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Introduction: Cortical blindness occurs with bilateral damage to the visual cortex. It can be caused by various reasons, including the posterior cerebral arteries stroke due to the tentorial herniation., Material and Methods: A case of a 40-year-old patient with a large right-sided sphenoidal meningioma. A systematic review on the problem of cortical blindness after tentorial herniation according to the PRISMA guideline., Results: Subtotal removal of dense meningioma. At night after the operation, there was an acute headache, then a coma. Immediately dehydration therapy, tracheal intubation, mechanical ventilation. CT scan showed a small hemorrhage in the tumor bed and subarachnoid space, brain edema and dislocation. After 53 minutes, ventricular drainage was installed, intracranial pressure was normal and ranged from 6 to 14 mmHg. After sedation withdrawal, cortical blindness was detected, which did not regress for 1.5 years. There are no other neurological symptoms, the patient walks, serves herself. Radiation therapy in a total of 54 Gy for the remainder of the grade 1 meningioma ensured tumor control., Discussion: The time window for restoration of the cerebral blood flow, according to the European Stroke Organization guidelines, is 4.5 hours. In this case, compression of the posterior cerebral arteries lasted less than 53 minutes, however, irreversible ischemia developed in their territory; the outcome on the modified Rankine scale was 4 points. Similar cases are not described in the literature., Conclusion: Patients should be warned about even the non-obvious risks of neurosurgical intervention, since even timely measures taken do not always avoid complications.

Meningiomas arising from accessory nerve sheath without dural attachment are rare. To date, only 5 cases are described in the literature. A 53-year-old male presented with long history of occipital pain and headaches. Magnetic resonance imaging revealed a small intradural extramedullary contrast enhanced tumor at the level of foramen magnum. The patient underwent microsurgical resection through minimally invasive midline suboccipital approach. According to intraoperative findings, cystic tumor arose from the left accessory nerve without dural attachment. Gross total resection was achieved without damage to the nerve. Histological analysis revealed angiomatous meningioma. Postoperative period was uneventful without new neurological symptoms. Meningiomas can rarely arise from accessory nerve sheath and mimic schwannoma. These tumors may be totally resected without damage to accessory nerve using minimally invasive surgical approaches.

Background: Surgical treatment of ventral and ventrolateral meningiomas of posterior cranial fossa is difficult in modern neurosurgery. This is due to peculiarities of approach to these areas and concentration of critical structures (cranial nerves and great vessels). Currently, endoscopic transnasal approach to these meningiomas allows partial, and in some cases, total resection. However, this technique is not widespread., Objective: To analyze the world literature data on postoperative outcomes in patients with clival and petroclival meningiomas after endoscopic transnasal resection., Material and Methods: We analyzed 22 articles representing treatment of 61 patients with clival and petroclival meningiomas., Results: Total or near-total resection was achieved in 22.9% of cases, subtotal resection - 40.9%, partial resection - 26.2% (data were not provided in other cases). Even partial and subtotal resection leads to significant regression of symptoms., Conclusion: Endoscopic transnasal surgery is a full-fledged alternative to transcranial approaches in surgical treatment of clival meningiomas. It is also an additional option for patients with petroclival meningiomas after ineffective transcranial approaches. Transnasal tumor shrinkage and devascularization lead to brainstem decompression, regression of hydrocephalus and baseline clinical symptoms.

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.

Objective: The modern concept of resection of hyperostotic craniofacial meningiomas involves the desire for one-stage surgery with excision of tumor and simultaneous extensive skull defect closure., Material and Methods: The authors present skull defect closure with an individual implant after resection of cranioorbital meningioma in a 61-year-old man. The neoplasm was accompanied by exophthalmos and eyelid edema. The patient underwent simultaneous microsurgical resection and skull reconstruction with an individual implant. At discharge (7 days after surgery), exophthalmos regressed to 3 mm. After 3 months, ophthalmologist revealed complete regression of exophthalmos., Results: Domestic software and 3D printers were used for implant modeling and preparing the necessary physical models and molds. We intraoperatively used domestic polymer and titanium fixation systems for manufacturing and fixation of implant., Conclusion: This clinical case confirms that resection of hyperostotic craniofacial meningioma with simultaneous bone defect closure using domestic analogues of software, technical equipment, materials and methods is possible at all stages of this procedure.

Intracranial meningeal solitary fibrous tumors (SFT) originating from mesenchymal tissue are much less common than those with lesions of the visceral pleura or liver and were isolated as a nosological form only in 1996. These tumors are identical in clinical manifestations, MRI and light microscopy data to meningiomas. The pathognomonic difference of SFT, according to the 5th edition of the WHO classification, is the detection of overexpression of the protein encoded by the STAT6 gene. Estimation of other immunohistochemical markers is variable. At the same time, SFT has a tendency to more frequent recurrence and delayed malignancy. Transitional forms are possible. To form a clearer nosological outline of the SFT, it is necessary to accumulate clinical observations. A case of a giant meningioma of the posterior cranial fossa, which recurred 18 years after total removal at a 5-year annual control, is presented. Light microscopy of both primary and recurrent tumors revealed fibrous meningioma (WHO GI). Immunohistochemically revealed diffuse overexpression of CD34 and CD99. Determining the expression of the STAT6 protein was not technically possible. This case is regarded as a meningioma of the posterior surface of the pyramid of the temporal bone, growing into the cavity of the IV ventricle, with late recurrence without malignancy, with specific immunohistochemical profile.

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.

Objective: To conduct a quantitative analysis of orbit volume at different stages of preparation and surgical treatment of patients with cranio-orbital meningiomas undergoing resection with simultaneous orbital wall reconstruction using 3D modeling and 3D printing technologies., Material and Methods: A prospective cohort non-randomized study included 24 patients with cranio-orbital meningiomas. The volumes were measured by segmenting the orbital structures using the planimetric method in the Inobitec PRO software package. Three expert neurosurgeons independently performed these measurements. The implants were modeled in Blender software. We used the intraclass correlation coefficient (ICC) and global similarity index (GSI) to analyze interrater agreement and ensure reproducibility of analysis., Results: Interrater agreement on orbital markings was very high for both metrics (ICC and GSI). The ICC (A,3) for intact orbit volume was 0.99 (95% CI 0.981; 0.996, p =1.9962018^{-33}), 0.99 (95% CI 0.983; 0.996, p =1.903203^{-34}) for damaged orbit volume at the preoperative stage, 0.99 (95% CI 0.979; 0.995, p =3.5939828^{-32}) for damaged orbit volume at the stage of modeling of resection and reconstruction, 0.99 (95% CI 0.978; 0.995, p =1.1048941^{-30}) for damaged orbit volume in postoperative period. The ICC for measurements related to EI was 0.94-0.97 (very high). This analysis revealed a strong inverse relationship between EI and volume index at the preoperative stage (rho= -0.55, p =0.004987), as well as between dynamics of EI and volume indexes in perioperative period (rho= -0.59, p =0.003). We found significant relationship ( p =0.006757) between implant displacement in the area of lateral orbital wall and differences of actual and theoretical volumes., Conclusion: The proposed method of planimetric contouring and segmentation of orbital volumes is highly accurate and reproducible. Significant patterns allow us to develop predictive models for preliminary calculation of target volume of the damaged orbit.

Sphenoorbital meningiomas (SOM) are a subgroup of skull base tumors with soft tissue component in the orbit and anterior and/or middle cranial fossa. According to different authors, SOMs account for 2-12% of all intracranial meningiomas. Reconstruction of bone defects after resection of SOM has own nuances. Along with cranial vault repair, patients encounter with cosmetic defects following facial skull lesion, ophthalmic symptoms due to orbital defects, dental and functional problems associated with opening of the mouth in case of damage to maxilla and mandible. Predominant infiltrative growth of tumor and common large bone defects involving various anatomical regions require multiple implants or implants with complex shape. Moreover, contact of implantation area with nasal cavity and paranasal sinuses requires additional impermeability of soft tissue reconstruction and inertness of materials., Objective: To summarize available modern data on bone defect closure after resection of SOM., Material and Methods: The authors reviewed available data on bone defect closure after resection of SOM. Effectiveness of modern methods of reconstruction and safety of materials were assessed., Results: We analyzed 96 available references. Technical features of tumor resection, materials used for bone defect closure and modern possibilities of 3D technologies in reconstructive surgery were described. The authors proposed the algorithms for selecting the materials for bone defect closure after resection of SOM., Conclusion: Improvement of surgical technique and development of new materials and technologies significantly improve cosmetic and functional results. A large percentage of negative ophthalmologic outcomes and high risk of complications in SOM surgery require further studies and elaboration of modern techniques.

Background. Meningiomas may be accompanied by peritumoral edema. Incidence and pathogenesis of edema are nor clearly established. Prevalence and severity of edema vary significantly in patients with meningiomas similar in various parameters., Objective: To assess peritumoral edema in intracranial meningiomas and factors influencing incidence and severity of this process., Material and Methods: There were 126 patients (69% women) aged 19-76 years (median 53), who were diagnosed with 142 meningiomas. Patients underwent surgery ( n =111) and radiotherapy ( n =15) in 2016-2018. The MRI protocol included T1, T2, T2-FLAIR, DWI and post-contrast T1-weighted images in three projections, diffusion tensor MRI in 27 cases and MR spectroscopy in 21 patients., Results: Peritumoral edema was detected in 46% ( n =66) of cases including 21 (31%) patients with severe edema. The ALPS index was 1.510±0.1931 in meningiomas without edema and 1.308±0.19 in those with edema ( p =0.014). There was positive correlation between edema, dimensions and uneven contours of meningioma, as well as negative correlation with CSF cleft sign. Blood flow velocity was higher in atypical and anaplastic meningiomas with edema ( p =0.03). Other signs (localization, histological variant, malignancy grade, characteristics of MR signal, peaks of the main metabolites, diffusion and perfusion parameters of tumor) did not significantly affect peritumoral edema in patients with meningiomas ( p >0.05)., Conclusion: Diffusion tensor tomography with ALPS index revealed significant effect of glymphatic system dysfunction on peritumoral edema. Large meningioma with uneven contours increased the risk of peritumoral edema, while CSF cleft sign reduced this risk. Other factors did not affect cerebral edema in meningiomas.

Surgical removal of cranio-orbital meningiomas is an effective method of treating this pathology. Modern surgical techniques and technologies make it possible to perform operations with a low risk of complications. Lumbar drainage or repeated lumbar punctures are often used intraoperatively or in the early postoperative period to prevent nasal CSF leak; this rarely leads to the development of significant neurological symptoms. We present a case of the development of severe intracranial hypotension with the formation of a subdural hygroma in the early postoperative period after removal of a cranio-orbital meningioma in a 41-year-old patient. The operation was performed using an individual model and molds for simultaneous reconstruction of the bone defect with an implant made of polymethyl methacrylate. On the 1st and 2nd days after surgery, lumbar punctures were performed. From the 2nd day there was a progressive deterioration with the development of symptoms characteristic of intracranial hypotension. Computed tomography revealed an increasing displacement of the midline structures of the brain and an increasing volume of epidural fluid accumulation in the area of surgical intervention. Magnetic resonance imaging revealed characteristic signs of intracranial hypotension. Conservative treatment (bed rest, active hydration) had no effect. On the 6th day after surgery, an epidural blood patch procedure was performed and closed external drainage of the epidural hygroma was performed, and a rapid regression of neurological symptoms was noted. Our experience and literature data indicate that it is necessary to remember the possibility of developing clinically significant intracranial hypotension even after a single lumbar puncture. The formation of hygromas in the surgical area is characteristic of intracranial hypotension, but in most cases does not require additional surgical intervention and does not have a negative impact on the outcome of treatment. Conservative treatment of intracranial hypotension is the first choice and often sufficient. If there is no effect and the patient's condition worsens, it is necessary to perform an epidural blood patch procedure.

The authors present a patient with petroclival meningioma complicated by trigeminal neuralgia. Resection of tumor via anterior transpetrosal approach with microvascular decompression of the trigeminal nerve was performed. A 48-year-old female patient presented with left-sided (V1-V2) trigeminal neuralgia. Magnetic resonance imaging revealed a tumor 33´27´25 mm with a base adjacent to the top of petrous part of the left temporal bone, tentorium cerebelli and clivus. Intraoperative examination revealed true petroclival meningioma extending to trigeminal notch of petrous part of temporal bone. There was additional compression of trigeminal nerve by caudal branch of superior cerebellar artery. Total resection of tumor was followed by disappearance of vascular compression of trigeminal nerve and regression of trigeminal neuralgia. Anterior transpetrosal approach provides early devascularization and resection of true petroclival meningioma, as well as wide imaging of anterolateral surface of the brainstem, identification of neurovascular conflict and vascular decompression.

Primary melanocytic tumors of the central nervous system (CNS) are extremely rare and account for only 1% of all melanomas and 0.05% of primary brain tumors. In case of diffusely invasive lesions of the pia mater with a tumor of melanocytic origin (without signs of extracranial metastases), the tumors are classified as primary diffuse meningeal melanomatosis (PDMM). The latter is an extremely rare subtype of CNS malignant tumor with an incidence rate of 1 in 20 million people. Despite the development of neuroimaging techniques, today a morphological examination remains the main and most accurate method for verifying CNS melanocytic tumors. The paper describes a fatal case of PMMD manifested as epileptic syndrome, with a rapidly progressive course.

The authors present a patient and neurosurgical nuances of total resection of recurrent meningioma of posterior surface of petrous bone 65´35´30 mm. The tumor captured two critical zones of posterior cranial fossa with unusual frontal growth and spread from the surface of petrous bone to the fourth ventricle. The neoplasm filled the ventricle without lesion of ependyma. Extensive fibrous meningioma of posterior surface of petrous bone was totally excised 18 years ago. MRI was annually carried out for 5 years. Surgical nuances that ensured total extraction of tumor without cytoreduction were as follows: 1) en-bloc resection of tumor from the fourth ventricle due to smooth surface of tumor and minimum number of adhesions with cerebellum; MR-confirmed CSF strip between the tumor edges and walls of the ventricle; no signs of hydrocephalus in subtotal ventricular tamponade; 2) unusual frontal tumor growth under 45º required appropriate angular traction of tumor with minimal rotation; 3) traction was followed by sequential appearance of 3 segments of tumor: petrous, apertural and ventricular; 4) topography of the area of lateral eversion of the fourth ventricle was established by identifying the narrowing (constriction) of tumor; 5) in extracting the tumor from the fourth ventricle, we performed minimal rotation to avoid damage to ventricular walls and lateral aperture due to difference between the larger and smaller diameters (by 6 mm) of ovoid ventricular segment of tumor; 6) no CSF leakage following appearance of ventricular segment (tumor enlargement) indicated integrity of ependyma of the fourth ventricle. Histological examination confirmed fibrous meningioma. Fast and complete regression of focal symptoms was observed after surgery. A 3-year follow-up after surgery revealed no signs of tumor recurrence.

Background: Development of meningiomas correlating with irradiation has been described in the last century. Different biological features of radiation-induced meningiomas depending on dose and type of irradiation have been observed in recent years., Material and Methods: There were 8848 patients (women - 74.3%) with intracranial meningiomas for the period from 2000 to 2014 who underwent surgery at the Burdenko Neurosurgical Center. Radiation-induced meningiomas were identified in 33 patients (13 (38%) men and 20 (62%) women) aged 16-76 years (median 56 years). Medical data were retrospectively analyzed. Follow-up period ranged from 5 to 22 years (median 12) after verification of histological diagnosis. Meningiomas were preceded by X-ray irradiation of the scalp for ringworm (microsporia or trichophytosis) in 26 cases (79%) (group A). Group B enrolled 7 (21%) patients after previous radiotherapy for other tumors (retinoblastoma, chiasmal glioma, pituitary adenoma, basalioma). Data were compared using Mann-Whitney and Fisher's exact tests., Results and Discussion: Incidence of radiation-induced meningiomas was 0.37% in our sample. Meningioma diagnosis dates after X-ray epilation (median 52 years) significantly differed from that after radiotherapy (median 22 years) (Mann-Whitney test, p =0.0003). Primary multiple meningiomas were diagnosed only in the 1 st group (Fisher's exact test, p =0.0005). Recurrent meningiomas after the first surgery were more common in the first group (58%) compared to the second one (14%) (Mann-Whitney test, p =0.0003)., Conclusions: The latency period is shorter after radiotherapy (median 22 years compared to 52 years after X-ray epilation). Incidence of atypical and malignant meningiomas directly correlates with irradiation dose. Approximately equal incidence of radiation-induced meningiomas after X-ray epilation in women and men can indicate other mechanisms of development of these tumors in comparison with spontaneous ones. Radiotherapy is followed by occurrence of meningiomas within the irradiated area. These tumors are usually single. In case of X-ray epilation, the tumors may be localized anywhere within the intracranial space (convexital and/or parasagittal localization in 77% of cases). Multiple neoplasms occur in 42% of cases. Refusal of head X-ray epilation for the treatment of a ringworm for the last 50 years may be followed by reduced incidence of radiation-induced meningiomas, especially multiple ones. However, extended indications for radiotherapy of various brain diseases can result an increase of the incidence of meningiomas within the irradiated area.

Over the past two decades, improvements in surgical tools, navigation systems, and endoscopic techniques have resulted in the widespread use of keyhole surgery for a wide range of skull base tumors. Currently, the trans-eyebrow supraorbital approach is being increasingly used in surgery for anterior cranial fossa and parasellar tumors., Material and Methods: The study included 7 patients who underwent surgery for meningioma using the trans-eyebrow supraorbital approach at the Burdenko Neurosurgical Institute in the period between 2013 and 2017. The age of patients ranged from 51 to 75 years (median, 60 years); there were 5 females and 2 males. The maximum diameter of resected tumors ranged from 20 to 60 mm (median 40 mm)., Results: Total resection of the tumor was achieved in all 7 cases, which was confirmed by postoperative MRI control. All 7 patients had a good cosmetic result. In 1 case, there was postoperative cerebrospinal fluid rhinorrhea due to incomplete closure of the frontal sinus, which required the patient to be re-operated. None of 7 cases was associated with injury to the main vessels or cavernous sinus., Conclusion: Supraorbital trans-eyebrow craniotomy provides a minimally invasive approach for removing most anterior cranial fossa base and suprasellar tumors. The advantages of keyhole surgery, in comparison with traditional craniotomies, are minimal complications associated with the approach.

Currently the differential diagnosis of anaplastic meningiomas often is quite complex. An interpretation of the data of radiological studies does not allow the exclusion of diseases with similar clinical course and character of a lesion, such as primary lymphoma and tuberculosis of the central nervous system, neurosarcoidosis and others. The article presents a clinical case, representing a rare and difficult to diagnose variant of anaplastic meningioma with extremely aggressive nature of the current and widespread involvement of the brain and spinal cord.

Large parasagittal meningiomas, in particular hyperostotic ones, in children are rare and problematic in the differential diagnosis. The literature reports only single clinical cases related to this issue; opinions about the indications, surgical treatment options, and prognosis are contradictory. This paper presents a clinical case of a hyperostotic parasagittal meningioma with intra-extracranial growth in a 10-year-old boy with neurofibromatosis type II significantly worsening the prognosis. We discuss the epidemiological and clinical features of childhood meningiomas and issues of their diagnosis, treatment, and prognosis.

Background: Meningiomas of the foramen magnum (FMR) region account for 1.8 to 3.2% of all meningiomas. The international literature has insufficient data describing the state of cerebrospinal fluid (CSF) circulation in these patients., Material and Methods: We studied 38 patients with FM meningiomas, aged from 35 to 79 years (mean age, 56.7 years). The mean meningioma size was 30 mm (10-60 mm). Meningiomas had the anterolateral localization in 29 patients, ventral localization in 5 patients, and dorsal localization in 4 patients. Twenty nine patients underwent surgery. All operated patients were examined before and after surgery. The CSF circulation was studied using phase contrast MRI (PC-MRI)., Results: The size and localization of FM meningiomas do not significantly affect the CFS circulation parameters. Pyramidal symptoms, sensory disorders, and XIth cranial nerve dysfunction are correlated with the CFS circulation parameters. According to the preoperative PC-MRI data, the CFS circulation parameters in all FM meningioma patients were significantly higher than their normal values. Surgery was followed by a reduction in the peak positive velocity, negative peak velocity, and range of the maximum linear velocity amplitude. Positive and negative volumes and the stroke volume did not change. Recovery dynamics of the CFS circulation parameters was similar, regardless of surgery completeness. According to the PC-MRI data, the CFS circulation parameters did not reach normal values in all groups of operated patients., Conclusion: The results of investigation of the CFS circulation in patients with FM meningiomas support the use of palliative surgery (partial resection, dural plasty, craniovertebral junction decompression) in the case of inoperable meningiomas.

The paper discusses a case of recurrent posterior skull base meningioma with extracranial metastases. Metastases of meningioma may spread through venous system, lymphatic vessels and cerebrospinal fluid, and also via contact route (implantation). Penetration of dura mater of venous sinuses leads to invasion of tumor cells and their spread into pulmonary circulation, system of vena azygos and hemiazygos, vertebral venous plexuses which may facilitate further dissemination of the tumor. Histological examination of recurrent meningiomas requires additional immunohistochemical investigation with estimation of proliferative activity.

The results of computer tomogram images analysis of 32 patients (32 orbits) with soft tissue orbital tumors are presented. 22 patients appeared to have cavernous hemangioma, 10--optic nerve meningioma. The technique of three dimensional reconstruction of orbital soft tissue is described and its diagnostic value in patients with cavernous hemangioma and optic nerve meningioma is analyzed. The density of lesions and its variability were studied. Indications for two and three dimensional imaging were proposed to differentiate these tumors.

The results of a comprehensive ultrasonic examination of 12 patients with tumors of the eye orbit are described. A low echogenicity as well as heterogeneity of the echo-structure and of the contours' sharpness are the main sonographic features of the mentioned tumors. An examination of a vascularization degree in patients with gliomas of the optic nerve showed no blood circulation inside tumors; while a collateral blood circulation was detected in patients with meningiomas of the optic nerve. A compression of the ocular artery by the tumor and reduced hemodynamic indices were found to be typical. Finally, a triplex examination of the orbit makes it possible to diagnose tumors of the optic nerve.

The paper presents a rare case of meningioma associated with peritumoral abscess formed in a 63-year-old female undergone right nephrectomy for abscessed pyelonephritis and drainage of gluteal abscesses 3 months before admission. Brain computed tomography revealed a left frontotemporal heterogeneous mass lesion with margin contrast accumulation. At surgery, convexity meningioma with peritumoral abscess was totally removed. Hematogenous spread of Staphylococcus aureus is most likely to be responsible for peritumoral abscess. The paper also gives a review of literature and a brief account of the case.

The results of surgical treatment of 63 patients with basal meningiomas with supra-subtentorial spread were analyzed. The study has shown the effectiveness of one-stage tumor removal via supra-transtentorial approach with skull base bones resection. It is recommended to estimate an extent of operation on the basis of intraoperative assessment of biological behavior of the tumor, including interrelationship of tumor capsule and brainstem pia mater. Mortality rate was decreased from 23.8% to 11.1% following introduction of these principles.

The authors suggest a noninvasive method for determining the linear blood flow in the superior sagittal sinus (SSS) and in the veins of the parasagittal region directly during the operation. The results of intraoperative study of the blood flow in 41 patients show that the linear blood flow rate ranges from 0 to 5 cm/sec, depending on the functional condition of the SSS and the veins connected with it. The use of an ultrasonic blood flow detector on an open brain allows the functioning paths of venous drainage to be preserved to maximum and makes it possible to determine authentically the optimum boundaries of the future resection of the SSS area involved in the neoplastic process.

Analysis of the results of cerebral angiography in 64 patients with cranio-orbital meningiomas provides evidence that this method of examination is of valuable diagnostic significance in determining the growth of craniobasal meningiomas into the orbit. It not only helps in determining precisely the topography of the new growth in the cavity of the skull and the orbit but aids identifying the sources of blood supply to the tumor.

A total of 224 patients with different diseases of the brain, lungs, heart, focal and chronic liver diseases, voluminous kidney changes and metastatic bone lesions were examined. A new radiodiagnostic method of emission computerized tomography was used in correlation with planar scintigraphy and x-ray computerized tomography. The author showed the value of the method in the diagnosis of the disturbed blood circulation of the organs. Its potentialities in the diagnosis of focal lesions were considered. A high informative value of the method as compared to statistical scintigraphy was noted.

The authors analyze the clinical picture and computerized tomography data in 49 patients, aged 31-69, with symptoms of involvement of the orbital apex. The secondary orbital apex syndrome (OAS) has been diagnosed in 9 patients, and the primary one in 40, the reasons of the condition being optic nerve tumors (in 50% of cases), pseudotumor (22.5%), endocrine ophthalmopathies, etc. Differential diagnostic criteria of the primary and secondary OAS are suggested. The reasons responsible for primary OAS may be practically specified only by computerized tomography.

Computed tomographic changes developing in the surroundings of a supratentorial meningioma were studied in 31 patients. Four types of changes were revealed: brain edema, softening, pathological accumulation of fluid, and foci of hyperemia. A possible mechanism of these changes is discussed and their common origin is pointed out.

The authors described methods of the individual precision anatomodosimetric planning of proton-beam irradiation of tumors of the cavernous sinus. The results of computerized tomography in 2 planes (axial and frontal) were used for planning. Manual tumor reconstruction with subsequent dose planning was done on direct and lateral telecraniograms. The procedure was tested in 25 patients. Complications and noticeable radiation reactions in adjacent tissues were undetectable during 3.5 yrs.

CT scans in 91 patients revealed the increased density ovoid or circular structures with sharply defined borders to be most characteristic of the intracranial meningiomas. However, these often had densities very low or indistinguishable against the background of the surrounding tissues' absorption coefficients. Irrespective of the initial tumor density CT will reveal the contrast media accumulating in it, diffuse as a rule. Perifocal edema is also typical of the meningiomas, manifested by the early detected shifts and compression fo different brain structures. CT and pathological data compared, the structural features of the meningiomas were identified which determine their density, borders and contrasting media accumulation.

X-ray examination of 57 patients with tumours of the brain and meninges revealed general and local roentgenological alterations of the skull bones as well as secondary changes in the sella turcica. Tumours of the brain and meninges were associated with a diminution or an enlargement of the volume of the skull bones, intensification of the vascular pattern of the cranial vault and tumour calcification. A thorough craniographic examination of patients with a suspicion of brain and meningeal tumours gives definite information about general and local alterations of the skull bones and contributes to their purposeful radiographic contrast examination, which is important when surgery is contemplated.