Background. Severe traumatic brain injury (TBI) remains one of the leading causes of mortality and disability, particularly in resource-limited settings where invasive intracranial pressure (ICP) monitoring is unavailable. The international Brain Trauma Foundation guidelines require specialized equipment, creating a substantial gap between evidence-based medicine and actual clinical practice in low-resource institutions.

The aim. To present and analyze the international consensus protocol CREVICE (Consensus REVised ICE (Imaging and Clinical Examination)) – a modified management system for patients with severe TBI designed for use in the absence of ICP monitoring – and to evaluate its potential applicability in Russian healthcare facilities.

Main provisions. The CREVICE protocol is a logical development of the ICE protocol, which was validated in the randomized BEST:TRIP trial. The protocol is based on the use of computed tomography (modified Marshall classification) and clinical-neurological criteria (motor response on the Glasgow Coma Scale, pupillary response) as surrogate markers of intracranial hypertension. The protocol includes clear criteria for initiating treatment of suspected intracranial hypertension, a hierarchical escalation therapy with dosing of hyperosmolar agents, an algorithm for managing neurological deterioration, and a detailed de-escalation system using visual decision-making matrices. Contraindicated therapeutic modalities (corticosteroids, prolonged hyperventilation, continuous mannitol infusion) are specifically addressed.

Conclusion. The CREVICE protocol is a practical tool that enables the application of modern neurocritical care principles in the absence of invasive neuromonitoring. Its implementation into clinical practice may contribute to treatment standardization, reduced mortality, and improved functional outcomes in patients with severe TBI. For Russian healthcare facilities, the CREVICE framework can serve as a reference for the development and modernization of local clinical protocols.

Background. Paraclinoid aneurysms of the internal carotid artery account for 5–15 % of all intracranial aneurysms, with approximately 49 % of these reaching large or giant sizes. Microsurgical treatment of these aneurysms in the acute phase of subarachnoid hemorrhage is associated with difficulties in visualizing the proximal neck, ensuring proximal control, decompressing the optic nerve, and reconstructing the internal carotid artery lumen. Despite the development of endovascular technologies, microsurgical clipping remains important in this patient population.

The aim. To evaluate the efficacy and safety of microsurgical treatment of large and giant paraclinoid aneurysms of the internal carotid artery in the acute phase of subarachnoid hemorrhage.

Materials and methods. This retrospective study included 35 patients with large and giant paraclinoid aneurysms of the internal carotid artery who underwent surgery for acute subarachnoid hemorrhage at the Moscow Regional Research and Clinical Institute from June 2019 to December 2025. All patients underwent microsurgical treatment within 24 hours of admission. Clinical and neurological status, neuroimaging characteristics of the aneurysm and hemorrhage, surgical approach, anterior clinoidectomy, use of intravascular blood aspiration, aneurysm exclusion efficacy, functional outcomes according to the modified Rankin scale (mRS), perioperative complications, and mortality were assessed.

Results. Anterior clinoidectomy was performed in 33 (94.3 %) patients, including extradural in 25 and intradural in 8. Intravascular blood aspiration was used in 14 (40.0 %) patients. The radicality of aneurysm exclusion was 94.3 %. Favorable functional outcomes (mRS 0–2) in the follow-up period were achieved in 24 (68.6 %) patients, moderate/severe disability (mRS 3–4) in 5 (14.3 %) patients, and profound disability (mRS 5) in 1 (2.9 %) patient. Symptomatic cerebral vasospasm with foci of delayed cerebral ischemia was observed in 8 (22.9 %) patients, shunt-dependent hydrocephalus in 5 (14.3 %) patients, and a hemorrhagic complication requiring revision in 1 (2.9 %) patient. Development or worsening of third nerve dysfunction in the early postoperative period was detected in 12 (34.3 %) patients, with residual deficit persisting in 2 (5.7 %) patients. Transient visual impairment was noted in 10 (28.6 %) patients. Improvement was observed in 11 (64.7 %) of 17 patients with preoperative visual deficit after optic canal decompression. Mortality at discharge was 8.6 %, and in follow-up, it was 14.3 %.

Conclusion. The use of modern microsurgical techniques, including anterior clinoidectomy, direct and retrograde relaxation of the aneurysm sac, and reconstructive clipping, ensures effective and safe treatment of patients with large and giant paraclinoid aneurysms of the internal carotid artery during the acute phase of subarachnoid hemorrhage.

Introduction. The generational shift in the higher medical education system highlights the need to study the career expectations and professional preferences of Generation Z, whose members constitute the majority of students and early-career specialists.

The aim. To analyze the perception of neurosurgery as a specialty among Generation Z as a direction for further professional choice, assessing attitudes, motivational factors, expectations, and perceived barriers.

Materials and methods. An online survey was conducted among 149 respondents (4–6th-year students, residents, postgraduate students, general practitioners, and early-career neurosurgeons). The questionnaire consisted of 23 items covering sociodemographic characteristics, factors influencing the choice of neurosurgery, barriers, expectations from professional activity, as well as engagement with social media and innovative technologies.

Results. It was found that 48 % of students consider neurosurgery as a potential career path. The key motivating factors are the uniqueness of surgical procedures (78.5 %), the diversity of subspecialties (58.9 %), and the technological nature of the profession. The main barriers include psychosocial factors (responsibility, risk of burnout), and among residents – paperwork (51 %) and a lack of mentorship (44.8 %). A high demand was identified for international internships (87 %), rotations, and financial support during training. High levels of engagement with social media (76.4 %) and use of artificial intelligence (75.7 %) were recorded.

Conclusion. The data obtained in the study demonstrate the need for active modernization of educational programs, taking into account the value orientations of the new generation. Priority areas should include: developing mentorship systems, integrating active rotations and internships into the curriculum, reducing documentation burdens, and introducing digital technologies into simulation-based training.