ИСТИНА

Introduction. Methods of noninvasive neurovisualization allow a lifelong detection of clinically asymptomatic brain and spine pathology. Objective. The objective was to develop the tactics for follow-up and treatment of clinically asymptomatic congenital and acquired diseases of the central nervous system. Material and methods. 1800 cases of asymptomatic brain and spine pathology (tumors, cysts, unruptured saccular aneurysms, magistral artery stenoses, subdural hematomas etc) verified by CT, MRI, angiography, are reported. Results and discussion. Asymptomatic congenital and acquired nervous pathology was systematized. Alongside with its individual tactics of treatment, some other aspects should be considered: 1) the character of pathology, 2) its probable occurrence and manifestation time in the future and complete clinical compensation in the present; 3) the risk of severe complications of preventive surgery. Accidentally detected acquired pathology and its treatment tactics are divided into 3 groups: 1) residual substrates of CNS trauma and diseases in anamnesis, which usually do not require any active manipulations, especially surgical ones. 2) agerelated changes (stenosis of magistral arteries, atrophic hydrocephalus, osteochondrosis of the spine etc.) As a rule, follow-up in dynamics and preventive pharmacotherapy are indicated, if clinical symptoms are absent. 3) pathological brain and spine lesions with a potential risk of dangerous growth (for instance, tumors or chronic subdural hematomas), however clinically still asymptomatic. The decisive factor in choosing the algorithm of treatment is maintaining the quality of life in practically healthy patients. Here, the spectrum of treatment strategy is extremely diverse: follow-up in dynamics, radiosurgery or radiotherapy, chemotherapy, surgical intervention. Conclusion: Diagnosis in preventive neurosurgery is based on neuroimaging only. Still, the decision making about treatment tactics - follow-up or aggressive surgery – should be clinical and philosophic. Preventive treatment of clinically occult brain and spine pathology claims much more responsibility compared to surgery of the manifested disease. Preventive neurosurgery should be guaranteed, and only qualified and experienced specialists can deal with it.