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;

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.

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.

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;

   Enfermedades degenerativas de la columna vertebral: protrusiones y hernias discales,espondiloartrosis, espondilodiscitis, escoliosis;

    traumatismos craneoencefálicos y sus consecuencias;

    trastornos de la circulación cerebral;

    traumatismos de la columna vertebral y la médula espinal;

    lesiones nerviosas periféricas;

    tumores cerebrales;

    epilepsia;

    esclerosis múltiple;

    parálisis de Bell;

    trastornos neuróticos;

    enfermedades
neurodegenerativas del sistema nervioso central: enfermedad de
Parkinson, enfermedad de Alzheimer, enfermedad de Binswanger;

As an example of plasty of the post-trepanation defect of the skull vault after severe traumatic brain injury, we can cite the clinical observation of patient P., 60l, who was injured in September 2010 at work in a car service center as a result of a tire rupture. The patient was transferred to the City Clinical Hospital #39 in Nizhny Novgorod from the Central District Hospital in Shatki village of Nizhny Novgorod region.

On admission the patient's condition was of average severity. Consciousness is clear, adequate. In the neurological status there are general cerebral symptoms, meningeal syndrome. Below are CT tomograms performed at the patient's admission, which show a depressed splinter fracture of the frontal bone in the area of the frontal sinus.

Fig.1,2,3: Bone-mode MSCT of the brain performed on admission to the hospital.

Patient V., 32 years old, applied for a telemedicine consultation.

Past medical history: on March, 2022, a cavernoma, venous angioma of the bridge, was accidentally detected on MRI of the brain upon referral from a neurologist. I had never previously had a brain MRI so was unaware of this diagnosis.

October, 2019 (without knowing about the cavernoma) I gave birth to my first child in a regular maternity hospital (Pushkin, Leningrad region), the birth was natural, on time, without complications. Now I am pregnant again, the term of 35 weeks.

My question is the following: can I give birth as well as the first time in a regular maternity hospital naturally, arriving in labor or do I need to go to some specialized place and give birth by Caesarean section, for example ? I live in St. Petersburg.

MRI of the brain. Conclusion: On a series of MRI images of the brain were obtained.In the upper half of the pontine there is a formation (cavernoma) of rounded shape, with clear irregular contours, heterogeneous, cellular structure, the size of 10 mm in diameter. A vessel (venous angioma) extends from the ventral surface of the bridge to the cavernoma. The midline structures are not displaced. No foci of pathologic signal intensity in the brain substance were detected. Ventricles of usual shape and size. Subarachnoid space without visible changes. Brain membranes without peculiarities. Structures of the brainstem, chiasmal-sellar region without features. The paranasal sinuses are pneumatized. Conclusion: Cavernoma, venous angioma of the bridge.

Patient N., 20 years old, was taken by the NSR team to the Regional Hospital No. 3.Tobolsk from the scene of an accident in September 2019. The patient underwent an MSCT of the brain: a depressed fracture of the scales of the frontal bone passing to the base of the anterior cranial fossa, a fracture of the left zygomatic bone with displacement, and a fracture of the lower jaw were revealed. MSCT scans are shown below.

Fig.1,2,3: 3d reconstruction based on preoperative MSCT of the brain.

Patient S., born in 1986, was injured as a result of a fall during an epiprime while abstaining from alcohol after two weeks of abuse. Upon admission, the patient underwent a CT scan of the brain. An acute subdural hematoma was detected in the right frontal-temporal-parietal region. The patient refrained from the proposed operation.

Fig.1: CT scan of the brain upon admission of the patient to the hospital.

The patients were interviewed again. Consent for the operation has been obtained. On the 5th day, the patient was admitted for surgery. Taking into account the transition of the subdural hematoma to the subacute stage, the compensated condition of the patient (15 points on the scale scale), it was decided to remove the hematoma not by bone-plastic trepanation of the skull, but through a small trefination hole using a flexible boat.

Fig.2: CT scan of the brain after 5 days.