DIAGNOSIS AND FEATURES OF THE SURGICAL TREATMENT OF CAVERNOUS MALFORMATIONS OF THE BRAIN

. The article presents an analysis on the modern aspects of diagnosis and surgical treatment of cavernous malformations of the brain. The modern approaches to surgical treatment depending on the type of clinical course of cavernous angiomas you can see in this paper.

understood. Taking into account the fact that cavernomas are benign by nature, determining the indications for surgery is a rather difficult task [1]. Many aspects of CM remain controversial. Depending on the localization of the pathological focus, there are different points of view on the pathogenesis (their blood supply, growth and clinical course), the information content of various diagnostic methods, as well as the tactics of surgical treatment. Surgical removal of the cavernoma has proven to be an effective treatment for eliminating the risk of hemorrhage and, in many cases, significantly alleviating the course of epilepsy. However, the experience of various clinics has shown that surgery, especially for cavernomas located in functionally important areas, can be associated with the development of severe complications [5]. According to current data, cavernous malformations (CM) account for 5-13% of vascular malformations in the brain [8,10] and occur in approximately 0.5% of the population [11]. The main clinical manifestations of symptomatic cerebral supratentorial cavernous angiomas (CAs) are epileptic seizures (79%) and hemorrhages (16%), with symptoms most often developing in patients aged 30-50 years [13]. Cavernomas can cause rare seizures that respond well to antiepileptic conservative therapy and cause severe drug-resistant epilepsy [3]. Pharmacoresistant epilepsy due to supratentorial CA accounts for approximately 4% of all pharmacoresistant partial epilepsies [3].
In cases of symptomatic CM, their clinical manifestations are extremely diverse: epileptic seizures, intracerebral or subarachnoid hemorrhages, with focal neurological symptoms, occlusive hydrocephalus [6]. Currently, there is no final opinion on the causes of the varied course of cerebral coronary artery disease.
Despite modern research methods, the diagnosis of cerebral coronary artery presents certain difficulties. Focal changes detected by CT or MRI studies are often assessed as an intracerebral tumor-glioma, and in cases of a deep location of a mass with a projection onto subcortical nodes, the "tumor" is recognized as inoperable. Therefore, the issue of the possibility of improving the diagnosis of coronary artery disease, revealing the pathognomonic signs of this defect is widely discussed. Analysis of CT, MRI, AH and gamma-topography of the brain showed that none of the above studies, taken separately, is capable of revealing pathognomonic signs of a cavernoma, which would make it possible to diagnose cavernous angioma with confidence. At the same time, their detectability as a volumetric formation is high in cases of using CT or MRI.
According to our data, AH examination in 26% of cases reveals only indirect signs of a mass formation in the form of a displacement of great vessels or venous collectors, in 79% angiography does not reveal either vascular pathology or signs of a volumetric process of the brain, in 9% angiograms either small vascular a network, which is most often interpreted as a tumor network, or a conglomerate of vessels is contrasted by the type of arteriovenous malformations.  are conditionally designated as functionally "non-sound" zones.
A total of 176 (100%) patients with BM were operated on. All operations were performed using microinstrumentation and magnifying equipment (binocular optics, Leica operating microscope). In all 100% of observations, radical removal of cavities was performed.
Used conventional approaches to the above-mentioned parts of the brain.
Osteoplastic trepanation in all cases was performed according to the standard technique. One of the morphological features of BM is the absence of the medulla in the structure of the malformation; therefore, manipulations on BM did not lead to significant brain injury. Access to the malformation is considered the most traumatic stage of the operation; therefore, sparing approaches with minimal encephalotomy were used. Out-of-projection approaches were widely used, in which encephalotomy was performed outside the functionally "sounding" zones or with minimal trauma. When BM was localized in the deep parts of the temporal lobe, access through the lateral cleft of the brain was used. A prerequisite was the use of microsurgical techniques. Taking into account that BM is supplied from small vessels of the capillary type and is not

SCIENTIFIC TRENDS AND TRENDS IN THE CONTEXT OF GLOBALIZATION
180 connected with large vessels, when isolating them, it is necessary to preserve the arteries and veins that are located near the malformation, and often adjoin its wall.
Intraoperative ultrasound navigation was used in 98 (55.7%) cases to clarify the localization of deeply located BMs and to select the optimal approach, and intraoperative neuronavigation was used in 56 (31.2%) cases. In 84 (47.7%) patients, intraoperative electrocorticography was performed to determine the localization of the focus of paroxysmal activity. The data obtained made it possible to clarify the location and type of the dura mater incision, the encephalotomy zone.
The indications for the removal of cavernous malformations in the epileptic type of course were: 1) focal epileptic seizures, reflecting lobar localization; 2) manifestation of an epileptic focus on the EEG, coinciding in localization with the location of the cavernoma; 3) frequent epileptic seizures resistant to anticonvulsant therapy.

Indications for removal of cavernous malformations in hemorrhagic flow
were: 1) subarachnoid hemorrhage with the formation of an intracerebral hematoma, accompanied by dislocation symptoms; 2) a history of repeated hemorrhages; 3) deepening of neurological deficit; Indications for removal of cavities in mixed flow were: 1) a history of repeated hemorrhages; 2) focal epileptic seizures reflecting lobar localization; 3) manifestation of an epileptic focus on the EEG, coinciding in localization with the location of the BM; 4) frequent epileptic seizures resistant to anticonvulsant therapy;

5) deepening of neurological deficit;
Results and its discussion: 1. For the diagnosis of BM, a comprehensive examination of the patient using CT, MRI and AH of the brain is necessary, since none of these studies, carried out separately, fully reveals the pathognomonic signs of cavernous malformations.  can reduce trauma to the brain and great vessels, which makes it possible to remove cavernous malformations located in functionally "sounding" areas of the brain.