Search

Treatment of clival meningiomas is still one of the unresolved issues in modern neurosurgery. There are several treatment strategies. These ones include various combinations of follow-up, surgical CSF drainage, tumor resection and radiotherapy., Objective: To assess postoperative outcomes in patients with clival meningiomas., Material and Methods: We analyzed 18 patients with large or giant clival meningiomas., Results: We assessed extent of resection using the scale by G. Frank and E. Pasquini (2002): total resection - 95-100%, subtotal - 80-95%, partial - 50-80%, extended biopsy - <50% of tumor. Total resection was achieved in 1 patient (5.5%), subtotal - 5 (27.8%), partial - 12 (66.7%). At the same time, brainstem decompression and regression of hydrocephalus were observed in all cases. Fourteen patients were followed-up. Median follow-up was 8.5 months. Seventeen patients underwent radiotherapy due to predominant partial and subtotal resection. Total focal dose ranged from 50 to 57 Gy in standard fractionation mode. None patient had residual tumor enlargement throughout the follow-up period. There were no lethal outcomes., Conclusion: Endoscopic transnasal access to clival meningiomas in appropriate anatomical features of tumor and surrounding structures is a full-fledged alternative to transcranial treatment in these patients. This approach provides total resection and brainstem decompression. These facts increase life expectancy without deterioration of the quality of life.

Treatment of craniovertebral junction meningioma is a difficult task. Surgical treatment is the gold standard for these patients. However, it is associated with high risk of neurological impairment, while combined treatment (surgery + radiotherapy) provides more favorable outcomes., Objective: To present the results of surgical and combined treatment of patients with craniovertebral junction meningioma., Material and Methods: There were 196 patients with craniovertebral junction meningioma who underwent surgical or combined (surgery + radiotherapy) treatment at the Burdenko Neurosurgery Center between January 2005 and June 2022. The sample included 151 women and 45 men (3.4:1). Resection of tumor was performed in 97.4% of patients, craniovertebral junction decompression with dural defect closure - 2%, ventriculoperitoneostomy - 0.5%. As the second stage, 40 patients (20.4%) underwent radiotherapy., Results: Total resection was achieved in 106 patients (55.2%), subtotal - 63 (32.8%), partial - 20 (10.4%), tumor biopsy was performed in 3 (1.6%) cases. Intraoperative complications occurred in 8 patients (4%), postoperative complications - in 19 (9.7%) cases. Radiosurgery was carried out in 6 (15%) patients, hypofractionated irradiation - 15 (37.5%), standard fractionation - 19 (47.5%) patients. Tumor growth control after combined treatment made up 84%., Conclusion: Clinical outcomes in patients with craniovertebral junction meningioma depend on tumor dimensions, topographic and anatomical localization of tumor, resection quality and relationship with surrounding structures. Combined treatment of anterior and anterolateral meningiomas of the craniovertebral junction is preferable compared to total resection.

Background: A thorough understanding of the central nervous system anatomy is a fundamental part of a neurosurgeon's training. Development of novel neurosurgical approaches and optimization of existing ones directly depend on the comprehensive study of topographic anatomy of the head and neck using cadaveric specimens. Staining the vessels of the arterial and venous systems of a cadaveric specimen aids a detailed study of the vascularization of anatomic structures of the brain. Here we describe an alternative expedited method for creating anatomic preparations of the human brain using colored silicone for vascular perfusion staining., Methods: A nonfixed, whole cadaver (with the head intact), without central nervous system pathology, no later than 48 hours after death, is used to prepare the human brain specimen through staining of arterial and venous vessels., Results: Our proposed method provides a fast and inexpensive approach to making anatomic preparations of the human brain with staining of the vascular system. The preparations thus obtained can be used for educational purposes, aiding the study of normal and topographic anatomy of the brain, as well as the development of new microsurgical and/or endoscopic approaches., Conclusions: In experienced hands, our proposed method allows the creation of anatomic preparations relatively fast, at low cost, and with excellent quality., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Unlabelled: Surgical treatment of skull base tumors invading the craniovertebral junction is a complex medical problem due to a high rate of adverse postoperative outcomes in these patients., Aim: The study aim was to optimize surgical treatment in patients with skull base tumors invading the craniovertebral junction., Material and Methods: A comparative analysis of 2 groups of patients was performed. The study group included 28 patients with skull base and craniovertebral junction chordomas who underwent single-stage surgery, including posterior occipitospondylodesis and tumour resection using the transoral and combined transoral and transnasal approaches, in the period between 2000 and 2015. The control group included 21 patients with the same pathology who underwent microsurgery using the transoral approach without occipitospondylodesis in the period between 1990 and 2009., Results: Most of the patients in both groups were operated on at late disease stages when they presented with gross clinical signs. The use of single-stage occipitospondylodesis and transoral skull base tumor removal significantly (compared to the control group) extends indications for surgical treatment of skull base tumors, which were previously considered unresectable, and provides better results., Conclusion: New surgical techniques significantly increase the completeness of tumor resection, decrease the rate of postoperative complications, accelerate the rehabilitation process, and improve the patient's quality of life.

Background: Various suboccipital approaches are extensively used in modern neurosurgery for treatment of posterior cranial fossa disease. The main patient's positions on the operating table during surgery are half-sitting and lying ones., Material and Methods: The article provides a detailed description and methodology of retrosigmoid suboccipital and median suboccipital approaches in a lying position., Conclusion: The retrosigmoid suboccipital and median suboccipital approaches in a lying position, when used correctly, provide a good view of the operating field with the minimal risk of complications associated with the patient's position on the operating table.

Introduction: Lhermitte--Duclos disease is a rare autosomal dominant inherited disorder characterized by the loss of the normal cerebellar cortex architecture and hamartoma formation in the cerebellar hemispheres. Most commonly, this disease manifests in the third and fourth decades of life. Approximately 220 cases of Lhermitte--Duclos disease have been reported in medical literature to date., Material and Methods: The authors describe successful two-stage surgical treatment of a young female patient with Lhermitte--Ducos disease., Conclusion: This case report familiarizes practitioners with the clinical manifestations and neuroimaging features of Lhermitte--Duclos disease that facilitates timely diagnosis and proper treatment of the condition.

Aim: The objective of the study was to develop the tactics of surgical treatment of large and giant pituitary adenomas, spreading into the posterior cranial fossa., Material and Methods: Patients with large hormonally inactive pituitary adenoma, extending to the right cavernous sinus and posterior cranial fossa., Results: The endoscopic endonasal removal a large endo-supra-latero(D)-retrosellar pituitary tumor was conducted. Control MRI shows that the tumor was removed radically. Oculomotor disturbances were observed in the early postoperative period, which significantly regressed within 6 months. The article provides detailed analysis of the world literature on the issue under discussion. Illustrative pre-, intra-, and post-operative photographs, as well as histological preparations are shown., Conclusion: Modern minimally invasive techniques make it possible to remove large pituitary adenomas (and other tumors) of the posterior cranial fossa using endoscopic endonasal approach. Such operations must be carried out at highly specialized institutions by the surgeons who have extensive experience in endoscopic transnasal surgery of skull base tumors.

During the period of 2010-2012, 33 patients with cerebellopontine angle tumors were operated on at the Burdenko Neurosurgical Institute (Moscow, Russia) using different types of endoscopic assistance. All patients were operated on via the retrosigmoid suboccipital approach in semi-sitting and prone positions. 30° and 70° endoscopes were used during the surgery. Endoscopic assistance allowed us to increase the completeness of tumor removal and to reduce the risk of postoperative complications by retaining the anatomic integrity of cranial nerves and vascular structures in the base of the posterior cranial fossa. These benefits made it possible to maintain and improve quality of life in patients with CPA tumors in the postoperative period.