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Surgery is an effective approach for drug-resistant temporal lobe epilepsy following hippocampal sclerosis. There is still no clear and unanimous opinion about advantages and disadvantages of certain surgical technique.There were 103 surgical interventions in 101 patients. Females prevailed (1.45:1). Age of patients ranged from 16 to 56 years (median 28). Anteromedial temporal lobectomy and selective amygdaloghippocampectomy were performed in 49 (47.6%) and 54 (52.4%) patients, respectively. In the latter group, 30 patients were operated via a 14-mm burr hole-subtemporal approach. Postoperative outcomes were assessed using the Engel grading system. The follow-up period ranged from 2 to 8 years (median 4 years).By the 2Selective amygdaloghippocampectomy is not inferior to anteromedial lobectomy. Moreover, this procedure is associated with a lower risk of complications and adverse events.Хирургия является эффективным методом лечения фармакорезистентной височной эпилепсии, обусловленной склерозом гиппокампа. До сих пор нет четкого и единого мнения о преимуществах и недостатках отдельных методов хирургического лечения.Провести анализ и сравнение исходов лечения больных с мезиальным темпоральным склерозом после антеромедиальной височной лобэктомии и селективной амигдалогиппокампэктомии, включая приступы, а также качество жизни пациентов после операции.Выполнено 103 оперативных вмешательства у 101 пациента (возраст от 16 до 56 лет (медиана 28 лет)). Преобладали женщины — 1,45:1. Антеромедиальная височная лобэктомия выполнена 49 (47,6%) пациентам. Селективная амигдалогиппокампэктомия проведена 54 (52,4%) пациентам, из них 30 прооперированы с применением технологии burr hole — субвисочный доступ через фрезевое отверстие диаметром 14 мм. Исходы хирургического лечения оценивались по шкале Engel. Длительность наблюдения составила от 2 до 8 лет, медиана — 4 года.Через 2 года после операции исход Engel I зафиксирован в 74 (72%) наблюдениях, Engel II, III и IV — в 20 (19,4%), 6 (5,8%) и 3 (2,9%) соответственно. Исход Engel I достигнут после антеромедиальной височной лобэктомии (68%), селективной амигдалогиппокампэктомии со стандартными доступами (75%), а с использованием субвисочного burr hole-доступа — в 80% случаев. Нейрокогнитивные нарушения в группах антеромедиальной лобэктомии и селективной амигдалогиппокампэктомии не различались, в то время какСелективная амигдалогиппокампэктомия не уступает по эффективности антеромедиальной лобэктомии и при этом ассоциирована с меньшим риском развития осложнений и нежелательных последствий.

Background Immunohistochemistry is a basic diagnostic technique. Immunohistochemical examination results reflect mainly qualitative and less quantitative characteristics of proteomic status of cells. A combined approach with complex quantitative evaluation of marker expression using colorimetric analysis and computer technologies can expand the diagnostic capabilities of immunohistochemistry. We studied such an approach developed by using expression of the proliferative marker Ki-67 in pituitary adenomas. Methods A retrospective, blind, randomized, comparative study was performed of Ki-67 expression activity in pituitary adenomas using the traditional Ki-67 labeling index and a simple immunohistochemical cytocolorimetric analysis developed by us with immunohistochemical cytocolorimetric index (ICI) estimation as predictors of relapse, assessing the relationships of these indicators with the time before relapse. Results Mean Ki-67 labeling index was 3.87% ± 0.29% in the relapse-free group and 4.01% ± 0.29% in the relapse group; the difference was not statistically significant. The average Ki-67 ICI was 24.16% ± 0.51% in the relapse-free group and 30.68% ± 0.64% in the relapse group; the difference was statistically significant. The correlation coefficient of ICI values and time before relapse was −0.302, indicating the presence of a weak negative correlation. Conclusions We successfully tested an ICI estimation method developed by us to assess Ki-67 expression in pituitary adenomas. The ICI technique can be used both as a prognostic factor for relapse and, in combination with other modern proteomic and genetic methods, as the basis for creation of new multimodal analyzing systems for functional state assessment of cells and tissues.

Currently, cabergoline therapy is the main method of treatment with prolactin. The use of the drug in most cases leads to tumor regression, normalization of prolactin levels and restoration of gonadotropic function. The mechanism of its impact on tumor cells in vivo, which is dynamically traced in the same human tumor, is the case of considerable interest. We observed a 30-year-old patient who was operated on twice for a giant prolactinoma before and on treatment by cabergoline. The morphological study after the first surgery (before introducing of cabergoline therapy) revealed a prolactin-positive pituitary tumor with a Ki-67 labeling index of 8% and with strong expression of dopamine type 2 receptors (D2R), CD31 and CD34. After 4 months, during which the patient received cabergoline at a dose starting from 0.5 mg to 1.5 mg per week, a second transsphenoidal surgery was performed with subtotal removal of residual tumor tissue. During the morphological study of the second biopsy sample, the tumor retained a pronounced immunopositivity to prolactin and D2R, with a decrease in the labeling index Ki-67 to 2%, as well as a decrease in the expression of CD31 and CD34. Subsequent cabergoline therapyresulted in persistent normoprolactinemia, restoration of androgen (and reproductive) status, and no tumor recurrence over a 10-year period on cabergoline treatment. Thus, one of the mechanisms of effect of cabergoline that leads to tumor regression is a decrease in the proliferative index and angiogenesis of the tumor.

Material and methods In the period from 2010 to 2016. 14 patients with cavernous hemangioma (CH) and 2 patients with capillary hemangioma (CapH) of the orbit were examined. The age of CH patients varied from 17 to 67 years (median, 53 years); 8 females and 6 males. The age of CapH patients was 35 and 54 years. All patients underwent surgery with subsequent histological verification. CT-perfusion was performed in 10 CH patients and 2 CapH patients according to a developed low-dose protocol (80 kV, 200 mAs, tscan=40 s) with allowance for a target localizer (80 kV, 120 mAs) and at a maximum radiation dose of not more than 4.0 mZv. Neoplasm microcirculation was quantitatively assessed by calculating hemodynamic parameters: blood flow velocity (BFV), blood volume (BV), and mean transit time (MTT). MRI without and with contrast enhancement was performed in 11 CH patients and 2 CapH patients according to the ophthalmologic protocol (Signa GE, 3.0 T) accepted at the Institute: without contrast enhancement - T1, T2, and T2-FLAIR modes, T1 and T2 with a Fat Sat technique at a scan thickness of 3 mm, and DWI MRI; contrast enhancement - T1 (three projections) mode, including the Fat Sat technique. SWAN (n=2) and non-contrast MR perfusion ASL (n=3) were also used. Diffusion-weighted images (DWI) were processed with calculation of the apparent diffusion coefficient (ACD). Results In all CH patients, CT-perfusion revealed low perfusion parameters of blood flow: BVCH=0.86±0.37 mL/100 g, BFVCH= 4.89±2.01 mL/100 g/min with a high mean transit time MTTCH=10.13±3.05 s compared to the same parameters of blood flow in the normal white matter: CBVNormWM=1.63±2.22 mL/100 g, CBFVNormWM=9.72±3.13 mL/100 g/min, and MTTNormWM=6.76±2.78 s. In CapH cases, significantly increased blood flow velocity and volume values and a low MTT value in the tumor were observed: BVCapH=10.30±4.10 mL/100 g, BFVCapH=119.72±53.13 mL/100 g/min, and MTTCapH=4.35±1.79 s. In the case of orbital hemangiomas, optimal MRI modes were T1 and T2 with the Fat Sat technique, a scan thickness of 3 mm, and intravenous contrast enhancement. The revealed pattern of contrast agent accumulation by CH, initially in the central part and then in the periphery, may be a useful radiographic sign in the differential diagnosis with other orbital tumors. Conclusion Modern CT- and MRI-based diagnostics of orbital hemangiomas provides not only the exact location, size, and spread of the lesion but also reveals the characteristic structural features of these tumors, and the use of perfusion techniques visualizes hemodynamics of the tumors. CT-perfusion-based hemodynamic parameters of cavernous hemangiomas typical of this type of hemangiomas may be used in the differential diagnosis with other tumors of this location. The use of contrast enhancement and the Fat Sat technique with a scan thickness of not more than 3 mm is optimal for MRI diagnostics of orbital hemangiomas.

Diencephalic cachexia (DС) is progressive weight loss despite a normal caloric intake and a satisfactory state of health, which is caused by hypothalamic lesions. This is a rare (about 100 cases were reported) and potentially fatal disorder of unknown pathogenesis. At present, there is no effective pharmacological therapy for the disorder. Cachexia may regress only if the tumor reduces in size, therefore the timely diagnosis and treatment are of vital importance for the patient. DС is typical of early childhood, and only a few cases have been reported in adults. We present a rare case of DС in a 24-year-old female with papillary craniopharyngioma.Под диэнцефальной кахексией (ДК) понимают прогрессирующее снижение массы тела, обусловленное опухолевым поражением гипоталамуса. Это редкое (в литературе описано около 100 случаев), но потенциально смертельное расстройство с неизвестным до сих пор патогенезом. В настоящее время не существует эффективных фармакологических методов его лечения. Регресс кахексии может отмечаться только на фоне уменьшения объема опухоли, поэтому своевременная диагностика и лечение становятся жизненно важными для пациента. Развитие ДК характерно для раннего детского возраста и лишь единичные случаи зарегистрированы у взрослых. Мы представляем редкое наблюдение - развитие ДК у женщины 24 лет с папиллярной краниофарингиомой.

To identify mutations in cerebral cavernous malformation (CCM) genes in patients with hereditary and sporadic CCMs in the Russian population.Blood samples from 73 randomly selected patients, including 29 MRI-confirmed familial cases, 8 clinically confirmed familial cases and 38 so-called sporadic cases, were examined. A search for large deletions/duplications was performed using multiplex ligation-dependent probe amplification (MPLA). For MLPA-negative samples, the whole genome sequencing was performed to search for single nucleotide polymorphisms (SNP).Deletions in three genes (ССМ1, ССМ2, ССМ3) were identified in 14 patients, including 5 without definitely established familial type, in whom the familial character of disease was not confirmed by clinical and neuroimaging results. SNP mutations were found in 13 patients, CCM gene mutations in 27. Mutations were detected in 91.7% of familial cases. In two patients, new CCM3 deletions were identified. Gene distribution was as follows: 60.7 for CCM1, 32.2 for CCM2 and 7.1% for CCM3. In two members of a family with hereditary CCMs, no high effect mutations in the known CCM genes were found. Patients with mutations had greater severity of disease. Two patients with CCM3 mutations demonstrated the most aggressive clinical course. De novo formation and growth of CCM were observed only in patients with mutations.The distribution of pathogenic mutations in known CCM genes is consistent with other large-scale studies. Familial CCMs are associated with more severe disease course and may be caused by mutations beyond the known CCM genes.Цель исследования. Определение мутаций генов, ассоциированных с формированием церебральных кавернозных мальформаций, у больных с наследственной формой заболевания в российской популяции. Материал и методы. Генетические исследования выполнены у 73 больных: у 29 - с наследственной формой заболевания, у 6 - с условно доказанными семейными каверномами и у 38 - со спорадическими. Во всех случаях выполнен поиск крупных мутаций методом мультиплексной амплификации лигазносвязанных проб. Если крупные изменения генов у больных с клинически доказанными наследственными формами обнаружены не были, выполняли полноэкзомное секвенирование для выявления и анализа точечных мутаций и полиморфизмов. Результаты. В 14 образцах выявлены крупные перестройки в трех известных генах кавернозных мальформаций (ССМ1, ССМ2, ССМ3), в том числе у 5 больных с неустановленным по клинико-нейровизуализационным данным наследственным характером болезни. Всего с однонуклеотидными мутациями было 13 больных, а с мутацией в генах кавернозных мальформаций - 27. Мутации в генах выявлены в 91,7% обследованных семей. В 2 случаях найдены ранее не описанные делеции в гене CCM3. Соотношение генов CCM1, CCM2 и CCM3 составило 60,7, 32,2 и 7,1% соответственно. У 2 человек из семьи с наследственными каверномами в известных генах кавернозных мальформаций мутаций с высоким эффектом не обнаружено. Для больных с мутациями было характерно более тяжелое течение заболевания. Наиболее агрессивное клиническое течение отмечалось при мутациях в гене ССМ3. Случаи роста и новообразования каверном наблюдались только у больных с мутациями в генах кавернозных мальформаций. Заключение. Распределение частоты мутаций в трех генах кавернозных мальформаций в нашей работе и по данным других крупных исследований совпадает. Наследственные каверномы склонны к более тяжелому клиническому течению. Наследственные формы каверном могут быть обусловлены мутациями вне известных генов кавернозных мальформаций.

The median overall survival of glioblastoma patients is about 15 months. Only a small number of patients survive 3 years. The factors of a favorable prognosis for the 'longevity phenomenon' in glioblastoma patients are not fully understood.to determine the occurrence rate of long-living patients with glioblastomas, identify clinical predictors of a favorable prognosis, and identify the presence and prognostic significance of an IDH1 mutation.Among 1494 patients operated on for glioblastoma at the Burdenko Neurosurgical Institute from 2007 to 2012, there were 84 (5.6%) patients who lived more than 3 years after primary surgery. In all the cases, histological specimens were reviewed, and immunohistochemical detection of a mutant IDH1 protein was performed. Overall survival was calculated from the time of first surgery to the date of the last consultation or death, and the recurrence-free period was calculated from the time of first surgery to MRI-verified tumor progression.The median age of long-living patients with glioblastoma was 45 years (19-65 years). All tumors were located supratentorially. The median Karnofsky performance status score at the time of surgery was 80 (range, 70-100). All patients underwent microsurgical resection of the tumor, followed by chemoradiotherapy. The median recurrence-free period was 36 months (5-98 months). Overall survival of 48, 60, and 84 months was achieved in 23, 15 and 6% of patients, respectively. Among 49 specimens available for the IDH1 analysis, 14 (28.6%) specimens had a mutant protein. There was no significant difference in survival rates in patients with positive and negative results for IDH1 (44.1 vs. 40.8 months; p0.05).The significance of various factors that may be predictors of a favorable course of the disease is discussed in the literature. This work is the first part of analysis of prognostically significant factors positively affecting overall survival of glioblastoma patients. In our series, the predictors of a favorable prognosis for long-living patients with the verified diagnosis of glioblastoma were as follows: young age, the supratentorial location of the tumor, a high Karnofsky score before surgery, and tumor resection. In our series, we used immunohistochemical tests and found no prognostic significance of the IDH1 gene mutation; further analysis will require application of direct sequencing. We plan to study other morphological and molecular genetic features of tumors, which explain prolonged survival of glioblastoma patients, as well as the role of various types of combined chemoradiation treatment.Медиана общей выживаемости пациентов с глиобластомами составляет около 15 мес. Лишь небольшое количество пациентов переживают 3 года. Факторы благоприятного прогноза при 'феномене долгожительства' у больных с глиобластомами в настоящее время до конца не изучены. Цель исследования - определить частоту встречаемости пациентов-'долгожителей' с глиобластомами, идентифицировать клинические предикторы благоприятного прогноза, выявить наличие и прогностическую значимость мутации IDH1. Материал и методы. Среди 1494 пациентов, оперированных в Институте нейрохирургии им. Н.Н. Бурденко (ныне - Национальный научно-практический центр нейрохирургии им. акад. Н.Н. Бурденко) с 2007 по 2012 г. по поводу глиобластом, выявлены 84 (5,6%) пациента, проживших более 3 лет после первичной операции. Относительно всех пациентов гистологические препараты были пересмотрены, проведено иммуногистохимическое исследование на наличие мутантного протеина IDH1. Общая выживаемость высчитывалась с момента первой операции до даты последней консультации или смерти, безрецидивный период - с момента первой операции до прогрессии опухоли по данным МРТ-исследования. Результаты. Медиана возраста у пациентов-'долгожителей' с глиобластомой составила 45 лет (в среднем 19-65 лет). Все опухоли были расположены супратенториально. Медиана индекса функционального состояния по шкале Карновского на момент операции составила 80 (диапазон 70-100). Всем пациентам было проведено микрохирургическое удаление опухоли с последующей химиолучевой терапией. Медиана безрецидивного периода составила 36 мес (5-98 мес). Уровень общей выживаемости в 48, 60 и 84 мес был достигнут у 23, 15 и 6% пациентов соответственно. Среди 49 образцов, доступных для анализа на IDH1, 14 (28,6%) имели мутантный протеин. Достоверной разницы показателей выживаемости у пациентов с положительным и отрицательным IDH1 не выявлено (44,1 мес против 40,8 мес; p0,05). Заключение. Значимость различных факторов, которые могут являться предикторами благоприятного течения болезни, обсуждаются в литературе. Данная работа является первым фрагментом анализа прогностически значимых факторов, позитивно влияющих на общую выживаемость больных с глиобластомой. В нашей серии предикторами благоприятного прогноза для пациентов-'долгожителей' с верифицированным диагнозом 'глиобластома' оказались: молодой возраст, супратенториальное расположение опухоли, высокий индекс Карновского до операции, удаление опухоли. Прогностическая значимость мутации в гене IDH1 с использованием иммуногистохимических методов в нашей серии не выявлена; для дальнейшего анализа необходимо использование метода прямого секвенирования. Планируется проведение исследований других морфологических и молекулярно-генетических особенностей опухолей, объясняющих факт 'долгожительства' пациентов с глиобластомой, а также роли различных вариантов комбинированного химиолучевого лечения.

An increased blood level of the thyroid stimulating hormone (TSH) is usually associated with primary hypothyroidism (PHT) but can also be observed in such rare cases as TSH-secreting pituitary tumor. The article describes four clinical cases of elevated TSH blood levels: 1) TSH-secreting pituitary adenoma with hyperthyroidism; 2) TSH-secreting adenoma with hypothyroidism; 3) hormonally inactive pituitary adenoma combined with primary hypothyroidism; 4) reversible thyrotropic hyperplasia. These clinical situations substantiate the importance of considering different diagnoses in a patient with a pituitary gland tumor associated with an increased TSH blood level.Повышение уровня тиреотропного гормона (ТТГ) в крови, как правило, вызвано первичным гипотиреозом, но может наблюдаться и в таких редких случаях, как ТТГ-секретирующая опухоль гипофиза. В статье рассматриваются четыре клинических случая повышения уровня ТТГ в крови у пациентов: 1) ТТГ-секретирующая аденома гипофиза с гипертиреозом; 2) ТТГ-секретирующая аденома с гипотиреозом; 3) гормонально-неактивная аденома гипофиза в сочетании с первичным гипотиреозом; 4) случай обратимой тиреотрофной гиперплазии. Эти клинические ситуации обосновывают важность рассмотрения различных диагнозов у пациента с опухолью гипофиза, сопровождающейся повышением уровня ТТГ в крови.

An extended endoscopic endonasal approach is increasingly used in surgical treatment of space-occupying skull base lesions. The international literature reports only 20 cases of surgical treatment for fibrous dysplasia (PD) of the skull base using the endoscopic endonasal approach. We present our experience with the endoscopic endonasal approach in surgical treatment for giant fibrous dysplasia of the skull base, spreading to the right orbital cavity and nasopharynx.A 26-year-old male patient presented with cranial pain, Vth nerve dysfunction on the right, right keratopathy. OD=0.2 (near acuity - 0.3), OS=1.0, OD - incomplete eyelid closure of 2 mm, conjunctival injection, mucous discharge, corneal opacity in the lower pole and paracentrally, OS - normal appearance. Severe right-sided exophthalmos (more than 15 mm), impaired nasal breathing on the right, nasal (hemorrhagic) discharge. Magnetic resonance imaging and spiral computed tomography scans revealed a bone density lesion located in the area of the orbit, nasal cavity, maxillary sinus on the right, and labyrinth of the ethmoid bone. The patient underwent endonasal endoscopic resection of the lesion.The lesion was resected totally, which was confirmed by control SCT. Right-sided exophthalmos partially regressed (on the right: exophthalmos of 8 mm; protrusion: OD=23 mm, OS=15 mm; the eyeball was displaced downward and outward). The visual and oculomotor functions did not change. The neurological status remained at the preoperative level.Fibrous dysplasia of the skull base is an extremely rare disease. Modern techniques expand the indications for surgery of giant tumors of the skull base using minimally invasive approaches, in particular the endoscopic endonasal approach.Расширенный эндоскопический эндоназальный доступ находит все большее применение в хирургическом лечении объемных образований основания черепа. В мире описано всего 20 случаев оперативного лечения фиброзной дисплазии основания черепа (ФД) с использованием эндоскопического эндоназального доступа. Представляем наш опыт оперативного лечения эндоскопическим эндоназальным доступом гигантского патологического очага фиброзной дисплазии основания черепа, распространяющегося в полость правой орбиты и носоглотку. Клинический случай. Мужчина, 26 лет, с краниальным болевым синдромом, недостаточностью V нерва справа, кератопатией справа. OD=0,2 (вблизи — 0,3), OS=1,0, OD — несмыкание век 2 мм, конъюнктивальная инъекция, слизистое отделяемое, в нижнем полюсе роговицы и парацентрально помутнение роговицы, OS — спокоен. Выраженный правосторонний экзофтальм (более 15 мм), нарушение носового дыхания справа, выделения (геморрагического характера) из носа. На магнитно-резонансных томограммах и спиральных компьютерных томограммах выявлено образование костной плотности в области орбиты, полости носа, верхнечелюстной пазухи справа, лабиринта решетчатой кости. Произведено эндоскопическое эндоназальное удаление патологического очага. Результаты. Удаление патологического очага тотальное, что подтверждено контрольной СКТ. Частичный регресс правостороннего экзофтальма (справа — экзофтальм 8 мм, выстояние OD=23 мм, OS=15 мм, глазное яблоко смещено книзу и кнаружи). Зрительные и глазодвигательные функции без динамики. Неврологический статус на дооперационном уровне. Заключение. Фиброзная дисплазия основания черепа является крайне редким заболеванием. Современные технологии позволяют расширять показания к оперативному лечению гигантских новообразований основания черепа с использованием минимально инвазивных доступов, а именно эндоскопического эндоназального доступа.

Thyrotropinomas (TSH-secreting tumors) are a rare type of pituitary adenomas, which account for about 0.5-2.0% of all pituitary tumors. The criterion of thyrotropinoma is visualization of the tumor in the presence of a normal or elevated level of the thyroid-stimulating hormone (TSH) in the blood and elevated concentrations of free T4 (fT4) and free T3 (fT3).To study the clinical, diagnostic, and morphological characteristics and treatment outcomes of TSH-secreting pituitary tumors.The study included 21 patients aged from 15 to 67 years with pituitary adenoma and a normal or elevated blood TSH level combined with elevated fT4 and fT3 levels who were operated on at the Neurosurgical Institute in the period between 2002 and 2015. Before surgery, in the early postoperative period, and 6 months after surgery, the patients were tested for levels of TSH, fT4, fT3, prolactin, cortisol, the luteinizing hormone (LH), the follicle-stimulating hormone (FSH), estradiol/testosterone, and the insulin-like growth factor (IGF-1). The thyroid status was evaluated using the following reference values: TSH, 0.4-4.0 mIU/L; fT4, 11.5-22.7 pmol/L; fT3, 3.5-6.5 pmol/L. An immunohistochemical study of material was performed with antibodies to TSH, PRL, GH, ACTH, LH, FSH, and Ki-67 (MiB-1 clone); in 13 cases, we used tests with antibodies to somatostatin receptors type 2 and 5 and to D2 subtype dopamine receptors.Thyrotropinomas were detected in patients aged from 15 to 67 years (median, 39 years), with an equal rate in males (48%) and females (52%). Before admission to the Neurosurgical Institute, 11 (52%) patients were erroneously diagnosed with primary hyperthyroidism; based on the diagnosis, 7 of these patients underwent surgery on the thyroid gland and/or received thyrostatics (4 cases). Hyperthyroidism symptoms were observed in 16 (76%) patients. The blood level of TSH was 2.47-38.4 mIU/L (median, 6.56); fT4, 22.8-54.8 nmol/L (median, 36); fT3, 4.24-12.9 pmol/L (median, 9.66). Tumors had the endosellar localization in 4 (19%) cases and the endo-extrasellar localization in 17 (91%) cases. Total tumor resection was performed in 7 (33%) patients. All these tumors had the endosellar and endo-suprasellar localization. No total resection was performed in patients with infiltrative growth of adenoma (invading the skull base structures). An immunohistochemical study of tumor resection specimens detected only TSH expression in 3 (14%) cases; 18 (86%) tumors were plurihormonal and secreted TSH and GH and/or PRL. Of 13 tumors, expression of the type 2 dopamine receptor was detected in 9 (69%) cases; expression of somatostatin receptors type 5 and type 2 was found in 6 (46%) and 2 (15%) cases, respectively.The criterion for total tumor resection was a postoperative decrease in the TSH level to 0.1 mIU/L or less. Total resection was performed in 33% of patients with tumors of only the endosellar and endo-suprasellar localization. In most cases, tumors were plurihormonal and secreted TSH and GH and/or PRL.Тиреотропиномы (ТТГ-секретирующие опухоли) - редкий тип аденом гипофиза, на долю которых приходится около 0,5-2,0% всех опухолей гипофиза. Критерием тиреотропиномы является визуализация опухоли при нормальном или повышенном уровне тиреотропного гормона (ТТГ) в крови и при наличии повышенных концентраций свободного Т4 (св.Т4) и свободного Т3 (св.Т3). Цель исследования - изучить клинические, диагностические, морфологические характеристики и результаты лечения ТТГ-секретирующих опухолей гипофиза. Материал и методы. В исследование включены пациенты с аденомой гипофиза и нормальным или повышенным уровнем ТТГ в крови в сочетании с повышенными уровнями св.Т4 и св.Т3, оперированные в НИИ нейрохирургии с 2002 по 2015 г., всего 21 человек от 15 до 67 лет. До операции, в раннем послеоперационном периоде и через 6 мес после нее пациентам проводилось исследование уровней ТТГ, св.Т4, св.Т3, пролактина, кортизола, лютеинизирующего гормона (ЛГ), фолликулостимулирующего гормона (ФСГ), эстрадиола/тестостерона, инсулиноподобного фактора роста (ИФР-1). При оценке тиреоидного статуса использовались следующие референсные значения: ТТГ 0,4-4,0 мЕд/л, св.Т4 11,5-22,7 пмоль/л, св.Т3 3,5-6,5 пмоль/л. Иммуногистохимическое исследование материала проводили с антителами к ТТГ, ПРЛ, СТГ, АКТГ, ЛГ, ФСГ, Ki-67 (клон MiB-1), в 13 случаях исследование с антителами к соматостатиновым рецепторам 2-го и 5-го типа и дофаминовым рецепторам D2 подтипа. Результаты. Тиреотропиномы выявлялись у пациентов в возрасте от 15 до 67 лет (медиана 39 лет) с одинаковой частотой у мужчин (48%) и женщин (52%). 11 пациентов (52%) до поступления в НИИ нейрохирургии имели ошибочный диагноз первичного гипертиреоза, по поводу чего 7 из них были оперированы на щитовидной железе и/или получали тиреостатики (4 наблюдения). Cимптоматика гипертиреоза отмечена у 16 (76%) больных. Уровень ТТГ в крови составил 2,47-38,4 мЕд/л (медиана 6,56), св.Т4 22,8-54,8 нмоль/л (медиана 36), св.Т3 4,24-12,9 пмоль/л (медиана 9,66). В 4 (19%) случаях опухоли были эндоселлярными, в 17 (91%) случаях - эндо-экстраселлярной локализации. Радикальное удаление опухоли было проведено у 7 (33%) пациентов. Все эти опухоли были эндоселлярной и эндо-супраселлярной локализации. В случае инфильтративно растущей аденомы (врастающей в структуры основания черепа) ни у одного из пациентов радикального удаления не было. При иммуногистохимическом исследовании препаратов удаленных опухолей экспрессия только ТТГ выявлена в 3 (14%) случаях, 18 (86%) опухолей были плюригормональные и секретировали ТТГ и СТГ и/или ПРЛ. Из 13 опухолей экспрессия дофаминовых рецепторов 2-го типа выявлена в 9 (69%), соматостатиновых рецепторов 5-го типа - в 6 (46%), соматостатиновых рецепторов 2-го типа - в 2 (15%) случаях. Заключение. Критерием радикального удаления опухоли было снижение уровня ТТГ после операции до 0,1 мЕд/л и ниже. Радикальное удаление опухоли было осуществимо у 33% пациентов только с эндоселлярной и эндо-супраселлярной локализацией. В большинстве случаев опухоли были плюригормональные и секретировали ТТГ и СТГ и/или ПРЛ.Тиреотропиномы (ТТГ-секретирующие опухоли) — редкий тип аденом гипофиза, на долю которых приходится около 0,5—2,0% всех опухолей гипофиза. Критерием тиреотропиномы является визуализация опухоли при нормальном или повышенном уровне тиреотропного гормона (ТТГ) в крови и при наличии повышенных концентраций свободного Т4 (св.Т4) и свободного Т3 (св.Т3). Цель исследования — изучить клинические, диагностические, морфологические характеристики и результаты лечения ТТГ-секретирующих опухолей гипофиза. Материал и методы. В исследование включены пациенты с аденомой гипофиза и нормальным или повышенным уровнем ТТГ в крови в сочетании с повышенными уровнями св.Т4 и св.Т3, оперированные в НИИ нейрохирургии с 2002 по 2015 г., всего 21 человек от 15 до 67 лет. До операции, в раннем послеоперационном периоде и через 6 мес после нее пациентам проводилось исследование уровней ТТГ, св.Т4, св.Т3, пролактина, кортизола, лютеинизирующего гормона (ЛГ), фолликулостимулирующего гормона (ФСГ), эстрадиола/тестостерона, инсулиноподобного фактора роста (ИФР-1). При оценке тиреоидного статуса использовались следующие референсные значения: ТТГ 0,4—4,0 мЕд/л, св.Т4 11,5—22,7 пмоль/л, св.Т3 3,5—6,5 пмоль/л. Иммуногистохимическое исследование материала проводили с антителами к ТТГ, ПРЛ, СТГ, АКТГ, ЛГ, ФСГ, Ki-67 (клон MiB-1), в 13 случаях исследование с антителами к соматостатиновым рецепторам 2-го и 5-го типа и дофаминовым рецепторам D2 подтипа. Результаты. Тиреотропиномы выявлялись у пациентов в возрасте от 15 до 67 лет (медиана 39 лет) с одинаковой частотой у мужчин (48%) и женщин (52%). 11 пациентов (52%) до поступления в НИИ нейрохирургии имели ошибочный диагноз первичного гипертиреоза, по поводу чего 7 из них были оперированы на щитовидной железе и/или получали тиреостатики (4 наблюдения). Cимптоматика гипертиреоза отмечена у 16 (76%) больных. Уровень ТТГ в крови составил 2,47—38,4 мЕд/л (медиана 6,56), св.Т4 22,8—54,8 нмоль/л (медиана 36), св.Т3 4,24—12,9 пмоль/л (медиана 9,66). В 4 (19%) случаях опухоли были эндоселлярными, в 17 (91%) случаях — эндо-экстраселлярной локализации. Радикальное удаление опухоли было проведено у 7 (33%) пациентов. Все эти опухоли были эндоселлярной и эндо-супраселлярной локализации. В случае инфильтративно растущей аденомы (врастающей в структуры основания черепа) ни у одного из пациентов радикального удаления не было. При иммуногистохимическом исследовании препаратов удаленных опухолей экспрессия только ТТГ выявлена в 3 (14%) случаях, 18 (86%) опухолей были плюригормональные и секретировали ТТГ и СТГ и/или ПРЛ. Из 13 опухолей экспрессия дофаминовых рецепторов 2-го типа выявлена в 9 (69%), соматостатиновых рецепторов 5-го типа — в 6 (46%), соматостатиновых рецепторов 2-го типа — в 2 (15%) случаях. Заключение. Критерием радикального удаления опухоли было снижение уровня ТТГ после операции до 0,1 мЕд/л и ниже. Радикальное удаление опухоли было осуществимо у 33% пациентов только с эндоселлярной и эндо-супраселлярной локализацией. В большинстве случаев опухоли были плюригормональные и секретировали ТТГ и СТГ и/или ПРЛ.

Glioblastoma is the most common primary malignant glial tumor of the brain in adult patients.to define the prognostic value of isocitrate dehydrogenase-1 (IDH-1) mutation and methylguanine-DNA methyltransferase (MGMT) methylation status in patients with glioblastoma (GB) and to analyze the impact of clinical data (gender, age, and tumor site), histological variants of the tumor structure, and time to development of recurrences on the course of the disease.The investigation enrolled 63 GB patients aged 18 to 71 years who had received combined treatment (surgery, chemo- and radiotherapy) at the N.I. Burdenko Research Institute of Neurosurgery, Ministry of Health of the Russian Federation, in the period 2008 to 2011. The investigators performed a morphological examination of all tumor tissue samples and an immunohistochemical examination using anti-IDH-1 R-132 antibody clone («Dianova», Germany) and defined MGMT methylation status by a polymerase chain reaction using the CpGenome DNA Modification Kit («Chemicon International», USA). The data were statistically processed using a package of Statistica 6.0 programs.Patient age, time to development of recurrent glioblastoma, mutations in the IDH-1 gene and MGMT were found to be prognostic factors for overall survival among adult patients in this category.Analysis of clinical findings and identification of molecular genetic aberrations in the tumor cells will be able to elaborate an individual approach to treating patients with glioblastoma in order to increase their survival rates and to improve quality of life.Глиобластома - наиболее частая первичная злокачественная глиальная опухоль головного мозга у взрослых больных. Цель исследования - определить прогностическую значимость мутации изоцитратдегидрогеназы-1 (isocitrate dehydrogenase-1, IDH-1) и статуса метилирования метилгуанин-ДНК-метилтрансферазы (methylguanine-DNA methyltransferase, MGMT) у больных с глиобластомой (ГБ), проанализировать влияние клинических данных (пол, возраст, локализация опухоли), гистологических вариантов строения опухоли и сроки развития рецидивов на течение заболевания. Материал и методы. В исследование включили 63 пациента с ГБ в возрасте от 18 лет до 71 года, которым за период с 2008 по 2011 г. провели комбинированное лечение (операция, химио- и лучевая терапия) на базе НИИ нейрохирургии им. Н.И. Бурденко Минздрава России. Выполнены морфологическое исследование всех образцов опухолевой ткани, иммуногистохимическое исследование с антителами к белку IDH-1 (клон R-132 фирмы 'Dianova', Германия), определение статуса метилирования MGMT методом ПЦР с применением пробы CpGenome DNA Modification Kit, 'Chemicon International', США. Статистическая обработка данных проведена с использованием пакета программ Statistica 6.0. Результаты. Установлено, что возраст больного, время развития рецидива глиобластомы, мутации гена IDH-1 и MGMT являются прогностически значимыми критериями общей выживаемости среди взрослых больных данной категории. Заключение. Анализ клинических данных и выявление молекулярно-генетических аберраций в опухолевых клетках позволит в будущем разработать индивидуальный подход к лечению больных с ГБ для увеличения продолжительности их жизни и повышения качества жизни.

Determine the duration of persistence of IgM and IgG in reconvalescents of West Nile fever (WNF) 1 year after the disease in southern regions of Russia and evaluate effectiveness of PCR method for acute infection diagnostics.Blood sera of 87 patients with WNF diagnosis was studied for the presence of West Nile virus (WNV) RNA and IgM and IgG by PCR and EIA. Samples of the first sera were collected in 2010 at days 2 - 30 after the onset of the disease, samples of the second sera--at days 5 - 23 and third--264 - 385 days later.During the first 2 weeks of the disease WNV RNA was detected in more than 50% of patients. In all the first sera IgM at titers of ≥ 1:800 were detected. Seroconversion of IgG titers of 4 and more times was observedin 83% (30/36) of patients. In 2011 IgG were detected in 91% of reconvalescents (79/87), IgM--in 57% (50/87), and in 25% (22/87) IgM titers were ≥ 1:800.The results obtained give evidence on the necessity of using several diagnostic criteria simultaneously for the confirmation of WNF clinical diagnosis.

Authors show an example of a successful treatment of a patient with a giant intracranial hemangiopericytoma. Hemangiopericytoma are aggressive tumors with a high rate of recurrence and metastasis. Despite the malignant nature of these tumors often reach a large size with minor clinical signs. Surgical removal of the tumor is still the primary method of treatment.

Surgical management of pathological deformities of the internal carotid arteries, a cause of chronic brain ischemia, is discussed. This pathology is very common and is found in 25% of all individuals who underwent preventive medical examination according to the ultrasonography data. Most deformities do not pose any threat to patients, while some of them may cause ischemic stroke and chronic brain ischemia. The study included 165 patients with the known follow-up history who had been operated on at the N.N. Burdenko Neurosurgical Institute since 2001. A total of 196 reconstructive interventions of carotid arteries were analyzed. The indications for surgical management of pathological deformities based on clinical symptoms and identification of the signs of vascular wall dysplasia are thoroughly discussed. The local and cerebral hemodynamics during pre- and postoperative period are analyzed. The results of pathomorphological examination of the resected fragments of the deformed arteries are presented; they show that the changes are identical to those in patients with fibromuscular dysplasia. The follow-up history of the patients was recorded; it showed a sustained regression of transitory ischemic strokes and cerebral symptoms in most cases (69%). For proper indications for surgical management, reconstructive surgical interventions are a reliable and effective method for treating chronic brain ischemia and preventing recurrent ischemic strokes in patients with deformities of carotid arteries.

Because of the spread to different anatomical regions, craniofacial tumors (CFTs) usually receive blood supply from several arterial systems, and CFT removal is often accompanied by abundant blood loss.The study purpose was to develop an algorithm of diagnostic angiography for planning surgical treatment of CFT patients.Complex preoperative angiography was performed in 72 patients with craniofacial tumors, aged 10 to 78 years (mean age, 45.5 years), who underwent surgical treatment at the Burdenko Neurosurgical Institute in the period from 2012 to 2015. At the first stage, blood supply to tumors was quantified using SCT perfusion. Then, depending on an assessed degree of tumor vascularization, direct angiography or modern minimally invasive angiographic techniques (3D TOF HR MR angiography, SCT angiography) were applied.In 12 cases of hypervascular tumors, accessible afferents were preoperatively embolized through the external carotid artery, which was accompanied by an increase in the blood supply to tumors via alternative routes of the external and internal carotid arteries. The obtained data were used to plan the surgical approach. A comparative analysis of the SCT perfusion data and the expression level of endothelial markers in histological specimens revealed no significant correlation.The study demonstrated the importance of a comprehensive assessment of the blood supply to CFTs in planning of the surgical treatment and enabled the development of algorithms for preoperative angiographic diagnosis, depending on the baseline clinical and radiological data.Вследствие распространения в различные анатомические регионы краниофациальные опухоли (КФО) обычно получают кровоснабжение из нескольких артериальных систем, а их удаление зачастую сопровождается обильной кровопотерей. Цель исследования. Разработка алгоритма ангиографической диагностики для планирования тактики хирургического лечения больных с КФО. Материал и методы. Выполнено комплексное предоперационное ангиографическое исследование 72 пациентов с КФО в возрасте от 10 до 78 лет (средний возраст 45,5 года), получавших хирургическое лечение в ФГАУ 'ННПЦН им. акад. Н.Н. Бурденко' Минздрава России с 2012 по 2015 г. Первым этапом производилась количественная оценка кровоснабжения опухолей с применением СКТ-перфузии. Затем, в зависимости от полученных данных о степени васкуляризации опухолей, выполнялась прямая ангиография или современные малоинвазивные агиографические методики (МР-ангиография 3D TOF HR, СКТ-ангиография). Результаты. В 12 случаях с гиперваскулярными опухолями выполнена предоперационная эмболизация доступных афферентов из наружной сонной артерии, после чего отмечено усиление кровоснабжения опухолей из альтернативных источников наружной и внутренней сонных артерий. На основании полученных данных планировалась тактика хирургического лечения. Проведен сравнительный анализ данных СКТ-перфузии и степени экспрессии эндотелиальных маркеров на гистологических препаратах, не выявивший значимой корреляции. Заключение. Исследование показало важность комплексной оценки кровоснабжения КФО в планировании хирургического лечения, а также позволило выработать алгоритмы предоперационной ангиографической диагностики в зависимости от исходных клинико-рентгенологических данных.

Glioblastomas in children and adults are a heterogeneous group of tumors that can be divided into at least three different subgroups: pediatric glioblastomas, IDH1-mutant glioblastomas in adults (the most favorable prognostic subtype), and IDH1-wild type glioblastomas in adults. According to the frequency of detected cytogenetic aberrations (amplification of the MYC/MYCN, EGFR and PDGRFA oncogenes, homozygous deletion of the CDKN2A gene, and deletion of the PTEN gene), pediatric glioblastomas bear analogy to the subgroup of IDH1-mutant glioblastomas in adults.

Paper describes a study of language lateralization of patients with brain tumors, measured by preoperative functional magnetic resonance imaging (fMRI) and comparison results with tumor histology and profile of functional asymmetry.During the study 21 patient underwent fMRI scan. 15 patients had a tumor in the left and 6 in the right hemisphere. Tumors were localized mainly in the frontal, temporal and fronto-temporal regions. Histological diagnosis in 8 cases was malignant Grade IV, in 13 cases--Grade I-III. fMRI study was perfomed on scanner "Signa Exite" with a field strength of 1.5 As speech test reciting the months of the year in reverse order was used. fMRI scan results were compared with the profile of functional asymmetry, which was received with the results of questionnaire Annette and dichotic listening test.Broca's area was found in 7 cases in the left hemisphere, 6 had a tumor Grade I-III. And one patient with glioblastoma had a tumor of the right hemisphere. Broca's area in the right hemisphere was found in 3 patients (2 patients with left sided tumor, and one with right-sided tumor). One patient with left-sided tumor had mild motor aphasia. Bilateral activation in both hemispheres of the brain was observed in 6 patients. All of them had tumor Grade II-III of the left hemisphere. Signs of left-handedness were revealed only in half of these patients. Broca's area was not found in 4 cases. All of them had large malignant tumors Grade IV. One patient couldn't handle program of the research.Results of fMRI scans, questionnaire Annette and dichotic listening test frequently were not the same, which is significant. Bilateral activation in speech-loads may be a reflection of brain plasticity in cases of long-growing tumors. Thus it's important to consider the full range of clinical data in studying the problem of the dominant hemisphere for language.

Background MicroRNAs (miRNAs) are a class of small non-coding RNA molecules involved in the regulation of key biological processes. Different miRNAs with pro-oncogenic and anti-oncogenic properties have been identified in glioblastomas. We decided to analyze expression profiles of 10 mature miRNAs (miR-7-1, miR-10а, miR-17, miR-20а, miR-21, miR-23а, miR-26а, miR-137, and miR-222) in post-surgery glioma specimens of different grades in order to find whether the expression level correlates with tumor grades. We also measured expression of six key genes such as PTEN, p21/CDKN1A, MDR1, ABCG2, BAX, and BCL-2 involved in the regulation of critical glioma signaling pathways to establish the effect of miRNAs on these signaling mechanisms. Methods Using RT-PCR, we performed expression analysis of 25 tumor fresh samples (grades II-IV). Results We found gradual increase in miR-21 and miR-23a levels in all tumor grades whereas miR-7 and miR-137 were significantly down-regulated depending on the glioma grade. MDR, ABCG2, and p21/CDKN1A levels were significantly up-regulated while expression of PTEN was down-regulated in tumor samples compared to the normal brain tissue. Conclusions These observations provide new insights into molecular pathogenic mechanisms of glioma progression and suggest about a potential value of miRNAs as a putative diagnostic marker of brain tumors.

Brain metastases (BM) are the most frequent intracranial SOL and extremely heterogeneous group of tumours from morphological point of view. Nevertheless, studies devoted to BM up to now paid little attention to the histogenesis of the primary tumour. Lung carcinoma is the most common source of BM; morpologically this is a very heterogeneous group of tumors, and they demostrate different clinical pathway and outcome. The aim of present study was to evaluate clinical and morphological prognostic factors in 126 patients with lung carcinoma metastases to the brain, operated in 2004-2010 at Burdenko Neurosurgical Institute. Statistical analysis demonstrated that age, gender, amount and location of BM, primary operation and even histological tumour type were not significant prognostic factors, meanwhile absence of extracranial metastases and Karnofsky index above 70 were significant factors of the favorable prognosis.

Diffuse bithalamic glioma is rare entity. A few cases have been described so far. We present the data of 13 patients (both children and adults) with diffuse bithalamic gliomas observed and treated at Burdenko Neurosurgery Institute within the period of 2004-2011. Age of patients varied from 3 to 29 y.o. Bithalamic gliomas appear as symmetric enlargement of both thalami on MRI with frequent spreading to adjacent structures (brainstem, temporal lobes). Histologically they appear as astrocytomas (Grade II-IV). Bithalamic gliomas posess different clinical course. There is no indication for surgical treatment because of diffuse growth of these tumors. Stereotactic biopsy is indicated to verify histological origin. Treatment of bithalamic gliomas confined with radio- and chemotherapy. In cases with obstructive hydrocephalus CSF diverting operations are indicated. Attempts of surgical excision lead to worsening of patient's neurological condition. Most patients with bithalamic gliomas have unfavorable prognosis. Tumors remain stable with adjuvant therapy for a very short period of time in most cases. Benign course of this pathology with long-term follow-up is observed only in a few cases.

Absence of well-defined borders of the glial tumor due to their infiltrative growth is one of the main issues in neurosurgery. A number of methods for intraoperative visualization are available today. The fluorescent metabolic navigation with 5-aminolevulinic acid (5-ALA) combined with quantitative laser spectroscopy is one of the latest technique. In our series of 99 consecutive patients with brain gliomas (WHO Grade I-IV) we found that visible fluorescence was observed in 68% of cases. Additional use of the laser spectroscopy could increase method sensitivity up to 74% due to accumulation of the protoporphyrine IX in nonfluorescense tumors. It was shown that there are some differences in quantitative fluorescence not only within same tumor (glioblastoma) but also in-between low- and high-grade gliomas. Intraoperative fluorescence and laser spectroscopy are effective and very helpful methods of intraoperative imaging in of intrinsic brain tumor surgery.

Methods of diagnostics of primary intraocular lymphomas associated with primary CNS lymphomas are described. This article demonstrates the value of neurophtalmological assessment before surgery in patients with intracranial space occupying lesions. Three cases with bilateral primary intraocular lymphomas are presented. Authors analyzed initial results of intraocular lymphomas treatment with intravitreal methotrexate injections.

Photodynamic diagnosis (PDD) has been actively implemented into neurooncological practice, especially in cerebral gliomas surgery. This paper describes our first experience of PDD combined with laser spectroanalysis in intracranial meningiomas. The study included 21 patients (8 male and 13 female patients, mean age was 58 years, range--between 37 and 74 years) with intracranial meningiomas operated with PDD in Burdenko Neurosurgical Institute between 2008 and 2011. In 14 cases laser spectroanalysis was used. Tumor fluorescence was present in all but one cases (95%). Spectroanalysis demonstrated that peaks of fluorescence varied between 5 and 46 (mean level was 18.5). These data correlated with visual impression of fluorescence and confirmed that meningioma is a tumor with bright fluorescence. Radical removal (Simpson grade I-II) was achieved in 10 cases, subtotal resection was performed in the rest of the patients. Application of PDD and laser spectroanalysis allows gaining complete information about accumulation of photosensibilizer in the tissue. To our opinion, these methods may be the most useful for determination of the borders of dural and bony invasion which directly affects the surgical tactics and degree of radical removal. Further studies are needed to evaluate the influence of PDD and laser spectroanalysis on long-term surgical outcomes.

Objective This study is aimed at revealing the relationship between local interictal epileptic activity, cytoarchitectural disturbances and magnetic resonance imaging (MRI) findings. Material and methods We prospectively investigated a series of 25 patients with symptomatic epilepsy due to isolated forms of focal cortical dysplasia (FCD) or hippocampal sclerosis and low-grade tumours associated with FCD, all of whom underwent tailored surgical procedures under intraoperative electrocorticography; we conducted neuropathological examinations of 92 biopsies taken from different places. We examined the relationship between dysplastic changes in the cortex and the absence or presence of seizure patterns (SPs), including regular spikes/sharp waves, recruiting discharges, paroxysmal fast activity and rhythmic delta–theta activity. Comparisons with MRI findings were also performed. Results Complete removal of the SPs zone was associated with better results of surgical treatment. Areas with isolated architectural abnormalities were associated with SPs significantly more often than those where the cortex contains immature or giant neurons; these areas were associated with SPs more than areas containing dysmorphic neurons. The extent of MRI signs appearance in the neocortex correlated neither with the presence of SPs nor with the types of histological changes. Conclusions We suppose an inverse relationship between the morphological changes in neurons and their ability to generate epileptic activity. Electrocorticography may be used for the identification of the MRI-negative epileptogenic lesions.

Pilocytic astrocytoma (PA) is a low-grade glial tumor (WHO grade I) with predominant occurrence in pediatric patients. According to many authors, stereotactic radiosurgery (SRS) and radiotherapy (SRT) promote long-term remission or retardation of tumor progression in patients with in inoperable lesions after incomplete resection or recurrence. Therefore it is essential to determine the role of SRS and SRT in complex management of patients with deep-seated PA. Since April 2005 till May 2010 101 patient with intracranial PA was treated in department for radiation therapy of Burdenko Neurosurgical Institute. The series consisted of 70 pediatric patients (below 17 years inclusively) and 31 adults, of them--51 male and 50 female patients. Mean age was 15.1 years (9.8 years in children and 28.7 in adults). In 90 patients (89.2%) tumors were previously histologically verified (tumor resection in 83 cases and biopsy in 7). In 11 (10.8%) patients diagnosis of PA was based on clinical and neurovisualization data. In most cases SRT (66 (66.3%) patients) was preformed, the rest 35 (34.7%) patients were treated by SRS. Median follow-up from the onset of disease reached 52 months (2-228 months). Catamnestic data were available in 88 (87%) patients. By the end of catamnestic follow-up (December 2010) 87 (98.8%) patients treated by SRS and SRT were alive. Median follow-up from the start of radiation treatment was 22.7 months (6-60 months). Progression of tumor was observed in 20 patients (22.7%), in 18 of them due to cyst growth. 18 patients were reoperated. In 12 operated patients histological examination and its comparative analysis were performed. We found that alterations in the tumor tissue, accompanied by regression of solid component and progression of cystic portion, represent reactive-degenerative changes in the tumor as a consequence of radiation-induced pathomorphism. SRS and STR are effective techniques for treatment of patients with primary and recurrent PA despite regardless of localization of the tumor. There procedures should be performed shortly after non-radical resection. Control of tumor growth by the present time (median follow-up is 22.7 months) reaches 98%. "Progression" of the tumor due to enlargement of cystic portion shortly after SRT and SRS represents reactive-degenerative alterations in the tumor tissue and should not be evaluated as true recurrence; without neurological deterioration these cases do not require special treatment.

The aim of the study was to reveal MRI features of focal cortical dysplasia and sclerosis of the hippocampus in patients with symptomatic epilepsy. Twenty-four patients who underwent the surgery with symptomatic epilepsy were studied. The results of pre-surgical MRI and histological studies of the removed cortex were compared. The signs of focal cortical dysplasia in the lesion area were found in patients with oncologic and non-oncologic lesions. In patients with sclerosis of the hippocampus, such specific sign as the T2-signal elevation was not seen in all cases. Though MRI is a highly sensitive method for detecting cortical dysplasia, it does not allow to differentiate significantly different types of this pathology. Even in the presence of typical signs of focal cortical dysplasia, its real boundaries may spread beyond the clearly visualized lesion. In the absence of typical signs of focal cortical dysplasia, one should take into account non-specific signs in the comparison with clinical and neurophysiologic data. In sclerosis of the hippocampus, the changes in the signal intensity were not constantly seen and the decrease in the volume of the structure was a main diagnostic sign. In the cases of so-called "medial temporal epilepsy", any changes in hippocampus volume may be diagnostically important.

The authors describe 2 cases of primary intraosseous cavernous hemangioma (PICH). PICH are extremely rare tumors that represent less than 1% of all tumors of the bone. Only 20% of them involve skull. In both cases clinical findings were presented by proptosis, oculomotor disorders and chronic daily headaches. Surgery is the most recommended method of treatment. The best surgical management is gross total resection within intact tissue. In both cases tumor was removed completely.

The authors report a rare a case of gliosarcoma metastases in a 28-year-old male patient. The cauda equina roots were involved after brain tumor 16 months ago, which, on microscopic study, had a biphasic pattern and heterogeneous staining in the reaction with antibody to GFAP and vimentin; the tumor cells did not express EMA, EA, and desmin. Gliosarcoma was diagnosed, by taking into account morphological and immunohistochemical data. Tumor tissue of the cauda equine roots had the same immunophenotype as the brain tumor with a predominance of glial component, which permitted the source of metastases to be ascertained.

Treatment of intracerebral metastases is one of the key problems in neurooncology. Modern methods of combined treatment do not significantly affect terms of survival. Quality of life during the whole period of treatment depends on selected tactics. We summarized our experience of treatment of 119 patients with cerebral metastases of extracranial tumors with "Gamma-knife" stereotactic radiosurgery (GKSRS) during 2005 and 2006 years. "Leksell Gamma-knife C" was used for treatment procedures. Primary tumor was located in lung in 35 cases, in breast in 32 cases. Renal cancer metastases were less common (15 cases) as well as skin melanoma (14), colon cancer (8) and other localizations (6 cases). Total amount of treated metastases was 628. Marginal doses ranged between 15 and 24 Gy. During followup 77 patients were examined 153 times by contrast-enhanced MRI every 3 months. Mean follow-up period was 194.6 days (6.5 months). In 68 cases (88.3%) GKSRS provided total tumor control of 446 irradiated lesions (92%). Median survival after GKSRS was 8.2 months. All patients were assessed using RPA prognostic criteria. The best prognosis for life (1 year) was observed in RPA I class patients. Median survival in patients with initial Karnofsky performance level70% (RPA III class) did not exceed 3.5 months. Presence of circumscribed brain involvement (less than 10 foci) is associated with more favorable prognosis (median survival is increased to 9.4 months). In patients with disseminated brain involvement (more that 10 metastases) survival median was 3.8 months (p0.05). GKSRS is minimally invasive, safe and effective method for treatment of intracerebral metastases of all main histological types of extracranial tumors. Local tumor control is observed in 88% of patients. Life expectancy prognosis depends on activity of extracranial process, initial condition of patient by the moment of treatment and initial spread of metastatic brain involvement.

The relationship between disorders in the cytoarchitectonics (microdysgenesis) and formation of epileptogenic zones was studied on clinical material. Results of surgical treatment of 29 patients with drug-resistant temporal epilepsy are presented. Intraoperative electrocorticography was carried out in all patients. Histological studies of the cortex from the zone of regular epileptic activity registration were carried out in 23 cases. A relationship between completeness of radical removal of the zone of regular epileptic activity and treatment results was detected. Histological studies of resected cortex revealed signs of microdysgenesis in all cases. The presence of similar changes in the zone of regular epileptic activity registration, resection of which is essential for attack control, suggests a pathogenetic relationship between microdysgenesis and generation of epileptic activity.

Total removal of posterior cranial fossa meningiomas often leads to complications due to localization, direction and nature of tumor growth. Radical excision as well as histological grade are the principal factors determining recurrence of disease in follow-up period. The paper evaluates the role of ki67 in progression of posterior cranial fossa meningiomas. We performed 189 immunohistochemical studies and katamnestic analysis of patients operated in Burdenko Neurosurgical Institute (Moscow). We showed that level of expression of ki67 correlates with histological grade of posterior fossa meningiomas. We established that recurrence-free survival depends on ki67. This allows prediction of prognosis. Low expression of ki67 corresponds longer recurrence-free survival. If ki67 expression is over 4% recurrence within 2 years after surgery is observed significantly more frequently. Multifactor statistical analysis confirmed prognostic value of ki67 especially in females and patients below 50 because terms of recurrences in these populations are significantly smaller. Obtained data prove versatility of ki67 in neurooncology which should enable its wider application in neurosurgical clinics.

An objective of the study is an analysis of the results of surgical treatment and influence of resection volume on the treatment outcome. Sixty-four patients, aged 7-46 years, with an epileptic focus in a temporal lobe have been studied. Patients have been stratified into 2 groups. The first group included 55 patients with epileptogenic lesions of a temporal lobe (monoregional lesions) and the second one--9 patients who, along with the lesion of one temporal lobe, had the signs of lesions in other brain areas (multiregional lesions). In the group of patients with monoregional lesions, a resection of the affected area has been performed. In other patients, the techniques of resection of frontal-medial temporal lobe regions within the scope of the area of steady epileptiform activity have been used. The results have been assessed with the modified Engel scale: class I--an absence of clinically manifested seizures (auras are possible); class II--seizures that do not impact quality of life; class III--a decrease of seizures frequency by more than 80%; class IV--an absence of substantial improvement. In the monoregional lesions, the satisfactory results (I-II classes) were observed in 39 patients (74%), including outcomes of class I (28 patients). In other 16 cases outcomes of classes III and IV were observed. In the multiregional lesions and cryptogenic (possibly symptomatic) partial epilepsy, outcomes of classes III and IV were observed in all patients, regardless of the resection volume. In conclusion, the highest efficacy with regard to frequency and severity of seizures is achieved by resections including the whole area of visualized lesion and border-line area of steady epileptic activity, the identification of which demands the intrasurgery neurophysiologic study. In the extensive and multiregional lesions, the resection surgery confined to one temporal lobe has low effect.

The results of treatment were analyzed in 40 patients aged 5 to 43 years who had been operated on for symptomatic temporal lobe epilepsy, among them there were 29 patients with low-grade intracerebral tumors. Local and regional lesions were observed in 27 and 13 cases, respectively. Thirteen patients with local lesions had also a local type of epileptiform activity; the remaining had a regional type. The involved area was removed in 10 patients; in 15 cases that was removed, with the areas wherein epileptform activity persisted; 15 patients underwent temporal lobectomy adapted to the data of neurophysiological study made before resection. Magnetic resonance imaging indicated that the involved area was completely removed; in 18 patients the resection borders exceeded the involved area. In local lesions accompanied by local epileptic activity, there were no significant differences between the removal in the borders of a lesion and that in a greater extent (p0.05). In patients with regional epileptiform activity, the results of treatment with removal in the greater extent were significantly better (por = 0.01). In these patients, an association was found between the significant disturbances of normal cortical rhythm outside the visualized involved area and the severe impairments in the cortical cytoarchitectonics in these areas. Persistent epileptic activity along with cortical rhythm disturbances on an electrocorticogram may be as a sign of lesion spread outside the visible borders and an indication for additional resections.

The study was conducted at the Academician N. N. Burdenko Institute of Neurosurgery, Moscow, in 1999 to 2006. The paper presents the results of stepwise surgical treatment in 84 patients with chronic cerebral ischemia, caused by multiple stenotic and occlusive lesions of the brachiocephalic arteries, who underwent 183 reparative operations. Six major groups of patients with various combinations of lesions of major cerebral arteries were identified. An attempt was made to create an algorithm of the optimum stepwise surgical treatment policy in the identified groups of patients on the basis of the site, degree, and nature of stenotic lesions, by taking into account the cerebral hemodynamics and collateral circulation at all stages of surgical treatment. At the same time, changes in the degree of neurological deficit as one of the major determinants of the results of surgical treatment could be evaluated. The study has demonstrated that the chosen tactics of employing series arterial reconstructions in multiple stenotic and occlusive lesions of major cerebral arteries is an effective treatment option in patients with chronic cerebral ischemia.

The aim of the study was to assess the capabilities of diffusion kurtosis imaging (DKI) in diagnosis of the glioma proliferative activity and to evaluate a relationship between the glioma proliferative activity index and diffusion parameters of the contralateral normal appearing white matter (CNAWM).The study included 47 patients with newly diagnosed brain gliomas (23 low grade, 13 grade III, and 11 grade IV gliomas). We determined a relationship between absolute and normalized parameters of the diffusion tensor (mean (MD), axial (AD), and radial (RD) diffusivities; fractional (FA) and relative (RA) anisotropies) and diffusion kurtosis (mean (MK), axial (AK), and radial (RK) kurtosis; kurtosis anisotropy (KA)) and the proliferative activity index in the most malignant glioma parts (p0.05). We also established a relationship between the tensor and kurtosis parameters of CNAWM and the glioma proliferative activity index (p0.05).The correlation between all the absolute and normalized diffusion parameters and the glioma proliferative activity index, except absolute and normalized FA and RA values, was found to be statistically significant (p0.05). Kurtosis (MK, AK, and RK) and anisotropy (KA, FA, RA) values increased, and diffusivity (MD, AD, RD) values decreased as the glioma proliferative activity index increased. A strong correlation between the proliferative activity index and absolute RK (r=0,71; p=0.000001) and normalized values of MK (r=0.8; p=0.000001), AK (r=0.71; p=0.000001), RK (r=0.81; p=0.000001), and RD (r=-0.71; p=0.000001) was found. A weak, but statistically significant correlation between the glioma proliferative activity index and diffusion values RK (r=-0.36; p=0.014), KA (r=-0.39; p=0.007), RD (r=0.35; p=0.017), FA (r=-0.42; p=0.003), and RA (r=-0.41; p=0.004) of CNAWM was found.DKI has good capabilities to detect immunohistochemical changes in gliomas. DKI demonstrated a high sensitivity in detection of microstructural changes in the contralateral normal appearing white matter in patients with brain gliomas.Цель работы - оценить возможности диффузионно-куртозисной МРТ (ДК-МРТ) в диагностике пролиферативной активности глиом головного мозга. Оценить связь индекса пролиферативной активности глиом с диффузионными параметрами контралатерального нормального белого вещества мозга (КНБВ). Материал и методы. В исследование включены 47 пациентов (23 с глиомами низкой, 13 с глиомами III степени и 11 с глиомами IV степени злокачественности). Выявлена связь абсолютных и нормализованных параметров диффузионного тензора (средняя (СД), аксиальная (АД) и радиальная (РД) диффузия, фракционная (ФА) и относительная (ОА) анизотропия) и диффузионного куртозиса (средний (СК), аксиальный (АК) и радиальный (РК) куртозис, куртозисная анизотропия (КА)) с индексом пролиферативной активности глиом в их наиболее злокачественных участках (p0,05). Также была выявлена связь индекса пролиферативной активности глиом с тензорными и куртозисными параметрами КНБВ (p0,05). Результаты. Корреляция индекса пролиферативной активности со всеми абсолютными и нормализованными диффузионными параметрами глиом оказалась статистически значимой (p0,05), за исключением абсолютных значений ФА и ОА. С увеличением пролиферативной активности глиом отмечалось увеличение значений куртозиса (СК, АК и РК) и анизотропии (КА, ФА и ОА) и уменьшение значений диффузии (СД, АД и РД). Сильная корреляция индекса пролиферативной активности была выявлена с абсолютным РК (r=0,71; p=0,000001) и нормализованными значениями СК (r=0,8; p=0,000001), АК (r=0,71; p=0,000001), РК (r=0,81; p=0,000001) и РД (r=–0,71; p=0,000001). Статистически значимая слабая корреляция с индексом пролиферации глиом была найдена для значений РК (r=–0,36; p=0,014), КА (r=–0,39; p=0,007), РД (r=0,35; p=0,017), ФА (r=–0,42; p=0,003) и ОА (r=–0,41; p=0,004) КНБВ. Заключение. ДК-МРТ показала высокую чувствительность в выявлении как иммуногистохимических изменений в глиомах, так и микроструктурных изменений в неизмененных, по данным стандартной МРТ, структурах мозга, которые наблюдаются при повышении малигнизации глиом.

Despite the advances in microsurgery, the choice of the most adequate approach to the posterior part of the medial temporal region (MTR) remains a very controversial issue. The supracerebellar transtentorial approach (STA) is considered as the most preferable one, since it provides the optimal balance between retraction, incision, and resection of the brain tissue. Here, we present our consecutive series of 20 patients who underwent STA surgery.Twenty patients with glial tumors affecting the posterior MTR underwent STA surgery between 2006 and 2014. The mean age of the patients was 20 years. Benign tumors were predominant (18 out of 20 cases).Resection of the posterior and middle MTRs was conducted in 16 cases. The anterior MTR was accessed through STA in 1 patient only; in 2 patients, STA was combined with the infraoccipital approach. Cerebellar edema occurred in 4 patients, with hemiparesis persisting in one of the cases for 1 year after surgery. Of 8 patients with drug resistant epilepsy, the Engel class 1 or 2 outcome was achieved in 6 cases within 1 year after surgery.STA provides an excellent surgical route to the posterior and middle MTR portions; however, the anterior MTR portions cannot be reached safely. The operative risks of STA increase as the surgeon proceeds with resection of the anterior MTR portions. Anterior MTR structures can be removed using a combination of the supracerebellar and infraoccipital transtentorial approaches or two-stage resection.Цель исследования - большая протяженность медиальной височной области (МВО) вдоль критических нейроваскулярных структур и ее сложная конфигурация делают проблемным выбор хирургического доступа к ней. По мнению ряда хирургов, оптимальный баланс между тракцией мозга, рассечением и резекцией коры при доступе к задним отделам МВО дает супрацеребеллярный транстенториальный доступ (СТД). Материал и методы. Анализируется последовательная серия хирургических вмешательств у 20 больных, оперированных в институте нейрохирургии с 2006 по 2014 г. с применением СТД к опухолям задних отделов МВО. Средний возраст больных составил 20 лет. Преобладали доброкачественные опухоли (18 случаев). Результаты. В 16 случаях удаление было проведено до границ с передней МВО, у 2 пациентов СТД был комбинирован с инфраокципитальным доступом, что позволило удалить ункус и амигдалу. Осложнения возникли у 4 из 20 больных, в 2 случаях они были связаны с отеком мозжечка и в 2 - с ишемией в подкорковых узлах, у 1 из этих больных имел место постоянный неврологический дефицит в виде гемипареза и полной гемианопсии. В 8 случаях опухоли проявляли себя фармакорезистентной височной эпилепсией, к 1-му послеоперационному году у 6 больных отмечался исход Engel 1-2. Выводы. СТД может быть надежной альтернативой транскортикальным подходам при опухолях задней МВО. Передние отделы МВО не могут быть безопасно достигнуты через СТД, поскольку тракция мозжечка возрастает при продолжении резекции в переднем направлении. При необходимости удаления крючка и амигдалы для контроля приступов возможна комбинация с инфраокципитальным доступом или же двухэтапное удаление структур МВО.

Despite the achievements of recent years, cerebral AVMs continue to pose a challenge to treatment. The objective of this work was the development of recommendations for combined treatment of AVMs based on analysis of the available material and published data.The study included 93 patients hospitalized at the Neurosurgical Institute for combined treatment of cerebral AVMs in 2010-2014. A group of combined surgery (removal of an AVM with preoperative embolization) consisted of 40 patients, and a group of combined radiotherapy (radiation after partial embolization or partial removal of an AVM) included 53 patients. 36 patients underwent radiosurgery, and 17 patients received stereotactic radiation therapy. Both groups were analyzed in terms of outcomes, complications, and follow-up results.In the group of combined surgery, according to the Glasgow outcome scale, good results (grade 4-5) were achieved in 35 (87.5%) patients at discharge and in 27 (90%) patients during follow-up. Treatment outcomes, surgery duration, and the amount of blood loss were not significantly different from those in the control group. Complete AVM obliteration was achieved in 29 (80.6%) patients 3 years after radiosurgery and in 8 (47%) patients after stereotactic radiotherapy. In discussion, these findings are compared to the published data, and recommendations for AVM treatment are suggested.The combined treatment of AVMs is effective management for patients with complex AVMs (Spetzler-Martin grade III-IV AVMs). Successful treatment of AVMs requires careful planning and teamwork of vascular and endovascular neurosurgeons, radiologists, and neurologists.Цель. Несмотря на достижения последних лет артериовенозные мальформации (АВМ) головного мозга по-прежнему представляют собой сложную задачу для лечения. Целью работы стала выработка рекомендаций по комбинированному лечению АВМ на основе анализа имеющегося материала и литературных данных. Материал и методы. В работу включены 93 пациента, госпитализированных в Институт нейрохирургии для комбинированного лечения АВМ головного мозга в 2010-2014 гг. Группа комбинированного хирургического лечения (удаление АВМ с предварительной предоперационной эмболизацией) составила 40 пациентов, группа комбинированной лучевой терапии (облучение после частичной эмболизации или неполного удаление АВМ) - 53 пациента. Радиохирургия проведена 36 больным, стереотаксическая лучевая терапия - 17 больным. Обе группы проанализированы с точки зрения исходов, осложнений и результатов катамнеза. Результаты. В группе комбинированного хирургического лечения были достигнуты хорошие результаты по шкале исходов Глазго (4-5-й степени) у 35 (87,5%) больных при выписке и 27 (90%) больных в катамнезе. Исходы лечения, сроки операции, величина кровопотери достоверно не отличались от контрольной группы. Полная облитерация АВМ после радиохирургии через 3 года достигнута у 29 (80,6%) больных, после стереотаксической лучевой терапии у 8 (47%) больных. В обсуждении полученные результаты сопоставлены с литературными данными и предложены рекомендации по лечению АВМ. Заключение. Комбинированное лечение АВМ является эффективным методом лечения у больных со сложными АВМ (III-IV степени по Спецлеру-Мартину). Успешное лечение АВМ требует тщательного планирования и командной работы сосудистых и эндоваскулярных нейрохирургов, радиологов и неврологов.

The results of treatment were analyzed in 37 patients with drug-resistant symptomatic temporal lobe epilepsy among whom there were 22 patients with low-grade intracellular tumors, 2 with cavernomas; 6 with cortical malformations, and 9 with residual organic lesions. Double pathology was noted in 4 patients. Mono- and multiregional lesions were observed in 30 cases. Removal of the site of lesion, extended medial resections, and temporal lobectomy were performed in 7, 5, and 25 cases, respectively. There was an association of the quality of outcomes with the scope of an intervention: the best results were achieved when the affected area with adjacent cortical portions was completely removed within the eliptogenic area. Resections for multiregional lesions are low effective.

Hemorrhage into the structures of the anterior visual pathway, apoplexy of the chiasma or optic nerves, is a rare pathology that can be caused by different pathological processes among which cavernous angioma and arteriovenous malformation are more frequently mentioned. The cause of chiasmatic apoplexy may be also hemorrhage into the tumor--chiasmatic glioma of blood penetration into the chiasma in pituitary apoplexy. The authors describe a rare case of chiasmatic apoplexy whose cause was chiasmatic cavernoma. In addition to acute visual disorders suggesting the involvement of the left optic nerve, chiasma, and left visual pathway, 23-year-old patient had endocrine disorders as polyuria, polydipsia, which first suggests craniopharyngioma and glioma of the chiasma. A capsule and hematomic clots were removed from the thickened left optic nerve and left chiasmatic half during surgery. Only did a morphological study involving immunohistochemical analysis permit identification of the process as hemorrhage from cavernous micromalformation with the formation of hematoma.

Aspergillosis of the central nervous system presents a challenge faced with the problems arising from the establishing the diagnosis, the low efficiency of treatment, and high mortality rates (about 95% as shown by some data). This paper presents a clinical case of a patient with aspergillosis-induced central nervous system lesion verified by autopsy. Possible errors in the diagnosis and treatment of the patient are analyzed. The literature data including clinical cases, etiopathogenesis, and clinical manifestations and its possible complications are presented. Groups of patients at risk for invasive aspergillosis are considered. The paper gives the data available in the foreign literature on the methods and efficiency of treatment and mortality rates in different groups of patients. The urgency of the problem in the diagnosis and treatment of cerebral aspergillosis rises with the increased number of patients with immunological disorders due to infectious diseases (HIV), social (drug addiction, alcoholism), environmental, and other factors.

A clinical observation of a rare neurosurgical pathology, i.e. meningioma growing in the cavity of ventricle IV, is reported. The female patient underwent a surgery of tumor eradication. Issues related with diagnostics, treatment tactics and disease prognostication are discussed on the basis of literature survey. Practical recommendations on treatment tactics are provided with regard for the discussed published data and the mentioned clinical case.

The study was undertaken to examine the clinical picture, diagnosis, morphology and substantiate management policy for patients with supratentorial cavernomas. Examination was made in 160 patients with this abnormality, 87 of them were operated on. The histological structure of cavernomas was shown to be heterogeneous. Different types of their clinical course are analyzed and the optimum diagnostic criteria of the diseases substantiated. Removal of supratentorial cavernomas is the method of choice, which eliminates a risk for rehemorrhage and positively affects the course of the convulsive syndrome. Exceptions are the cavernomas that are located in the functionally important brain regions difficult to reach. In these cases, the indication for surgery may be severe rehemorrhage or drug-untreated frequent seizures. Removal of cavernomas does not rule out a long-term use of anticonvulsants. They may be discontinued only on the basis of clinical and electroencephalographic control.

Blood serum samples were obtained from patients with West Nile fever (WNF) from the city of Volgograd and its region within the disease weeks 1-3 (July-October 1999), month 6-7 (May_June 2000) and month 12-18 (May-June 2001) after the disease onset. In the sera of 40 patients examined 6-7 months after the disease onset IgM-antibodies to WNF virus were absent (dilution 1:50), IgG ones were detected in 35 patients (87.5%). 18 months after the disease IgG-antibodies were identified in 23 of 26 convalescents (88.5%). The serum samples obtained in autumn 1999 and May-June 2000 contained antihemagglutinins to WNF virus for 6-7 months in all 18 patients. In May-June 2000 the sera were positive in 38 convalescents who had WNF in 1999.

Routine pathological examination cannot precisely predict the clinical course of meningiomas because even histologically benign tumors may recur after total removal. And so, numerous efforts have been made for evaluation of meningioma growth fraction and its prognostic value. In this study the prognostic significance of DNA toposiomerase II alpha (topoII) and cyclin A immunohistochemistry was examined in a series of 263 meningiomas. The topoII and cyclin A scores exhibited a close correlation with Ki-67 immunostaining. Significant differences between the indices for all the three markers were noted among the three grades of meningiomas. The scores for all the three markers were significantly different between recurrent and non-recurrent meningiomas including removed benign tumors. The most important information for an individual clinical outcome of histologically benign meningiomas should be elicited from simultaneous evaluation of all the three proliferative markers.

Six clinical observations of a rare condition, delayed radiation-induced optic neuropathy (RON) are presented. RON developed in patients with brain tumors treated by radiotherapy and radiosurgery; in the majority of patients the condition developed during exposure to therapeutic doses; its incidence was 0.5% of the total number of patients treated by radiotherapy during this period. Asymmetrical chiasmal syndrome developed rapidly in all the patients. Clinical diagnosis of RON was confirmed by magnetic resonance tomography in all cases, and in one case by morphological analysis. Conservative therapy including hyperbaric oxygenation just stabilized the visual function. Remote period of observation was 42 months.

Ninety cases with cerebrovascular micro-malformations were analyzed. These abnormalities amount to 5.3% of the total number of patients with arteriovenous malformation. These include various vascular defects from 0.5 to 1.0 cm. Most of them run as strokes (80%); the others have a pseudotumorous course. Angiography reveals 60.5% of cerebrovascular micro-malformations. In other cases they are undetectable or their identification requires functional and gross angiography. Computed tomography and magnetic resonance tomography reveal intracranial hemorrhages from cerebrovascular micro-malformations, without identifying the latter. They cannot differentiate a tumor from parenchymatous hemorrhages from cerebrovascular micro-malformations in 37.7%. The greater diagnostic difficulties arise in subtentorial cerebrovascular micro-malformations having a pseudotumorous course. In these cases they are angiographically invisible, and CT (MRT) diagnosis prior to surgery is a volumetric brain formation, providing no specification of the process.