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Additive technologies are now widely used in various fields of clinical medicine. In particular, 3D printing is widely used in neurosurgery, vertebrology and traumatology-orthopedics. The article describes in detail the basic principles of medical 3D printing. The modern classification of 3D printers is presented based on the following principles of printing: FDM, SLA, SLS and others. The main advantages and disadvantages of the above-mentioned 3D printers and the areas of clinical medicine in which they are used are described. Further in the review, the authors discuss the experience with 3D printing applications, based on the data of the modern scientific literature. A special attention is paid to the use of 3D printing in the manufacture of individual implants for cranioplasty. 3D printing technologies in reconstructive neurosurgery make it possible to create high-precision implants, reduce the time of surgical intervention and improve the aesthetic effect of the operation. The article also presents the data of the modern literature on the use of 3D printing in vertebrology, where a special role is given to the use of guides for the installation of transpedicular screws and the use of individual lordosing cages. The use of individual guides, especially for severe spinal deformities, reduces the risk of metal structure malposition and the duration of surgical intervention. This technique is also widely used in traumatology and orthopedics, where individual implants made of titanium, a bone-substituting material, are created using 3D printing, thanks to which it is possible to replace bone defects of any shape, complexity and size and create hybrid exoprostheses. The role of 3D modeling and 3D printing in the training of medical personnel at the present stage is described. In conclusion, the authors present their experience of using 3D modeling and 3D printing in reconstructive neurosurgery and vertebrology.

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ОБЗОР ЛИТЕРАТУРЫ Резюме За последние 70 лет количество пострадавших с позвоночно-спинномозговой травмой выросло в 200 раз. В России ежегодно регистрируется около 8-9 тысяч случаев позвоночно-спинномозговой травмы, в 80% случаев это является прерогативой лиц 15-45 лет. Проблема лечения пострадавших с травмой позвоночника является острой проблемой отечественной нейрохирургии. В статье представлен обзор литературы, посвященный ошибкам нейрохирургического лечения повреждений грудных и поясничных позвонков. Из основных тактических ошибок авторы выделили неадекватную инструментальную фиксацию при крайне нестабильных переломах (тип В и С). В работе затронуты причины формирования посттравматической деформации позвоночника. Так же выделены следующие тактические ошибки: неадекватная декомпрессия, отказ или неудачи в коррекции деформации, целенаправленное разрушение задней опорной колонны. Техническими ошибки представлены: нарушения в технике имплантации металлоконструкции, перелом и мальпозиция стержней; перелом, дислокация и мальпозиция транспедикулярного винта. Пристальное внимание уделено ошибкам, допущенным пациентом и недостаткам металлоконструкций. Особое внимание уделено инфекционным (пневмония, уроинфекция, пролежни, нагноение послеоперационной раны) и неврологическим (ликворея, дуротомия, радикулопатия) осложнениям. Подробно изучены причины этих осложнений и предложены мероприятия по их снижению. В заключение авторами предложены пути по снижению осложнений оперативного лечения позвоночноспинномозговой травмы. Ключевые слова: перелом позвонка, мальпозиция винта, транспедикулярный остеосинтез, посттравматическая деформация позвоночника, транспедикулярный винт.

The authors have considered the capabilities of decompressive craniotomy in malignant ischemic stroke treatment. Malignant stroke is understood to be stroke with extensive cerebral ischemia, post-ischemic edema formation, and the presence of lateral and/or axial cerebral displacement that is mainly due to proximal middle cerebral artery occlusion. There were highlighted the etiology and pathogenesis of this type of cerebrovascular disease. The disease predictors (clinical, radiological, laboratory) were described in detail, the most significant among them being emphasized. Based on randomized multicenter studies the researchers determined the indications, contraindications and selection criteria of patients when this surgical approach is used to treat malignant ischemic stroke. Surgical approach was demonstrated to enable to reduce case mortality, and improve functional treatment outcomes and results. There were described in detail the technique and peculiarities of decompressive craniotomy in this pathology, as well as the main postoperative complications. The authors considered the problem of optimal surgery time, and suggested an original treatment algorithm for patients with this pathology.

Carotid chemodectoma (CC) (carotid glomus tumor, carotid tumor, carotid paraganglioma, carotid gland struma) is in most cases a benign, slow-growing tumor from paraganglionic cells of the carotid glomus. Glomus tumors account for 60–70 % of all paragangliomas of the head and neck. This article describes in detail the anatomy of the carotid glomus, histological types of tumors and the causes of their formation. A special role is given to the clinical picture in this pathology and modern methods of instrumental diagnostics. Modern CT surgery has established a correlation between anatomical classification and the severity of surgical resection complications, which allows neurosurgeons to predict blood loss and neurological complications in each patient. Operations to remove the carotid glomus with a chemodectomy are complex and technically different from classical operations on the carotid arteries. Despite the possibility of chemoradiotherapy with chemodect, surgical remains the main method of treatment.

In this publication, the authors provide an overview of the literature devoted to modern methods of surgical treatment of non-traumatic intracerebral hemorrhage. Currently under hemorrhagic stroke is meant a wide range of non-traumatic origin of diseases which are accompanied by bleeding in the brain tissue under its shell and / or into the ventricular system. Relevance of the work associated with high mortality (74%) and disability (75-80%) among surviving patients with this pathology. The paper details the etiology and pathogenesis of this type of disorders of cerebral circulation. We describe the surgical technique used in modern neurosurgery. Highlighting their positive and negative sides, given the outcome of treatment of various authors. On the basis of these studies the indications, contraindications, and patient selection criteria for surgical treatment of non-traumatic intracerebral hemorrhage.

The article is devoted to the analysis of actual problems of training neurosurgeons in residency in Russia and ways to solve them. By analyzing the modern literature, the systems of training resident neurosurgeons in Europe, North America and Asia are described. Based on the experience of foreign countries, proposals have been made to reorganize the system of practical training in the residency in neurosurgery in Russia.