaches accompanied by dizziness for many years. In 2021, a mass was fi rst detected in the right parietal region, which gradually increased in size. By 2024, the headaches had become intense. Clinical examination revealed a fi rm, elastic mass approximately 7 cm in diameter in the right parietal region, immobile, with signifi cant local tension of the scalp skin and no tenderness on palpation. No neurological defi cit was detected.

Computed tomography (CT) revealed an oval-shaped mass (73 × 52 × 50 mm) of heterogeneous structure with intra- and extracranial extension and bone destruction. Brain MRI in T2-mode showed a hyperintense mass compressing the right hemisphere without infi ltrative changes in the brain parenchyma. In T1-mode with contrast enhancement, no contrast accumulation was observed. Removal of the epidermoid cyst with resection of the lysed bone and simultaneous cranioplasty using a titanium mesh was performed.

Conclusion. Giant epidermoid cysts with extra-intracranial extension represent a rare pathology, more commonly found in middle-aged and elderly patients. Despite their benign nature, their growth can lead to signifi cant destruction of bone structures and compression of surrounding tissues, necessitating timely surgical intervention. This clinical case highlights the importance of a multimodal approach in the diagnosis (computed tomography, magnetic resonance tomography) and surgical treatment of such lesions. With timely and radical intervention, the prognosis for patients remains favorable.

While arterial compression is the predominant cause of trigeminal neuralgia, venous etiologies remain poorly characterized. Developmental venous anomalies (DVA) are generally regarded as benign incidental fi ndings but may occasionally result in symptomatic neurovascular conflict. We report a case series of four patients with trigeminal neuralgia attributed to developmental venous anomalies, focusing on imaging features, underlying pathophysiological mechanisms, and surgical management.

All patients underwent brain magnetic resonance imaging (MRI) using a standardized cranial nerve protocol. MRI demonstrated DVAs with direct venous contact or compression of the trigeminal nerve root entry zone, sometimes associated with nerve thinning, complex venous networks, or altered venous drainage due to chronic venous outfl ow obstruction. Microvascular decompression was performed using tailored, vein-preserving approaches.

Postoperative pain relief was achieved in all four patients; however, postoperative sensory defi cits and late pain recurrence were observed in individual cases. These findings indicate that DVAs can represent a rare but clinically relevant cause of trigeminal neuralgia. Advanced MRI plays a pivotal role in diagnosis and surgical planning, and recognition of venous neurovascular confl ict is essential, particularly in younger patients with atypical imaging findings.

Introduction. Endovascular thrombextraction is the treatment of choice for ischemic stroke associated with thrombosis of large cerebral arteries. According to the literature, complications due to thrombextraction occur in 4–29 % of cases. Distal thrombus migration, arterial dissection, and hematomas at the femoral artery puncture site are the most common complications of the procedure. One rare but serious complication is cerebral artery perforation during thrombextraction, the incidence of which varies from 0.3 to 9 % according to different researchers.

Description of cases. This paper describes two clinical cases of patients with ischemic stroke in whom perforation of the middle cerebral artery occurred during thrombextraction. To stop bleeding in both cases, embolization and closure of the middle cerebral artery lumen with microcoils were performed. Both patients survived despite developing ischemic areas. One patient was discharged with a functional outcome according to the modified Rankin scale of Rankin 2, the second patient – Rankin 4.

Discussion and conclusion. In our series, the incidence of cerebral artery perforation during thrombextraction was 0.5 % (2 out of 403 cases). Both cases involved elderly women (72 and 77 years old). No risk factors or causes for middle cerebral artery perforation were identifi ed. A review of the surviving angiograms and surgical protocols revealed no technical errors or difficulties during the procedure. Despite the catastrophic complication, prompt embolization of the vessel and subsequent intensive care (control of cerebral edema and vasospasm) saved the patients’ lives and even achieved satisfactory functional status in one case.

The aim. Toconduct acomprehensive historical andanalytical review ofthedevelopment ofneurosurgical thought and practice in Egypt in the context of global historical epochs: from the Ancient World to the Modern Era.

Materials and methods. Based on the analysis of primary historical sources (Edwin Smith Papyrus), data from the scientific literature on the history of medicine, and modern organizational and statistical reports, a systematic retrospective review was performed. The historical-genetic method was used to identify continuity and key transformations.

Results. The development of neurosurgery in Egypt is presented within four periods. First period – Ancient World (IV millennium BC – V century AD): formation of empirical foundations (Edwin Smith Papyrus) and translation of knowledge through the Alexandrian School into ancient medicine. Second period – Middle Ages (V century – end of XV century): preservation of theoretical heritage in the Arab-Islamic medical tradition amid practical stagnation. Third period – Modern History (end of XV century – beginning of XX century): influence of European medical schools under Ottoman rule, laying the foundations of modern education (Kasr-el-Ainy School, 1837). Fourth period – Modern Era (mid-XX century – present): formation of the specialty through the efforts of pioneers (S. Boktor, O. Serour), institutionalization (Egyptian Society of Neurosurgeons, 1967), technological modernization and integration into the global community.

Conclusion. The evolution of neurosurgery in Egypt was intermittent, directly dependent on the political and cultural context of the epochs. The modern stage is characterized by overcoming the historical gap: while maintaining a colossal practical workload, there is an active introduction of high technologies and the strengthening of the leading positions of Egyptian neurosurgeons in the Middle East and Africa region.