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Objective: based on the analysis of literary sources, to justify the feasibility of using collagen-based biopolymer films for dura mater, to analyze experimentally the ability of this material to biodegrade and form a new dura mater using light optical microscopy and IR spectroscopy, and to investigate the possibility of application of biopolymer collagen-based films as a substitute for the dura mater. Materials and methods. Thirteen rats weighing 200–250 g under general anesthesia were operated. Craniotomies were performed. The dura mater was incised crosswise from the middle to its corners. The surface of the cerebral cortex was exposed and was penetrated with a G18 needle to a depth of 2 mm. Dura mater flaps were not sutured with diastasis between the edges. A small piece of collagen film was placed over dissected dura and the bone flap was removed. The basic group consisted of 10 animals and the control group without collagen film included 3 animals. Three weeks after the intervention, all animals were euthanized and operating sites, including skull and cortical tissue, were explanted for histological, macroscopic examination and molecular analysis by infrared spectroscopy. Results. According to the results of macroscopic and histological examination, collagen substitute for the dura mater does not lead to severe inflammatory complications and excessive scar adhesions, prevents cerebrospinal fluid outflow, is capable of biodegradation with the replacement of connective tissue resembling a newly formed dura mater. Conclusions. 1. The experiment confirmed the ability of collagen-based films to biodegrade in 3 weeks after penetration trauma in rats. 2. The data of both infrared spectroscopy and morphological study indicate that at the border of the collagen implant and the native dura mater the regeneration processes prevail over the formation of scar tissue. 3. The data obtained confirm the collagen-based substitute to be used for dura mater plastics.

The aim of the research was to reveal the pathomorphological patterns of periventricular glioblastoma (PVG) dissemination and assess the rationale for extended surgical removal of subventricular zone (SVZ) as a step towards supratotal resection.A total of 54 patients (16 females and 38 males, mean age 48.9 ± 13.4 years, range 22–69) with PVG were prospectively included in the study. Standard preoperative evaluation included an MRI using 3D T1 with Gd-enhancement, T2, and T2-FLAIR series. The neuronavigation system was used to identify the SVZ and to remove of ventricular wall, additionally to image-guided total tumor resection. The pathomorphological assessment of PVG features with the description of the SVZ and changes in perifocal brain matter was performed by two pathologists.The median Karnofsky Performance Scale (KPS) score raised from 67.8 to 81.9 in the postoperative period. The overall median survival was 13.0 ± 2.7 months. The low postoperative KPS score (p = 0.05) and basal ganglia invasion (p = 0.008) significantly decreased survival rates.Microscopically, the typical multilayer structure of SVZ was disrupted. The invasive spread of tumor cells in thesubventricular space was identified. The ependymal layer had prominent dystrophic alterations of cells and destruction of intracellular connections. The hyperplastic reaction on neoplastic process was typical for adjacent ependyma.The pathomorphological identification of periventricular glioblastoma invasion in the subependymal space supports the supratotal tumor resection with removal of adjacent SVZ as a potential source for relapse.

Two cases of a large fungal ball of the paranasal sinuses and nasal cavity are presented and its removal via an endoscopic approach is detailed. The clinical symptoms of the fungal body of the paranasal sinuses are not specific. With one-sided localization and large sizes of fungal bodies, they must be differentiated from neoplasms. The most informative non-invasive diagnostic method is computed tomography. We are presenting two cases of giant fungal bodies of the paranasal sinuses and identified specific CT signs.

The capabilities of the central nervous system to receive, integrate and process the incoming information, as well as to ensure an adequate timely response, are directly determined by the ability to maintain the electrochemical gradient of ions, a certain concentration of organic molecules and the transport of water through the plasma membrane of nerve cells. This dynamic disequilibrium is a key mechanism in the generation and transmission of information in neuronal intercellular communication, in the activation of extracellular signaling molecules, and in the metabolic support of the neural tissue. It is obvious that maintaining stable homeostasis in the central nervous system is strictly regulated by the mechanisms of ion transport, organic and inorganic molecules, and water. Astrocytes provided with proteins of ionic and aqueous transmembrane channels communicate with neurons and cells lining the cavities filled with fluid. So astroglia is the basic element in achieving such homeostatic regulation of the CNS. Astroglial-mediated homeostasis is highly dynamic, and it has been proven that the disruption of surface expression and the polarization of transport proteins in astroglial cells underlies various pathological conditions. The discovery and further investigation of functional characteristics of specialized water channels — aquaporins was one of the milestones in the study of the mechanisms for maintaining water homeostasis of CNS. The present review deals with base ideas concerning the role of aquaporins in the processes of water transport, such as regulating cell volume, controlling the size of extracellular space, production and drainage of cerebrospinal fluid. Certain pathological conditions caused by a violation of water homeostasis and the drainage system of the central nervous system are considered.

Introduction. The current approach to oligoastrocytoma (OA) treatment includes surgery taking into account the anatomical and physiological accessibility using various radio- and chemotherapy protocols. Nevertheless, it should be recognized that influence of OA histological structure on the surgery of these tumors has not conclusively established. Objective. To improve diagnostic and surgical tactics in oligoastrocytoma by comparing determined clinical-histological patterns. Materials and methods. Retrospective clinical-morphological comparison and analysis of treatment results in 163 patients with OA were performed taking into account histological structure. OAII (WHO) was diagnosed in 32 patients (19.6 %), 131 patients (80.4 %) developed OAIII (WHO). Results. In 52 OA cases (32 %) oligodendroglial component (oOA) prevailed, in 48 OA cases (29 %) astrocytic component (aOA) prevailed, in 63 OA cases (39 %) there was relatively equal cells distribution of both components (оаОА). The surgical treatment of 163 patients included the following: gross total removal, 60 patients (31.4 %); subtotal removal, 98 patients (60.2 %); and partial removal, 4 patients (2.4 %). A total of 106 (65.0 %) patients presented with Karnofsky Performance Status Scale (KPS) ≥ 80. One hundred and fifty-three patients (93.9 %) experienced postsurgery KPS ≥ 80. There was no perioperative death. All 163 patients received radiation therapy and 87 patients (53.4 %) received chemotherapy as well. A significant difference (p< 0.05) in overall survival (OS) was found between surgery results of OA histological groups. Clinical and MRI/CT findings significantly correlated with histological types of OA as well as results of treatment: the overall survival in patients with oOA was 100.5 ± 4.6 months, aOA — 48.2 ± 4.5 months, oaOA — 76.6 ± 4.9 months, averaging 49.9 ± 2.4 months. Conclusions. Diagnosing, surgery, and survival of OA are determined by the uniqueness of the histological structure of these tumors, the interaction of their components, topography and expansion direction. The key to successful results is a differential approach to planning diagnostic tactics, method of removal and management in late post-op period.

Purpose. To study X-ray anatomy of craniovertebral zone considering structural features of the second cervical vertebra for differential diagnosis of pathology and its variable anatomy in the clinical aspect. Materials and methods. In the period from 2004 to 2014 in the clinic 43 patients were examined, maldevelopments of the dens of the second cervical vertebra (C II ) were revealed. Clinical and radiological examinations were conducted, with functional tests, CT, MRI. Results. We used differentiated approach to: fixation of C I –C II vertebrae; craniovertebral fixation involving C I –C II vertebrae; decompression of C I –C II vertebrae; decompression on craniovertebral level involving C I –C II vertebrae. After spinal cord compression riddance it’s necessary to perform locking operations. Regression of symptoms in average was 1.8 points on ASCIA scale. Long-term results were studied in terms up to 10 years, in average 3.2 years. Conclusions. Variants of axis dens development were revealed in 20% cases; in some of them there were individual development options, in others — anomalies and maldevelopments. Anomalies and maldevelopments with craniovertebral disorders or secondary pathological conditions with danger of severe neurological disorders are indications for surgical stabilization of craniovertebral, zone, suboccipital decompression and laminectomy. Features of axis dens anatomy are often misinterpreted that causes difficulty in decision about indications for use of different methods of surgical treatment and rehabilitation, prognosis and expert diagnostics.

Purpose. Developing and clinical testing of effective technology of multimodal images combining and use of additional neuroimaging methods for differentiated diagnostics, coordinates determination and trajectories for stereotactic biopsy (STB), optimal target zone, STB diagnostic informative increasing. Materials and methods . 339 patients with focal brain lesions were included in our study. Stereotactic intervention was performed using stereotactic system CRW Radionics with software StereoFusion, StereoPlan (Radionics) for coordinates calculation. Statistical analysis of the data was performed using nonparametric methods. Results. STB planning before operation was done by MSCT and MRI fusion for maximum information content of diagnostics. MRI and MSCT images fusion was done in 282 (83.2%) cases (group A), multi-modal images comparison (emission computed tomography, MRI-spectroscopy and MSCT-perfusion) — in 57 (16.8%) patients (group B). Conclusions . Optimal diagnostic algorithm should include standard MSCT and MRI with contrast enhancement, MR-spectroscopy, emission tomography and computed tomography perfusion. Multimodal technology improved STB diagnostic informative at focal brain lesion.

Вступ. Висвітлені результати використання сучасних методів лікування злоякісних ембріональних пухлин головного мозку (ГМ) — супратенторіальних примітивних нейроектодермальних пухлин (сПНЕП) у дітей. Матеріали і методи. Проведений ретроспективний аналіз результатів лікування 73 дітей з приводу сПНЕП ГМ за період 1995–2011 рр. Застосовували методику комбінованого лікування — хірургія, променева терапія та хіміотерапія. Результати. Результати дослідження свідчать про необхідність застосування за наявності цих злоякісних пухлин агресивної лікувальної тактики. Післяопераційна смертність становила 5,5%, показники виживання у середньому 31,2 міс. Радикальність операції, використання променевої терапії та хіміотерапії позитивно впливають на показники загального, безрецидивного виживання та якість життя пацієнтів. Висновки. Вік хворих старше 3 років, у яких, згідно з протоколами лікування сПНЕП, можна використовувати променеву терапію, а також комплексний підхід у лікуванні є позитивними факторами прогнозу виживання та покращення якості життя.

Objective. To study the frequency of identifying DNA of human herpesvirus type 4 (Epstein-Barr virus – EBV) in different brain tumours. Materials and methods. Following the surgical resection, 89 samples of brain tumours were analyzed by real time PCR (“DNA technology” commercial kit) for the presence of EBV DNA. Results. EBV DNA was detected in about 40% of the samples of different brain tumours. The frequency of EBV DNA in the samples of extracerebral tumours was higher than in intracerebral glial tumours. EBV DNA positivity in benign gliomas was superior to that in malignant ones. The mechanisms of EBV infection of tumour cells in the brain and the role of EBV in stimulation of tumour growth have not been yet elucidated. Conclusion. EBV DNA is detected in the cells of brain tumours of different histology, prevalently in glial tumours.

The article deals with problems of humanitarian activity. The authors carry out a comparative legal analysis of legal acts regulating humanitarian activity. The result of this study is quite meaningful disclosure of the concept of «humanitarian aid». The results of the study can be tested in the national and international rule-making and law enforcement.

Обзор посвящен новому классу инфекционных агентов — прионам и их роли в болезнях человека с преимущественным поражением ЦНС. Представлены этиологические, патогенетические и молекулярно-генетические особенности этой патологии. Показана роль интрацеребрального пути поступления инфекционного агента и его значение. Эти данные важны в дифференциальной диагностике прионных болезней человека и разработке системы их профилактики и безопасности.

Стереотаксическая биопсия (СБ) по данным магниторезонансной томографии (МРТ) проведена у 38 пациентов с внутримозговыми опухолевыми и неопухолевыми очагами в головном мозге. МРТ проводили в стандартной последовательности и в соответствии со специальным протоколом при толщине среза3 мм. Наиболее сложными диагностическими и техническими моментами были гетерогенность опухолевых узлов, очагов с участками некроза и малый объем полученного материала. Проанализированы результаты СБ, рассмотрены ее нейрохирургические, морфологические и радиологические аспекты.