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The work presents simulation models of the control and monitoring system, the study of the dynamics of the parameters of the elements of a hybrid car using simulation modeling in Matlab / Simulink environment is performed. A series-parallel drive of driving wheels is considered. The electric drive is carried out from an asynchronous electric motor. The model includes energy consumption regulation and control subsystems, calculation and state control of the battery, internal combustion engine, electric drive, mechanical model of the car, simulator of driver's influence on the fuel pedal, driving mode control system. The changes in the operating parameters of the hybrid vehicle components and the vehicle itself on the given driving modes are presented. The results obtained correspond to the real values for the selected class of cars.

The global trend of improving vehicle and traction transmissions is associated with the use of robotic preselector gearboxes, an important component of which is the friction clutch. The review of existing designs and analysis of clutch development concepts allows determining the directions of their improvement, in particular, the improvement of dry double clutches, which is the subject of research in this paper. A significant disadvantage of existing dual-clutch designs is the use of additional special (mostly hydraulic or combined) systems for on-off friction pairs, so the structural cost and energy costs for control are increased, and the design, maintenance, and repair are complicated. The proposed design of the drive to control the original dry dual-clutch involves a lever mechanism with the use of rotary stops, which are made in the form of mobile carriages with rollers, this provides switching clutches in a short time and actually without interruption of power flow, so the acceleration dynamics of vehicles will be improved, the clutch design will be simplified and energy consumption for its control during the start and gear shifting will be reduced. The mathematical model of the proposed clutch drive on the basis of which the control mechanism operation is simulated and influence of its design parameters on operational indicators of the clutch drive, in particular, on kinematic characteristics of the drive, ranges of kinematic and power gear ratios, the power interaction of the mechanism links, the power of the actuator when each clutch is turning on. It is established that the switching of clutches requires less energy, the movement of the mechanism elements is different, and the compression force of the friction pairs when starting the first and second clutches is different. The simulation results confirm that the proposed original lever design of the clutch control mechanism is effective. The obtained results allow us to reasonably determine the parameters of a clutch, but the choice of optimal-rational parameters of its control mechanism requires further research, for which appropriate methods, search algorithms, and their software implementation have been developed.

Contact interaction of structural elements has been studied in the case of nominally close (nearly matching) surfaces. A non uniform gap is present between the contacting parts. Contact pressure and contact spot depend on the shape of this gap. Correspondingly so does the stress-strain state of the contacting bodies too. Since the problem is essentially nonlinear, the contact pressure distribution and the contact zones change with the growing loads. The solution is qualitatively different to the case of perfectly matching bodies. For the latter case, the contact pressure is linearly proportional to the load and the contact zone is predefined. Hence for the real structures for which the deviation from the nominal shape is unavoidable the impact of these inaccuracies on the contact pressure distribution and the stress-strain state need to be taken into account. This problem is addressed in the paper by example of elements of stamping dies. Keywords: element of stamping dies, stress-strain state, contact pressure, contact interaction, variational inequalities, Kalker’s variational principle, finite element method, boundary element method

The contact interaction of bodies with surfaces of similar shape is investigated in the work. Cases of bodies with contact surfaces, the gap between which is a function of two coordinates, are considered. On the example of semi-matrices of molds the regularities of contact pressure distribution are established. The effect of geometry variation away from the nominal shape as well as the properties of the intermediate layer on contact pressure distribution is evaluated. The contact of bodies whose surfaces coincide in the nominal state along one line is also investigated. The influence of perturbations of the gap shape between these bodies along the lines of incidence was investigated on the example of rollers. The influence of such perturbation on the contact pressure distribution is demonstrated. The influence of the perturbation of the crossing angle between the rollers and the properties of the intermediate layer on the contact pressure distribution is also investigated. It was established that ultimate performance of machine units that contain parts in conforming contact are determined not by the nominal shape of the working surfaces but rather by the actual shape due to the deformations under the loads.

Cushing’s disease is caused by a pituitary tumor which causes increased production of adrenocorticotropic hormone, leading to chronic hypersecretion of cortisol by the adrenal cortices. Endoscopic transnasal adenomectomy is the initial treatment of choice with the greatest efficiency for the treatment of the disease. However in the absence of remission or relapse of hypercortisolism after neurosurgical surgery, as well as in cases when surgical intervention cannot be carried due to medical contraindications to surgical intervention, radiation treatment is used as an alternative or adjoining therapy. In this literature review the efficiency of different radiation techniques (the conventional and the modern techniques), as well as possible complications of modern methods of radiosurgery and radiotherapy have been looked for.

The relevance of cachexia syndrome is determined by its high prevalence in clinical practice. It accompanies the course of not only oncological diseases, but also the majority of chronic somatic pathologies, such as chronic heart failure, renal failure, diabetes mellitus, chronic obstructive pulmonary disease, acquired immunodeficiency syndrome, rheumatoid arthritis, Alzheimers disease and others. It is known that even a slight weight loss in patients can determine an unfavorable prognosis of the underlying disease and reduce the effectiveness of therapy, and sometimes it becomes the direct cause of death of the patient. Cachexia is a complex metabolic syndrome, which is based on a violation of the central regulation of metabolism. The dangerous combination of decreased appetite (anorexia) and increased metabolism is the result of an imbalance in energy exchange. Treatment of cachexia syndrome is ineffective and limited in means. Given the progressive and irreversible nature of this syndrome, early diagnosis and prevention of its development are the primary task of the doctor. The article describes the main pathogenetic aspects of the development of cachexia syndrome. They can be common in different diseases. The article discusses the difficulties of diagnosing cachexia syndrome, the possibilities and prospects of treatment.

Introduction: Currently, cabergoline therapy is the main treatment for prolactinomas. The use of the drug in most cases leads to regression of the tumor, normalization of prolactin (PRL) levels, and restoration of gonadotropic function. The mechanism of its action in tumor cells “in vivo” tracked in dynamics in the same human tumor is of considerable interest. Materials and Methods: A 30-year-old male was admitted to N.N. Burdenko National Medical Research Center of Neurosurgery. An magnetic resonance imaging (MRI) revealed a giant pituitary adenoma. The level of PRL was more than 5000 mU/l (30-360) (serum dilution was not used to determine PRL). Transcranial microsurgical removal of the tumor was performed. He was treated by cabergoline after surgery. Endoscopic transsphenoidal approach was repeated with subtotal removal of the rest of the tumor. Morphological and immunohistochemical studies of the tumor were done. Results: A morphological study revealed PRL-positive tumor with a Ki-67 LI of 8% with a distinctive expression of D2R, CD31, and CD34 markers. Control MRI in 3 months after surgery revealed remnants of a tumor of endoinfrasellar localization, the tumor remainders were found in endoinfrasellar localization. The tumor retained pronounced immunopositivity to PRL and D2R and a decrease in the Ki-67 to 2% and in the expression of CD31 and CD34. Subsequent therapy with cabergoline resulted in persistent normoprolactinemia, restoration of androgenic function, and absence of tumor recurrence during the 10-year follow-up period. Conclusions: Cabergoline is an effective treatment for prolactinoma, which leads to tumor regression. One of its mechanisms is the reduction of the proliferative index and tumor angiogenesis.

The clinical picture of craniopharyngiomas (CPs) is diverse and polymorphic in its manifestations, including endocrine, neurological disorders, visual and mental impairment. Mental disorders in the clinical picture of CPs are detected from 6 to 100 %, according to the literature. But more often one can find a description of individual syndromes only — memory impairment, disorders of the emotional sphere and/or behavior. There is not enough information about mental disorders in different topographic and anatomical variants of craniopharyngioma, possible pathognomonic psychopathological symptoms and/or syndromes. Objective of the article is to describe mental disorders in the clinical picture of craniopharyngioma with different topographic and anatomical variants in adults. Materials and methods. The study included 120 adult patients (18–68 years old, mean age 39 ± 2; 59 women and 61 men) who were first admitted for treatment to the National Medical Research Center for Neurosurgery named after academician N. N. Burdenko with the diagnosis of craniopharyngioma (2007–2015). The clinical-psychopathological method was the main in the research. Results. Mental disorders in the clinical picture of CPs were detected in 103 (85.8 %) patients before surgery in the form of the main syndromes: asthenic syndrome was found in 83 (69 %) patients, emotional-volitional disorders in 79 (65,8 %), amnestic disorder in 71 (59,1 %), personality changes in 71 (59,1 %), paroxysmal conditions in 55 (45,8 %), sleep and dream disorders in 54 (45 %), consciousness disorders in 24 (20 %) patients. Mental disorders did not appear separately, but in combination with each other, prevailing in the clinical picture to one degree or another in various topographic and anatomical variants of craniopharyngioma, respectively. Conclusion. Mental disorders in the clinical picture of CPs were detected in 85,8 % of patients before surgery, they were determined by the location of the tumor lesion — topographic and anatomical variant of CP, the spread and influence of the tumor on the structures of the diencephalic region, limbic system, and third ventricle: in 65 % of cases with endosuprasellar craniopharyngioma, in 86 % of cases with stem craniopharyngioma, in 100 % of cases with extra- and intraventricular CPs.

Introduction Surgery is the primary treatment for Cushing's disease(CD). In cases with no biochemical remission after surgical resection or when recurrence occurs after a period of remission stereotactic radiosurgery (SRS) is used as alternative/adjuvant treatment. The aim of this study is to demonstrate the effectiveness of SRS and FSRS(Fractionated stereotactic radiosurgery) for the treatment of CD in a long term follow up. Methods This is a retrospective study in which 41 patient (36 females and 5 males) who underwent surgery for CD from 2009 to 2019 were included. Out of 41 cases, 34 cases had microadenomas while 7 had macroadenomas. These patients had recurrence or persistence of hypercortisolism post-operatively. After multidisciplinary evaluation, these patients were treated by CyberKnife (SRS & FSRS). Results Remission rate in our study was 60.97% with a median follow up period of 79.03 months. The median time to biochemical remission was 14 months. Tumour growth control was achieved in 95.12%. Hypopituitarism of different axes was seen in 34.14% patients. Secondary hypothyroidism was the most common pituitary insufficiency (34%) followed by secondary hypogonadism in 17%. Conclusion CyberKnife radiosurgery and hypofractionated radiosurgery can be used as an adjuvant treatment in patient with active disease and no biochemical remission after one or multiple surgical resections. Risk of radiation induced hypopituitarism and other complication is relatively low 34.14% and tumour growth control is significantly higher.

The solution to the problem of choosing a rational combination of characteristics of mechanisms included in the technological goods transportation chain is based on kinematic, dynamic and power analysis. However, in a comprehensive solution to the problem of compliance of a new product with a criterion for improving its characteristics, it is necessary to take into account many factors and parameters. The creation of an adequate mathematical model that allows to consider and study the indicated set and its influence on the behavior of the mechanism greatly facilitates the process of achieving this task. The study of the influence of gear ratios of gears (gear-tooth system), the definition of the necessary parameters of the mechanism allows one to choose the best combinations in order to achieve the given characteristics of both speed and steady work. To study the dynamics of these objects, a single approach is used, based on the use of a unified mathematical model.

The article presents a clinical case from the practice of a patient with craniopharyngioma. The man of reproductive age with diencephalic obesity (BMI 35 kg/m2), recurrent craniopharyngioma, a long history of endocrine disorders (panhypopituitarism, including secondary hypogonadism, with the corresponding sexual function disorders and the lack of sexual activity), with visual disorders and psychiatric symptoms in the early postoperative period after shunting surgery and reducing the volume of the craniopharyngioma cyst, erection conditions arose against the background of episodes of disorders of consciousness within the framework of sleep dissociation. After the operation (installation of the Ommaya system), the patient had a state of «spontaneous» erection lasting up to 30 minutes against the background of dream-oneiric states of impaired consciousness with erotic experiences. These states were observed for 3 nights, the patient remembered the experiences and events that occurred to him «in a dream», and could tell about them to others on the next morning. The identity of the patient remained intact, he was active in the department, ordered in behavior; memory for current events and new information was intact. These disorders in the patient did not require specialized treatment, regressed independently on the 6th day of the postoperative period.

The study objective is evaluate the effectiveness and risks of using intradural and extradural decompression of the optic nerve channels during standard transcranial removal of meningiomas of the chiasmal-cellar region region. Materials and methods. The results of 161 decompression of channel of optic nerve in 129 patients are analyzed. In most patients (n = 122), an intradural decompression (resection) of the canal roof was performed. In 7 patients, an extradural decompression of the upper and lateral walls of the canal was performed. Results. In assessing the risks of visual impairment as a result of channel decompression, we found that decompression itself, without attempts to separate the tumor from the nerve, causes vision impairment in 8.6 % of cases. Attempts to separate the tumor from the optic nerves increase the risk of vision impairment from 16.7 to 26.9 %, depending on the radicality. Conclusion. A small number of complications (iatrogenic amaurosis and nasal liquorrhea) make it possible to recommend the described technique as an effective and safe addition to standard transcranial operations to remove the meningiomas of the chiasmal-cellar region.

This paper reports an experimental study that determines the dissipative properties of a pressure fire hose, the type of «T», whose inner diameter is 77mm, under the static load conditions, taking into consideration the structural elements of the hose in the transverse direction. For this study, experimental samples were separated from the different sections of the hose. The study involved both the outer fabric reinforced frame and the internal waterproofing rubber layer of the pressure fire hose. A series of field experiments were carried out while stretching the samples under the conditions of static loading-unloading cycles. The tests included 7cycles, which were carried out in a two-minute interval for the material of the hose. The study results showed that during the first two to three cycles, the materials manifest a short-term creep that stabilizes under modes 4‒7. The results from experimental research were approximated by polynomial trend lines. The deformation of samples demonstrated the curves that, under the conditions of cyclic loading and unloading, formed hysteresis loops. When analyzing the appropriate curves, it was found that, first, during the first two-three loading-unloading cycles the area of the hysteresis loops decreases, second, the inclination angle of hysteresis loops also decreased during each subsequent loading-unloading cycle. It was established that the dissipation coefficients of the hose material stretched in the transverse direction are significantly reduced under the first three test modes in the range from 0.49 to 0.37. At subsequent tests (cycles 4–7), dissipation coefficients stabilize at the level of 0.18 for the reinforced frame, and 0.316 for the rubber layer

The combination of intracranial tumors and asymptomatic brain aneurysms is an urgent problem, since it can significantly affect surgical intervention. Aneurysms are common in patients with meningioma, glioma and pituitary adenoma. According to certain authors, combination of aneurysms with pituitary adenomas is 7 times more common than with other tumors. In these cases, a comprehensive examination of the patient and decision-making on surgical strategy are required. This review is devoted to epidemiology, diagnosis and treatment of patients with a combination of pituitary adenomas and intracranial aneurysms detected intraoperatively or at the preoperative stage. The manuscript is illustrated by cases observed at the Burdenko Neurosurgery Center.Сочетание внутричерепных опухолей с бессимптомными аневризмами сосудов головного мозга является достаточно актуальной проблемой, так как может существенно влиять на ход хирургического вмешательства. Наиболее часто аневризмы обнаруживаются у больных с менингиомами, глиомами и аденомами гипофиза, причем с последними подобное сочетание встречается в несколько раз чаще, чем с другими опухолями. В таких случаях необходимо всестороннее обследование пациента и принятие решения о тактике хирургического лечения и ведения больного. Представлен обзор современной литературы, посвященный эпидемиологии, диагностике и лечению пациентов с сочетанием аденом гипофиза и интракраниальных аневризм, выявленных на дооперационном этапе или интраоперационно. Обзор иллюстрирован клиническими наблюдениями из опыта работы ФГАУ «НМИЦ нейрохирургии им. акад. Н.Н. Бурденко».

Cushing's disease is caused by a pituitary tumor causing increased production of adrenocorticotropic hormone, which leads to chronic hypersecretion of cortisol through adrenal cortices. Endoscopic trans-sphenoidal adenomectomy is the first choice of treatment with greatest efficiency for the treatment of the disease. However, in the absence of remission or recurrence of hypercortisolism after neurosurgical resection (adenomectomy), as well as in cases when surgical intervention cannot be carried due to medical contraindications to surgical intervention, radiation treatment is used as an alternative or adjoining therapy. In this literature review the efficiency of different radiation techniques (the conventional and the modern techniques), as well as possible complications of modern methods of radiosurgery and radiotherapy have been looked for.

Neuroblastoma is a malignancy developing from the embryonic neuroblasts of sympathetic nervous system. Primary sellar neuroblastomas are extremely rare (there are currently only 11 case reports in the literature). Possible development of neuroblastoma in sellar region expands differential diagnosis of local processes due to inclusion of neuroblastoma into the spectrum of suspected tumors. We report a literature review and description of a patient with primary sellar neuroblastoma.Нейробластома является злокачественной опухолью, развивающейся из эмбриональных нейробластов симпатической нервной системы. Первичные нейробластомы селлярной локализации встречаются крайне редко (в настоящее время в литературе представлено лишь 11 случаев). Возможность их развития в хиазмально-селлярной области расширяет объем дифференциальной диагностики локализующихся здесь патологических процессов из-за необходимости включения нейробластом в спектр предполагаемых опухолей. В нашей работе представлены анализ литературы и описание клинического наблюдения пациента с первичной селлярной нейробластомой.

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.

Brain metastases of various types of cancer are diagnosed in 8-10% of all cancer patients. In the world literature, only 30 cases of cancer metastasis to the pituitary adenoma are described. This article presents yet another observation of a patient with breast cancer metastasis into the hormone-inactive pituitary adenoma at the Burdenko neurosurgical center, Russia The patient underwent endoscopic endonasal transsphenoid removal of the neoplasm. During microscopy and immunohistochemical studies of the biopsy, two types of tissue (pituitary adenoma and cancer metastasis) with different Ki-67 treated surgically (1% and over 40%) were found.Метастазы различных видов рака в головной мозг выявляются у 8-10% от всех онкологических пациентов. В мировой литературе описано всего 30 случаев метастазирования рака в аденому гипофиза. В нашей публикации представлено еще одно наблюдение хирургического лечения пациентки с метастазом рака молочной железы в гормонально-неактивную аденому гипофиза, которое проведено в ФГАУ 'Национальный медицинский исследовательский центр нейрохирургии им. акад. Н.Н. Бурденко' Минздрава России. Пациентка подверглась эндоскопическому эндоназальному транссфеноидальному удалению новообразования. При проведении микроскопии и иммуногистохимического исследования биоптата выявлено два вида ткани (аденома гипофиза и метастаз рака) с разными индексами Ki-67 (1% и свыше 40%).

Introduction: Germinogenic central nervous system (CNS) tumors represent a heterogeneous group of tumors, constituting approximately 0.4% of all primary brain tumors. Removal of the tumor has no prognostic value. In “pure” primary germinomas of the CNS, the alpha-fetoprotein and human chorionic gonadotropin levels are within normal limits, and no specific biochemical tumor markers currently exist for this tumor type, making histological verification crucial for the choice of treatment tactics. When the tumor is located in the chiasmosellar region, one of the possible verification methods is endoscopic endonasal transsphenoidal biopsy. Objective: the main objective of the study is to demonstrate the feasibility and safety of endoscopic transsphenoidal approach for histological verification of primary germinomas of the CNS with chiasmosellar localization. Materials and Methods: The current study includes 13 patients with “pure” germinomas of the chiasmosellar region who underwent endoscopic endonasal surgical interventions with subsequent treatment according to the “Germinoma 2008” protocol. Results: The extent of surgical intervention ranged from biopsy (4) to partial (5) and total (4) removal of the tumor. In all cases, histological verification of the diagnosis was achieved and none of the patients presented with cerebrospinal fluid leaks and/or meningitis in the postoperative period, allowing to evaluate endoscopic intervention in our patient series as safe and effective. Two out of 13 patients were lost to follow-up. Conclusion: The endoscopic endonasal approach for histological verification and removal of chiasmosellar region germinomas is safe, and in some cases, less traumatic for the patient than transcranial and transventricular approaches.

The study objective is to describe currently available and optimal methods of central skull base reconstruction.Material and methods. This article describes a 10-year experience of endoscopic surgery in reconstructing the defects after the removal of chiasmosellar tumors.Results. We developed a strategy for assessing the risks for postoperative liquorrhea and choosing an optimal surgical technique. This strategy allows maintaining the incidence of postoperative liquorrhea of 4 %.Conclusion. Autografts are the most widely used material for reconstructing skull base defects after the removal of chiasmosellar tumors. The multilayer reconstruction is more preferable due to the high risk of postoperative liquorrhea.

McCune-Albright Syndrome is a rare genetic disease characterized by the formation of fibrous osteodysplasia foci of various localization, including the bones of skull base. Having a gross lesion of the main bone body and the simultaneous formation of the pituitary adenoma, its transnasal removal becomes very difficult.Two clinical observations are presented where at patients with the classic manifestation of McCune-Albright syndrome we were able to successfully remove somatotropinomas with endoextrasellar growth. In both cases the presence of visual disorder was the indication for surgery.Despite pronounced deviations in the anatomy of the skull base bones in both cases we managed to access the Turkish saddle. Removal of the pituitary tumor did not differ from standard surgery. Improved vision after surgery was observed in two patients. Tumors were removed subtotally and clinical and biochemical remission of acromegaly was not achieved. In both cases, the tumors had morphological signs of atypia. Patients continued to receive therapy with somatostatin analogues and radiation.The possibility of performing transnasal surgery in this category of patients using specific instruments and intraoperative navigation is shown.Синдром МакКьюна-Олбрайта - редкое генетическое заболевание, характеризующееся формированием очагов фиброзной остеодисплазии различной локализации, в том числе в костях основания черепа. При грубом поражении тела основной кости и одновременном формировании аденомы гипофиза ее трансназальное удаление представляется очень сложным. Материал и методы. Приведено два клинических наблюдения, в которых у пациентов с классическим проявлением синдрома МакКьюна-Олбрайта нам удалось успешно удалить соматотропиномы с эндоэкстраселлярным ростом. В обоих случаях показанием к операции было наличие зрительных нарушений. Результаты. Несмотря на выраженные нарушения анатомии костей основания черепа, нам удалось получить доступ к турецкому седлу у обоих пациентов. Удаление опухоли гипофиза ничем не отличалось от стандартной операции. Улучшение зрения после операции отмечено у обоих больных. Опухоли удалены субтотально, клинико-биохимическая ремиссия акромегалии не достигнута. В обоих случаях опухоли имели морфологические признаки атипии. Дальнейшее лечение включало аналоги соматостатина и лучевую терапию. Выводы. Показана возможность выполнения трансназальной операции у данной категории больных с использованием специальных инструментов и интраоперационной навигации.

Introduction. Pituicytomas and spindle cell oncocytomas (SCO) are very rare benign tumors of sellar and suprasellar region (grade I). In case of these tumors, the clinical symptoms and the results of neuroimaging are not specific, so it is almost impossible to diagnose the pituicytoma or SCO preoperatively. The feature of these tumors is ample blood supply which results in intense intraoperative bleeding. Such events on background of high density and infiltrative growth of the tumors make a radical resection difficult. Objective is to present our own experience in surgical treatment and perioperative management of 8 SCO and 5 pituicytomas and compare it with the data of the scientific literature. Materials and methods. The retrospective study included 8 patients with SCO and 5 patients with pituicytomas that underwent endoscopic endonasal transsphenoidal removal in 2012–2017. Also, the literature data on pituicytoma and SCO were analyzed. Results. Total resection of SCO was successful in 4 cases, subtotal resection was done in 2 cases, and partial resection was done in 2 cases. All pituicytomas were resected extensively. Relapse of SCO was found in 4 patients. Postoperative complications (visual disorders and hemorrhagic complications) occurred in 2 SCO patients and in 1 pituicytoma patient. Postoperative improvement was seen in 3 patients. Conclusion. Optimal treatment method for pituicytoma and SCO of sellar and suprasellar region is a total resection using endoscopic endonasal access. The prognosis is favorable if the resection was total, however, if the resection was not extensive a relapse of the tumor can occur, and repeated operation or radiation therapy can be required. In case of slow asymptomatic progression of the tumor, an observation can be continued.

Background. The pituitary stalk (PS) is an anatomical structure consisting of the portal vessel system and axons of the hypothalamic nuclei terminating in the posterior pituitary lobe. Surgical injury or compression (by a tumor or another space-occupying process) of the PS can lead to hypopituitarism, diabetes insipidus, and hyperprolactinemia. However, the literature lacks studies on the extent of these disorders depending on PS injury or compression in clinical practice. Aim. The study aim was to investigate pre- and postoperative endocrine disorders in patients with chiasmo-sellar region (CSR) tumors and the PS compressed and preserved or involuntarily transected during neurosurgery. Material and methods. The PS compressed before surgery was preserved in 82 patients (41 patients with non-functioning endosuprasellar adenoma and 41 — with suprasellar meningioma). The PS was transected during transcranial surgery in 57 patients (46 patients with pituitary stalk craniopharyngioma and 11 patients with non-functioning endosupresellar pituitary adenoma). All patients underwent blood tests for prolactin (PRL), TSH, LH, FSH, free T4, cortisol, testosterone, or estradiol levels before and 6 months after surgery. Results. Hyperprolactinemia was detected in 37.4% of patients with CSR tumors compressing the PS. Elimination of PS compression led to normalization of the PRL level in most patients and was not accompanied by worsening of hypopituitarism symptoms. Transection of the PS resulted in panhypopituitarism in 100% of patients and diabetes insipidus in 93% of cases. There was no evidence of hyperprolactinemia in 58.7% of patients with craniopharyngiomas and 81.9% of patients with non-functioning pituitary adenomas. Conclusion. Given the difference in symptoms, we distinguished two syndromes: PS compression syndrome and PS transection syndrome. Syndrome of PS compression by a CSR tumor was characterized mainly by hyperprolactinemia (37.4% of cases); elimination of PS compression due to tumor resection led to normalization of the PRL level in most patients and was not accompanied by worsening of hypopituitarism symptoms. Syndrome of surgical PS transection in patients with craniopharyngioma (CP) and non-functioning pituitary adenoma (NFPA) manifested as panhypopituitarism in all patients and as permanent diabetes insipidus in most of them. The causes for the absence of hyperprolactinemia in many patients with the transected PS require further research. We can not exclude both adenohypophysis ischemia (due to its impaired blood supply) with partial or complete atrophy of lactotrophic cells and pituitary revascularization with restoration of dopamine transport.

The key structure in the regulation of energy homeostasis is the hypothalamus. The damage of the hypothalamic region can lead to imbalance of energy exchange with the development of obesity or cachexia. The most common metabolic disorders occur in case of craniopharyngiomas. The article presents two clinical observations of papillary craniopharyngioma in young women. Cases were accompanied by different disturbances of the energy balance, in one - with the development of obesity, in the other - cachexia.

Cerebrospinal fluid (CSF) leak is a rare complication in of the prolactinomas treatment with dopamine agonists. In most cases CSF leak develops within the first three months of treatment starting. The article presents a rare clinical case – later development of CSF leak after pharmacological treatment of giant prolactinoma. Women 29 years with giant endo-supra-infra-laterasellar pituitary adenoma (8,7 cm in diameter), visual impairment, cachexia, secondary amenorrhea and prolactin level more than 2 million 200 thousand mU/l treated with cabergoline. On this background, complete regression of the tumor, recovery of visual function, body mass and normalization of prolactin level was marked. Nevertheless, after 6.5 years after beginning of cabergoline therapy CSF leak occured, which required endoscopic endonasal surgery with the plastic of a CSF fistula. All patients with large and giant prolactinomas which invade into skull base structures, receiving cabergoline even for a long time, should be aware of the possibility of such complications as CSF leak and, if necessary, should urgent appeals to the otolaryngologist and the neurosurgeon. In this case closure of skull base defect is a main tactics of treatment.

Background: Central nervous system (CNS) aspergillosis is more often met in patients with expressed immune suppression. Still, in 50% of cases of meningitis caused by Aspergillus spp., it is observed in patients without expressed immune suppression. The prognosis of CNS aspergillosis is unfavorable with the general rate of lethality around 70%. Case Description: Clinical case of a 58-year-old man who developed an Aspergillus abscess in the chiasmosellar region and an associated mycotic aneurysm of the right middle cerebral artery (MCA) and intracerebral hemorrhage. Microsurgical clipping of the fusiform-ectatic aneurysm of the right MCA in the conditions of rupture was performed. An extra-intracranial micro anastomosis was formed on the right. An open biopsy of the neoplasm in the chiasmosellar region was made. The neoplasm was yellow and destroyed the bone plate of the skull base. Biopsy results: Mycotic lesion (aspergillosis). The analysis of surgical treatment for mycotic aneurysms in the acute period of hemorrhage in patients with aspergillosis revealed a high rate of lethality. The issue of the feasibility and effectiveness of complicated revascularization interventions in the patients with hemorrhage and aspergillosis remains unsolved. Conclusion: The lack of generally accepted tactics of the treatment of this pathology requires further studies and systemic analysis. A high risk of the lethal outcome in patients with invasive mycotic infection and rupture of mycotic aneurysm highlight the importance of timely diagnostics and the beginning of antimycotic therapy. WThe issue of the evaluation of the revascularization methods effectiveness in patients after surgical treatment of a mycotic aneurysm associated with cerebral aspergillosis remains poor.

Background The lateral extended transsphenoidal endoscopic approach (LETEA) is used to remove tumors located lateral to the cavernous segment of the internal carotid artery under direct visual control and provides access to Meckel cave, pterygopalatine fossa, medial part of the middle cranial fossa, and orbit. We describe an extended transsphenoidal approach to the amygdalohippocampectomy through the pterygopalatine fossa. Methods The LETEA to the middle cranial fossa through the pterygopalatine fossa was studied on 3 injected human cadavers at the Burdenko Neurosurgery Institute in Moscow, Russia. Results LETEA and trepanation of the greater wing of the sphenoid bone allow access to the medial part of the middle cranial fossa. Medial segments of the temporal lobe (hippocampus and amygdala) and the temporal pole were removed under guidance of the 45° angled endoscope. Conclusions LETEA through the pterygopalatine fossa is minimally invasive and provides direct access to the temporal pole and medial part of the temporal lobe. This approach may reduce risk of neurologic deficit and help to avoid cosmetic defects in the frontotemporal region associated with injury to temporal muscle and facial nerve injury as can occur during transcranial approaches. Disadvantages that limit application of LETEA include risk of cerebrospinal fluid leak and skills needed for manipulation in a narrow and deep surgical field with angled 30° and 45° endoscopes.

In the article the authors presented a modified score for the evaluation of the management of adult patients with craniopharyngioma. Its application allows to estimate dynamics of patients before and after surgery, and in following-up observation. The main advantage of the score is the possibility of its application in patients with impaired self-esteem, which is very important in cases of craniopharyngioma. The application of the proposed scale is possible in scientific research on groups of patients, during the medical-social examination and evaluation of the effectiveness of rehabilitation

Introduction. Pituitary adenomas comprise 10–15 % of all intracranial tumors. Despite being benign tumors, 25–55 % of them exhibit invasive growth spreading into surrounding structures (sphenoid sinus, cavernous sinus, etc.). In literature, there isn’t a generally accepted definition of aggressive pituitary adenomas. As a result, there aren’t any studies reporting on the therapy of choice for this disease, except for several reports on using temozolomide as a “salvage” therapy in patients who didn’t respond to standard treatment methods.We present a clinical observation of a patient with “refractory” pituitary adenoma who successfully underwent 4 surgical interventions and 2 courses of high-dose stereotactic radiotherapy.Results. Application of stereotactic radiotherapy at high (59.4 Gy) dose, which is usually used for treatment of patients with malignant tumors, allowed to achieve long recurrence-free period of 5.5 years (65 months). Observation has shown that repeated courses of stereotactic irradiation can be sufficiently effective and safe in patients with large and gigantic tumors including “refractory” pituitary adenoma.Conclusion. Further studies are necessary for specification of parameters of “refractory” adenomas and their detection at the early stages of diagnosis. Confirmed diagnosis requires more aggressive surgical, radiological, and drug treatment.

Background Despite the rarity of epidermoid cysts in the chiasmatic region, their surgical treatment is particularly complicated because of the tendency toward massive dissemination of the epidermoid masses along cerebrospinal fluid pathways and significant deviation of the tumor from the midline. Objective The purpose of the present work is evaluation of the role of extended transsphenoidal endoscopic endonasal approaches in the surgery of epidermoid cysts. Methods The study included 6 patients with epidermoid cysts in the chiasmatic region who were operated on at the Burdenko Neurosurgery Institute in the last 5 years using an anterior extended transsphenoidal endoscopic endonasal approach. Results The epidermoid masses were totally removed in 5 patients, but in no patient was it possible to completely remove the epidermoid cyst capsule. Visual deterioration was not noted in any patient, nor did new focal neurologic symptoms appear. One of the patients developed hypopituitary disorders in the postoperative period. No recurrence of the epidermoid cysts was observed during the follow-up period. Conclusions Removal of epidermoid cysts in the chiasmatic region using an anterior extended transsphenoidal endoscopic approach may be an alternative to transcranial microsurgery operations. This technique is widely accepted as an approach to this area.

Summary A 32-year-old woman presented with primary amenorrhoea, prolactin (PRL) level of 154 150 mIU/L and was diagnosed with a giant pituitary adenoma measuring maximum 6.2 cm. Cabergoline (CAB) treatment at a dose of 0.5 mg/week was prescribed to the patient. The treatment decreased the tumour size after 3 months (MRI scans of the brain) and brought back to normal the level of the PRL (345 mIU/L) after 6 months of CAB treatment. After 7 months of CAB treatment, menarche was achieved, and after 12 months, the patient became pregnant. She discontinued taking CAB at 4-week gestation. The pregnancy resulted in a missed miscarriage at 6–7 weeks; an abortion was conducted by the vacuum aspiration method. The MRI scans of the brain did not show any tumour enlargement. After 18 months from the start of the treatment the patient got pregnant for the second time. At 25-week gestation an MRI scan of the brain was conducted which did not show any increase in the tumour size. At 38 weeks the patient delivered a healthy full-term girl via C-section. The patient chose not to breastfeed and resumed CAB therapy after the delivery. During the treatment, the PRL level returned to the normal range and the menstrual cycle was restored. After 3 years the patient got pregnant for the third time. The patient did not receive CAB during the pregnancies; the examination did not show any tumour enlargement. Further MRI scans did not show any tumour growth. CAB therapy was effective in normalization of the PRL level, tumour shrinkage, menarche and pregnancy-induction which led to the birth of healthy children in a woman with primary amenorrhoea and a giant prolactinoma invading the skull base bones. Learning points: Giant prolactinomas are very rarely found in women. Cabergoline therapy can be effective in the normalization of the PRL level, tumour shrinkage, menarche induction in a woman with primary amenorrhoea, and giant prolactinoma. Cabergoline therapy can be effective in pregnancy induction which leads to the birth of children in a woman with giant prolactinoma. Cabergoline discontinuation did not trigger tumour enlargement during pregnancy.

Oculomotor nerve neurinoma not associated with neurofibromatosis type II is an extremely rare pathology. According to the topography, cisternal, cisternocavernous, cavernous, orbitocavernous, and orbital tumor groups are distinguished. The clinical picture of the disease is characterized mainly by either oculomotor disorders or pyramidal symptoms, depending on the tumor localization. Neurinomas of the oculomotor nerve rarely occur without oculomotor disorders. However, in some patients with these tumors, the third nerve function remains intact. In this paper, we present clinical cases of two patients with oculomotor nerve neurinomas and analyze the relevant literature.Невринома глазодвигательного нерва при отсутствии нейрофиброматоза II типа является крайне редкой патологией. По топографии выделяют цистернальные, цистернально-кавернозные, кавернозные, орбитально-кавернозные и орбитальные опухоли. В клинической картине заболевания преобладают глазодвигательные нарушения, реже они дополняются другой симптоматикой. Невриномы глазодвигательного нерва редко протекают без глазодвигательных нарушений. Однако в некоторых наблюдениях функция III черепного нерва может оставаться сохранной. В нашей работе представлены клинические наблюдения двух пациентов (один из которых оперирован) с невриномами глазодвигательного нерва и проведен анализ литературы по данной проблеме.