Neurosurgeon, Ph.D. Sergey Tikhomirov 

degenerative diseases of the spine: protrusions and herniated discs, spondyloarthrosis, spondylodiscitis, scoliosis;

craniocerebral trauma and its consequences;

cerebral circulation disorders;

trauma to the spine and spinal cord;

peripheral nerve injury;

brain tumors;

epilepsy;

multiple sclerosis;

Bell's palsy;

neurotic disorders;

neurodegenerative diseases of the central nervous system: Parkinson's disease, Alzheimer's disease, Binswanger's disease;

neuropathies and polyneuropathies.

   MSCT (multispiral computed tomography), MRI (magnetic resonance imaging) in the original digital dicom format (manual), or high-quality photos/scans of the images in png or jpeg format;

Cranioplasty is the surgical repair of defects in the cranial vault
(the dome-shaped part of the skull). It sounds complicated, but in
reality, it is an operation that closes the “hole” in the head
caused by trauma or disease. Why is this necessary? First, the brain
needs to be protected from mechanical damage. Second, an intact skull
helps fluids circulate properly around the brain. Third, it is
important for the patient's appearance and psychological comfort.

When is cranioplasty
necessary?

Skull defects can
occur in several ways:

After severe head
injuries. In cases of serious fractures, when the bone is shattered,
surgeons have to remove the damaged fragments to prevent them from
entering the brain.

In cases of critical
brain edema. When the brain swells sharply due to a stroke,
hemorrhage, or severe trauma, doctors perform a decompressive
craniectomy — removing part of the bone to give the brain room to
expand and save the patient's life. Later, when the swelling
subsides, this bone must be put back in place.

Due to infection.
Sometimes an infection of the bone tissue (osteomyelitis) develops in
the area of the operation, and the infected area of the bone has to
be removed.

For tumors. If a
tumor affects the skull bone, surgeons remove that area along with
the tumor and then restore the brain's protection.

Trepanation
syndrome: when the defect affects life

After removing part
of the skull, patients often develop an unpleasant condition that
doctors call trepanation syndrome. Imagine: a hollow forms in the
head, and the skin above it sinks inward. Atmospheric pressure
literally presses on the brain through this hollow.

How it feels:

-- Headache —
often worse when standing or sitting. The pain is less severe when
lying down because atmospheric pressure is less intense.

-- Dizziness and
fatigue — patients feel exhausted and have difficulty
concentrating.

-- Memory and
thinking problems — the person has trouble remembering information,
finds it difficult to plan, and becomes distracted.

MRI of the patient's cervical spine after atezolizumab therapy. MRI scans show signs of myelitis.

MRI of the patient's cervical spine after atezolizumab therapy. MRI scans show signs of myelitis.

Kimmerli's anomaly, also known as ponticulus posticus, is an anatomical variant involving the ossification of the posterior atlanto-occipital membrane over the groove of the vertebral artery, leading to the formation of an arcuate foramen or ridge (). This anomaly can result in extravasal compression of the vertebral artery, which can sometimes cause cerebrovascular symptoms.

A complete Kimmerli anomaly on the right and an incomplete one on the left.

Patient C., 16 years old, applied. According to the patient's words, the previous day he accidentally shot himself in the head from a pneumatic weapon. On visual examination, an entrance hole with a diameter of 2-3 mm was seen in the right frontal region.

The patient underwent MSCT of the brain. A foreign body is seen in the soft tissues of the frontal region. Due to metal artifacts it is not possible to make an unambiguous conclusion about the presence or absence of damage to the frontal bone.

A patient came to the consultation complaining of pain in the lumbar region radiating along the posterior surface of the right lower limb. An X-ray report on an MRI examination of the lumbar spine by a radiologist described a left-sided herniated disc. Visual examination of the MRI scans shows that the herniation originates from the left segment of the intervertebral disc, and then spreads obliquely down and to the right with moderate compression of the right S1 root.

Patient K., 47 years old, was injured as a result of a fall from a snowcat. He was taken by an ambulance brigade to the Kineshma Central District Hospital (Ivanovo Region, Kineshma).

According to the results of MSCT of the brain, the patient was found to have:

-- Acute epidural haematoma of small volume in the pole section of the right temporal lobe of the brain.

-- Acute small-volume patch-like subdural haematoma in the right temporoparietal region without signs of brain compression.

-- Traumatic subarachnoid haemorrhage.

-- Linear fracture of the scale of the right temporal bone.

Fig.1,2: MSCT scans performed when the patient was admitted to hospital showing traumatic intracranial haematomas.

Fig.3: 3D reconstruction based on MSCT scans. A linear fracture of the scales of the right temporal bone is seen.

A foraminal block is a medical procedure in which a medication (usually a local anesthetic and/or corticosteroid) is injected into the area where the spinal nerve exits through the intervertebral foramen (foraminal opening). This procedure is used to diagnose and treat pain syndromes associated with compression or inflammation of nerve roots.

Indications for foraminal blockade

-> Radiculopathy - pain caused by nerve root compression (e.g., herniated disc, spinal canal stenosis, or osteophytes).

-> Radicular syndrome - pain that irradiates along the course of the nerve (e.g., sciatica).

-> Chronic back or neck pain that cannot be treated conservatively.

-> Diagnosis of the source of pain - if the cause of the pain is unclear, a block can help determine if the pain is related to a specific nerve root.

-> Inflammation of the nerve root (e.g. spondyloarthritis).

Fig.1: MRI of the lumbar spine. Right-sided foraminal herniation of the intervertebral disc L4-L5 is visible.

Fig.2: MRI of the lumbar spine. Right-sided foraminal herniation of the intervertebral disc L4-L5 is visible.

Patient B, 57l, came for a consultation. Past medical history. First time severe pain in the lumbar region with irradiation to the left lower extremity occurred in 2017. He refrained from the proposed surgery. I was treated conservatively. The pain gradually regressed and the patient had no back problems for several years. He became ill again in 2025, but this time the pain from the lumbosacral region irradiated to the right lower extremity. MRI scans from 2017 and 2025 were presented for consultation.

Below is a series of scans from 2017

MRI of the lumbar spine dated 2017. Left-sided paramedian sequestered L5-S1 herniation is seen.

degenerative Erkrankungen der Wirbelsäule: Bandscheibenvorwölbungen und -vorfälle, Spondyloarthrose, Spondylodiszitis, Skoliose;

Schädel-Hirn-Trauma und seine Folgen;

Störungen des zerebralen Kreislaufs;

Trauma der Wirbelsäule und des Rückenmarks;

periphere Nervenverletzungen;

Hirntumore;

Epilepsie;

Multiple Sklerose;

Bellsche Lähmung;

neurotische Störungen;

neurodegenerative
Erkrankungen des zentralen Nervensystems: Parkinsonsche Krankheit,
Alzheimersche Krankheit, Binswangersche Krankheit;

Neuropathien und Polyneuropathien.