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Introduction. Metastatic spinal lesion remains one of the most difficult problems of modern medicine. The purpose of treatment of patients with metastatic spinal lesion is to reduce pain, improve the quality of life, restore stability in the affected segment, prevent or reduce neurological deficits. In order to build the right treatment tactics, it is necessary to evaluate the prognosis of the life of a patient with spinal metastases before treatment.The study objective is to evaluate the prognostic significance of the Tokuhashi scale in patients with metastatic spinal lesion.Materials and methods. The study included 124 patients with metastatic spinal lesion operated in the spinal department in the period from March 2013 to July 2019 (64 (52 %) men and 60 (48%) women). The average age was 59 years and ranged from 18 to 78 years. The catamnesis ranged from 1 month to 6 years. 6 (5 %) spinal tumors were radically removed, palliative removal was performed in 77 (62 %) cases. In the remaining cases, 41 (33 %) underwent vertebroplasty. The mandatory diagnostic protocol of the preoperative examination included oncological status, clinical and neurological examination. The functional status of the patient was assessed on the Karnofski scale, life expectancy – on the Tokuhashi scale. In terms of preoperative examination, patients underwent computed tomography examination with intravenous contrast of three zones: the thoracic, abdominal cavities and pelvic region to determine the degree of dissemination of the process and, in some cases, to identify the primary focus. Currently, positron emission tomography is the optimal method of investigation at the preoperative stage. However, this method is not yet available in all clinics, so performing computed tomography scans of three zones is currently the optimal “gold standard” for examining this category of patients..Results. The life expectancy estimate was calculated for each patient according to the Tokuhashi scale (2005). Survival analysis was performed using Kaplan-Meier curves within the Tokuhashi prognostic groups. The median survival within the Tokuhashi groups was more than 3 years for the group of 12–15 points (life expectancy over a year), 14 months for the group of 9–11 points (life expectancy 6 to 12 months) and 7 months for the group of 1–8 points (life expectancy less than 6 months). The Cox model was used to identify factors related to survival.Conclusion. Determining the tactics of surgical treatment of a patient with a metastatic lesion of the spine is a complex and multicomponent question to which there is no unambiguous answer. A multidisciplinary consultation is currently the most adequate and reliable way to determine the treatment strategy for this category of patients. The use of the Tokuhashi prognostic scale is an additional effective tool for determining the life expectancy of patients with spinal metastases, and thus, in some cases, serve as the tool with which it is possible to determine the tactics of surgical treatment of patients.

Resection of anterior clinoidal meningiomas is a challenging task due to their localization, frequent involvement of the major cerebral arteries and cranial nerves, a high risk of postoperative neurological deficits, and low radicalness of surgery.To evaluate the radicalness of microsurgical removal and a neurological deficit in the early postoperative period in patients with anterior clinoidal meningiomas.A total of 35 patients with anterior clinoidal meningiomas underwent surgery at the Department of Neurooncology of the Novosibirsk Federal Neurosurgical Center in the period from 2013 to July 2016. There were 29 (82.9%) females and 6 (17.1%) males. The mean patient age was 50.1 years (31-72 years). According to the Al-Mefty classification (1990), type 1 tumors occurred in 10 (28.6%) patients, type 2 tumors were in 22 (62.8%) patients, and type 3 tumors were in 3 (8.6%) patients. Twenty four (68.6%) patients had large (greater than 4.0 cm) tumors, 7 (20.0%) patients had medium (2.0-4.0 cm) tumors, and 4 (11.4%) patients had small (less than 2.0 cm) meningiomas. The tumor involved the major arteries in 21 (60.0%) patients.The lateral supraorbital approach was used in 26 (74.3%) patients, and the pterional approach was used in 9 (25.7%) cases. The tumor was resected totally (Simpson II) in 25 (71.4%) cases and subtotally (Simpson IV, subtype A and B) in 10 (28.6%) patients. In the early postoperative period, cerebral symptoms regressed in 20 (57.1%) patients; visual acuity improved in 2 of 13 (15.4%) patients. Four (11.4%) patients developed IIIrd nerve palsy; 2 (5.7%) patients developed severe hemiparesis. The mortality rate was 2.9%.The completeness of resection directly depends on the tumor consistency: soft meningiomas can be totally resected (Simpson II) with a good functional outcome. In the case of solid tumors, total resection may lead to serious ischemic disorders with a high risk of death.Сложность хирургического удаления менингиом переднего наклоненного отростка связана с локализацией, частым вовлечением в опухоль магистральных артерий, черепно-мозговых нервов, высоким риском развития неврологического дефицита, низкой радикальностью операций. Цель исследования — оценить радикальность микрохирургического удаления и неврологический дефицит в раннем послеоперационном периоде у пациентов c менингиомами переднего наклоненного отростка. Материал и методы. С 2013 г. по июль 2016 г. в отделении нейроонкологии Федерального центра нейрохирургии Новосибирска были прооперированы 35 пациентов (29 (82,9%) женщин и 6 (17,1%) мужчин) в возрасте от 31 года до 72 лет (средний возраст 50,1 года) с менингиомами переднего наклоненного отростка. По классификации Al-Mefty (1990) опухоли 1-го типа наблюдались у 10 (28,6%) пациентов, опухоли 2-го типа — у 22 (62,8%) и 3-го типа — у 3 (8,6%). По размеру опухоли: у 24 (68,6%) пациентов — с большими (более 4,0 см), у 7 (20,0%) — со средними (2,0—4,0 см) и у 4 (11,4%) — с небольшими (до 2,0 см) менингиомами. У 21 (60,0%) пациента опухоль вовлекала в свой рост магистральные артерии. Результаты. По способу выполнения вмешательства 26 (74,3%) пациентов оперированы латеральным супраорбитальным доступом, 9 (25,7%) — птериональным. У 25 (71,4%) пациентов опухоль удалена тотально (Simpson II), у 10 (28,6%) — субтотально (Simpson IV подтип А и Б). В раннем послеоперационном периоде у 20 (57,1%) пациентов регрессировала общемозговая симптоматика, у 2 (15,4%) из 13 пациентов улучшилась острота зрения. У 4 (11,4%) пациентов развился парез III нерва, у 2 (5,7%) появился глубокий гемипарез. Летальность составила 2,9%. Заключение. Степень радикальности вмешательства напрямую зависит от консистенции опухоли. В случае мягких менингиом возможно радикальное их удаление (Simpson II) с хорошим функциональным исходом. При плотных опухолях эти попытки могут привести к грубым ишемическим нарушениям с высокой вероятностью летального исхода.