A. V. Vasilenko

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.

Today, thanks to recent advances in stroke treatment, mortality rates are declining and life expectancy is increasing for patients who have suffered a cerebrovascular accident. However, hemorrhagic stroke remains a leading cause of disability. The occurrence of adverse outcomes such as post-stroke seizures and epilepsy undoubtedly impairs patients’ quality of life. One approach to addressing the important clinical and research challenge of preventing post-stroke seizures is the administration of antiepileptic drugs in the early stages of hemorrhagic cerebrovascular accidents.

Posterior communicating artery (PСоA) aneurysms represent a serious medical problem associated with a high risk of rupture leading to severe neurologic deficits, disability, and, in some cases, death. Despite the advances in microsurgical and endovascular treatment, the recovery of patients requires long-term, comprehensive, and multidisciplinary neurorehabilitation aimed at correcting motor, cognitive, and psychosocial disorders. The present review examines current approaches to rehabilitation, including early initiation, as well as the use of specialized scales and neuropsychological tests in combination with promising methods of hyperbaric oxygenation and neuromodulation. Particular attention is paid to artificial intelligence (AI) technologies in neurorehabilitation: the use of adaptive game systems, robotic exoskeletons, brain-computer interfaces, and gamification to personalize and increase the effectiveness of recovery programs. The integration of AI into the rehabilitation process opens up new opportunities for improving the functional outcomes and quality of life in patients with PСоA aneurysms. However, further research and a systematic approach in care management are required.

This article provides an overview of the current state of the problem regarding the comorbidity of multiple sclerosis (MS) and epileptic seizures (ES). Epilepsy occurs in patients with MS 3–6 times more often than in the general population; however, its prevalence and clinical manifestations are variable. The pathogenetic link between the two conditions is bidirectional: demyelination and gray matter atrophy in MS contribute to epileptogenesis, while epileptic activity itself can exacerbate neurodegeneration. The clinical manifestations of ES in MS are heterogeneous and can include both focal and generalized seizures, which often serve as the first manifestation of the demyelinating disease. Electroencephalography and cerebral magnetic-resonance imaging play a crucial role in diagnosis, revealing focal activity and structural changes in the cortex. Treatment requires a comprehensive approach, whereby some disease-modifying therapies for MS and antiepileptic drugs can have a mutually positive influence. Conclusion. The comorbidity of multiple sclerosis and epilepsy is a complex problem due to shared pathogenetic mechanisms and mutual aggravating influence. Diagnosing epileptic seizures in MS can be challenging due to the variable clinical picture and non-specific changes on electroencephalogram. Given the high risk of developing epilepsy in this patient category and its potential impact on the progression of disability, neurologists need to maintain a high index of diagnostic suspicion. Further research in this area should be devoted to optimal treatment strategies aimed at both conditions simultaneously.

One of the main prognostic factors for meningioma recurrence is histological diagnosis with an assessment of tumor grade. Despite this, there are no clear microscopic criteria for recurrence prognosis in benign forms, and there is no common understanding of meningioma recurrence and continued growth clinical management. Objective. To evaluate neuroimaging, microscopic features and proliferative activity in meningioma recurrence and continued growth. Material and methods. Histological and immunohistochemical studies of tumor biopsies were performed in 16 patients with tumor progression who underwent surgery for recurrence and continued growth of intracranial meningiomas; the comparison group included 10 patients with newly diagnosed intracranial meningioma. All patients were performed pathomorphological and radiological examination assessment. Results. The average tumor volume in the meningioma progression group was 48.88±14.32 cm3; the average tumor volume was higher in the primary surgical treatment group — 51.51±14.48 cm3. Recurrent tumors were characterized by more pronounced cellular and tissue atypia, patterns of infiltrative growth with the involvement of large vessels. The meningioma proliferative activity, assessed by Ki-67(max) expression, was higher in the group with meningioma progression and amounted to 9.71±2.5%. Significant differences in the Ki-67 expression were noted by tumor localization, grade, and brain invasion (p<0.05) in the meningioma recurrence and continued growth group. Conclusion. Recurrent meningiomas are represented by different grade tumors, including benign typical meningioma (grade 1), which indicates the need for greater attention and patient follow-up with this pathology. There are differences in terms of grade progression and locally destructive growth in meningioma recurrence and continued growth. This indicates a more pronounced biological tumor aggression. The Ki-67 expression is an important prognostic factor in meningioma progression group.

This article investigates the phenomenon of epileptic aura in the context of medicine and literature. An epileptic aura is a focal epileptic seizure that occurs without loss of consciousness and manifests with visual, auditory, olfactory, tactile and other hallucinations. The descriptions of epileptic auras in the literature works of outstanding writers such as M.A. Bulgakov, F.M. Dostoevsky and L. Carroll are presented. The description of this epilepsy-related manifestation complements the psychological and physical experiences described in the works. The article combines scientific approach to studying epileptic auras and literary analysis, thereby emphasizing its relevance and informative impact for both the medical and literary community.

INTRODUCTION. Arteriovenous malformations of Spetzler – Martin grades III–V are characterized by complex angioarchitecture, deep localization, and a higher incidence of epileptic syndrome compared to grade I–II AVMs. These features complicate both the technical execution of the intervention and the objective assessment of its impact on seizure control. In the present study, special attention is given to the analysis of seizure dynamics following endovascular treatment in patients with high-grade AVMs in order to clarify its effectiveness in this clinical cohort. AIM. To identify prognostic factors for epileptic seizure control following embolization of arteriovenous malformations (AVMs), with a focus on the degree of vascular occlusion and its correlation with clinico-radiological parameters. MATERIALS AND METHODS. A retrospective study included 60 patients divided into two groups: group 1 (n=30) underwent total/subtotal embolization (>95 % occlusion), and group 2 (n=30) underwent partial embolization (RESULTS. In the total embolization group, complete seizure cessation (Engel Ia) was achieved in 56,7 % of patients compared to 23,3 % in the partial embolization group. The rate of unfavorable outcomes (Engel IVb+IVc) was 16,6 and 36,7 %, respectively. Complications were reported only in the total embolization group. In patients with partial embolization, a baseline low seizure frequency (CONCLUSION. Total embolization of AVMs provides a higher rate of complete epilepsy control but is associated with procedural risks. Partial embolization demonstrates satisfactory outcomes in patients with rare seizures, suggesting its potential as a first-line therapeutic strategy for carefully selected cases.

This article is devoted to the main issues related to the development of epileptic seizures in patients with meningiomas of the brain. The genetic aspects associated with the formation of meningioma in patients and the features of the localization and degree of malignancy of the tumor in each individual genomic subgroup are disclosed. The factors that play a major role in the occurrence of pre- and postoperative epileptic seizures are also named. Surgical resection of meningiomas remains a crucial factor in the treatment of patients with disabling symptoms at the moment. But also, an important topic touched upon in this article is the need for further research into the specifics of prescribing antiepileptic therapy to patients in the pre- and postoperative period, which mainly consist in correctly setting the dosage and timing of taking drugs, which may change the perception of the effectiveness of relieving epileptic seizures.

Vascular pathologies, despite the low percentage of prevalence among other etiological factors of epilepsy development, often cause such an important problem today as pharmacoresistance. This phenomenon can lead not only to a decrease in the quality of life of patients, but even to a fatal outcome.In this regard, the main task of this article will be to disclose the etiopathogenesis of epileptic seizures in patients with arteriovenous malformations, aneurysms and cavernomas. It is important to understand that the key role is played by the formation of organic pathology of the brain, the elimination of which should be paramount for the effective relief of epileptic seizures. Studying the issues discussed in this article can help structure the drug and surgical treatment of these patients, and perhaps even develop new algorithms.

Epileptic seizures occur in 20–25 % of patients with cerebral arteriovenous malformations (AVMs) and are often resistant to both surgical and conservative treatment methods. This literature review provides an analysis of current data on the epidemiology, diagnosis, and treatment of epileptic syndrome in patients with cerebral arteriovenous malformations. Over 100 literature sources available in the PubMed, eLibrary.ru, Medscape, Cochrane Library, and Medical NDX databases were analyzed as part of the study. To reflect the most up-to-date information, primary focus was placed on data published between 2018 and 2023.Special attention in the review is given to modern diagnostic approaches, including the use of neuroimaging and electroencephalography, as well as the latest treatment methods such as stereotactic radiosurgery, endovascular interventions, and combined therapeutic strategies. Factors influencing treatment effectiveness, including the location and size of the AVMs, as well as the clinical course of the epileptic syndrome, are discussed. The review highlights the prospects for further research in this field, aimed at improving patients’ quality of life and reducing the frequency of seizure recurrence. The review emphasizes the need for a multidisciplinary approach to managing patients with cerebral AVMs, as well as the importance of individualized treatment tailored to the specifics of each clinical case.