[Patients with long-term survival in malignant gliomas after photodynamic therapy]. / Patsienty s dlitel'noi vyzhivaemost'yu pri zlokachestvennykh gliomakh posle fotodinamicheskoi terapii.

OBJECTIVE: Analysis of long-lived patients from the group of patients with glioblastomas after using photodynamic therapy in the structure of their complex treatment in order to assess the influence of various factors on their life expectancy. MATERIAL AND METHODS: In total, a single-center, retrospective categorical study analyzed the long-term results of treatment of 63 patients with glioblastoma in the structure of complex treatment including photodynamic therapy. Clinical factors (age, sex, number of cases, preoperative Karnofsky index, location and size of the tumor, radicality of the operation), histological (nuclear polymorphism, mitosis, vascular proliferation, necrosis), immunohistochemical (Ki-67, p53 index) molecular-genetic factors (expression of VEGF, MGMT, IDH, CD34), amount of radiation and chemotherapy were analyzed. RESULTS: In the entire group of patients, there was a direct correlation of life expectancy with MGMT status, IDH status, the number of courses of chemotherapy, the age of the patient, and the severity of the first surgical intervention. CONCLUSION: Clinical features such as age at diagnosis and extent of surgical resection and amount of chemotherapy have predictive value in assessing their effect on life expectancy. Mutations in IDH and MGMT promoter methylation were the most important molecular factors determining long-term patient survival.

[MR morphometry in epileptology: progress and perspectives]. / Primenenie MR-morfometrii v epileptologii: dostizheniya i perspektivy.

Morphometric MRI analysis improves neuroimaging of structural changes in epilepsy. OBJECTIVE: To investigate diagnostic potential of MR brain morphometry in neurosurgical epileptology. MATERIAL AND METHODS: An interdisciplinary working group reviewed the studies devoted to MR morphometry in epileptology as a part of state assignment No. 056-00119-22-00. Study subject was trials of MR-morphometry in epilepsy. Searching for literature data was conducted in international and national databases between 2017 and 2022 using certain keywords. Final analysis included 36 publications. RESULTS: Currently, MR brain morphometry allows measurement of cortical volume and thickness, surface area and depth of furrows, as well as analysis of cortical tortuosity and fractal changes. In neurosurgical epileptology, MR-morphometry has the greatest diagnostic value in MR-negative epilepsy. This method simplifies preoperative diagnosis and reduces costs. CONCLUSION: Morphometry in neurosurgical epileptology is an additional method for verifying the epileptogenic zone. Automated programs simplify application of this method.

[Intraoperative photodynamic therapy in complex treatment of malignant gliomas]. / Primenenie intraoperatsionnoi fotodinamicheskoi terapii v strukture kompleksnogo lecheniya zlokachestvennykh gliom.

Treatment of malignant gliomas is an extremely difficult objective associated with difficult choice of correct strategy. Photodynamic therapy is still not the treatment standard in these patients although this approach significantly improves treatment outcomes in surgery of gliomas. OBJECTIVE: To demonstrate the possibilities of chlorin e6-mediated photodynamic therapy for malignant glial tumors. MATERIAL AND METHODS: There were 161 patients with malignant supratentorial glial tumors who were treated at the Polenov Russian Neurosurgery Institute between 2009 and 2016. Eighty patients comprised the main group (photodynamic therapy), 81 ones - control group (without photodynamic therapy). RESULTS: Photodynamic therapy in complex treatment of malignant brain gliomas significantly increases overall survival in patients with Grade III gliomas up to 39.1±5.5 months (control group - 22.8±3.3 months) and Grade IV gliomas up to 20.7±4.7 months (control group - 13.5±2.3 months) (p=0.0002). This method also increases relapse-free period in patients with Grade III gliomas up to 21.7±3.4 months (control group - 15.8±3.1 months) (p=0.0002) and Grade IV gliomas up to 11.1±2.1 months (control group - 8.0±2.3 months) (p=0.0001).

[Tumor progression of diffuse median glioma with H3 K27 alteration from pilocytic astrocytoma to glioblastoma]. / Opukholevaya progressiya diffuznoi sredinnoi gliomy s al'teratsiei H3 K27 ot pilotsitarnoi astrotsitomy do glioblastomy.

In the latest revisions of the WHO Classification of CNS Tumors, carried out in 2016 and 2021, the traditional histogenetic classification of gliomas is rebuilt on a new molecular genetic basis, according to which diffuse midline glioma with alteration of histone H3 K27 is distinguished as a specific pediatric oncosyndrome. The rationale was the association of this feature of midline gliomas in children with a worse prognosis and the prospective possibilities of targeted therapy. A thematic review of the literature and our own observation of H3 K27M-positive glioma in the area of the right thalamus in a 6-year-old child, which initially had the appearance of pilocytic astrocytoma, recurred three times (within 1.5 years) and underwent tumor progression with anaplastic transformation into diffuse glioma of the glioblastoma type, are presented. The authors are inclined to believe that although the determination of the molecular genetic status of H3 K27 provides important information regarding the probable prognosis, at the same time there is no reason to doubt that histological verification should continue to be the basis of oncological diagnosis.

[Isolated sarcoidosis of the brain]. / Izolirovannyi sarkoidoz golovnogo mozga.

Sarcoidosis is a granulomatous multisystem disease of unclear etiology. Among the many local lesions of different localization, lesions of the central and peripheral nervous system (neurosarcoidosis) are distinguished as particularly unfavorable manifestations of the disease. Only in rare cases, neurosarcoidosis can manifest as isolated or primary. Biopsy remains the gold standard for the diagnosis of neurosarcoidosis. However, significant difficulties remain in verifying the diagnosis, especially with an isolated variant of the lesion A rare case of isolated neurosarcoidosis with a primary focus in the right hemisphere of the brain is described. The data of histological, histochemical and immunohistochemical examination of the surgical material are presented.

[Chordoma as a neurosurgical pathology]. / Khordoma kak neirokhirurgicheskaya patologiya.

OBJECTIVE: Assess the significance of chordoma as a neurosurgical pathology, taking into account the latest edition of the WHO classification of soft tissues and bone tumors (2020). MATERIAL AND METHODS: An analysis of 28 chordomas was carried out. All chordomas were histologically verified, including using immunohistochemical markers of notochordal differentiation (S100, EMA, keratin, brachiuria protein). RESULTS: Patients with chordomas accounted for 0.25% of the total number of neurosurgical patients. The vast majority (27) of chordomas had a cranio-vertebral localization. Sacral localization (S3-S5) of the tumor was detected in 1 patient. In 4 (15%) cases, operations were performed for the recurrence of chordoma. The tumors tended to grow into the structures of the skull, overgrown the vessels and nerves, and compress the adjacent brain structures. This was manifested by pain syndrome, neurological symptoms, impaired liquorodynamics. According to histopathological criteria, 27 (96%) cases of tumors were classified as conventional (usual) chordoma type, among them 7 corresponded to the chondroid subtype of the chordoma. In 1 case (4%), a dedifferentiated chordoma was detected. CONCLUSION: Chordoma, due to its axial localization, naturally involves adjacent structures of the nervous system, has clinically significant neuropathological manifestations, and often provides direct indications for a special neurosurgical approach. This requires its consideration not only as a bone, but also as a neurosurgical oncological pathology, along with other non-meningothelial (mesenchymal) tumors of the CNS.

[The phenomenon of pseudotumorous cross immunohistochemical reactivity of glia in progressive multifocal leukoencephalopathy]. / Fenomen psevdotumoroznoi perekrestnoi immunogistokhimicheskoi reaktivnosti glii pri progressiruyushchei mul'tifokal'noi leikoentsefalopatii.

Progressive multifocal leukoencephalopathy (PML) is a subacute demyelinating brain damage caused by infection of oligodendrocytes and astrocytes with the lytic JC virus on the background of immunosuppression. A case report of PML with a tumor-like course is presented. Morphological diagnostics revealed non-specific staining of antibodies to Ki-67, p53, IDH1, NF and Vim in the nuclei of gliocytes affected by the JC virus. Histological examination and microscopic evaluation of the changes in the brain for the diagnosis of PML is a priority. The recommended intravital biopsy does not always help in clear verification of PML due to the limited volume of tissue fragments presented for research. For the correct interpretation of changes during an intravital pathological examination and verification of PML, it is important to take material during a stereotaxic biopsy, not only from the center, but from the edges and perifocal zone of the altered tissues for the possibility of a spatial histological assessment of the pathological process.

[Primary diffuse meningeal melanomatosis: a literature review and a case report]. / Pervichnyi diffuznyi melanomatoz myagkoi mozgovoi obolochki: obzor literatury i sobstvennoe nablyudenie.

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

[Comparative analysis of 5-ALA and chlorin E6 fluorescence-guided navigation in malignant glioma surgery]. / Sravnitel'nyi analiz fluorestsentnoi navigatsii v khirurgii zlokachestvennykh gliom s ispol'zovaniem 5-ALA i khlorina E6.

OBJECTIVE: To analyze specificity and sensitivity of 5-ALA and chlorin E6 fluorescence-guided navigation in malignant glioma surgery. MATERIAL AND METHODS: Fluorescence-guided navigation was analyzed in 50 patients (2 groups) with high-grade glioma. All patients were treated at the Polenov Russian Neurosurgery Institute. Chlorin E6 1 mg/kg intravenously (Photoditazin) was used as a fluorescence inducer in 25 patients (the 1st group), 5-ALA 20 mg/kg orally (Alasens) - in other 25 patients (the 2nd group). Each group included 10 patients with glioma grade III and 15 patients with glioma grade IV. Both groups were statistically representative (p>0.05). RESULTS: In patients with glioma grade III, sensitivity of chlorin E6 fluorescence-guided navigation was 83.8%, 5-ALA fluorescence - 82.5%. Specificity was 66.7% and 64.1%, respectively. In patients with glioma grade IV, sensitivity was 87.7% for chlorin E6 and 88.3% for 5-ALA. Specificity was 85.2% and 88.1%, respectively. CONCLUSION: Statistical analysis confirmed comparable high efficacy of both agents in surgery of malignant gliomas. Sensitivity and specificity of fluorescence-guided navigation with chlorin E6 and 5-ALA were similar (p>0.05).

[Morphological evaluation of the effectiveness of fluorescence navigation with chlorin e6 in surgery for malignant gliomas]. / Morfologicheskaya otsenka effektivnosti fluorestsentnoi navigatsii s khlorinom e6 v khirurgii zlokachestvennykh gliom.

OBJECTIVE: To evaluate the effectiveness of fluorescence navigation with chlorin e6 in surgery for malignant gliomas based on surgical material morphological and immunohistochemical data. MATERIAL AND METHODS: The surgical material obtained from patients with high-grade (Grade III-IV) anaplastic glioma was examined. Along with histological examination, the proliferation marker Ki-67, the cell cycle transcription factor protein p53, and vascular endothelial growth factor (VEGF) were determined. RESULTS: A significant direct correlation was found between the expression of Ki-67, p53, and VEGF and the fluorescence intensity of tumor tissues (p<0.05). CONCLUSION: The technique of fluorescence navigation using chlorin e6 in comparative morphopathological analysis has confirmed its effectiveness in surgery for malignant gliomas.

[Intraoperative fluorescence control with chlorin E6 in resection of glial brain tumors]. / Rezul'taty ispol'zovaniya intraoperatsionnogo flyuorestsentnogo kontrolya s khlorinom E6 pri rezektsii glial'nykh opukholei golovnogo mozga.

In recent years, fluorescence navigation has been increasingly used in surgery for gliomas. In most studies, 5-ALA derivatives are used as fluorescence inducers. However, there are few data regarding E6 chlorin for these purposes. OBJECTIVE: To evaluate an effectiveness and feasibility of fluorescence navigation with chlorin E6 in surgery of brain gliomas. MATERIAL AND METHODS: The study included 30 patients with glial brain tumors grade II-IV. All patients were operated at the Polenov Russian Neurosurgical Institute. We used surgical microscope (Leica OHS-1), D-Light AF System (Karl Storz, Germany), original fluorescence module (St. Petersburg LOMO, developed by G.V. Papayan) and special software RSS Cam - Endo 1.4.313 for visual analysis of fluorescence. Histological examination included hematoxylin-eosin staining of specimens and immunohistochemical studies. RESULTS: Fluorescence was weak in all patients with Grade II gliomas and strong in almost all patients with Grade III-IV gliomas. Sensitivity of fluorescence diagnosis with chlorin E6 was 72.2% for Grade II gliomas, 83.8% for Grade III gliomas and 87.7% for Grade IV. Specificity of this method was 60% for Grade II gliomas, 66.7% for Grade III gliomas and 85.2% for Grade IV. CONCLUSION: Certain method of fluorescence imaging ensured resection of glial brain tumors using chlorin E6. Intensity of tumor fluorescence correlated with glioma malignancy grade. These results indicate that chlorin E6 is an effective photosensitizer for intraoperative fluorescence diagnosis in surgery for glioma.

[Structural heterogeneity of epileptic foci in local drug-resistant epilepsy]. / Strukturnaya geterogennost' epilepticheskikh ochagov pri lokal'noi farmakorezistentnoi epilepsii.

BACKGROUND: To study etiopathogenesis is one of the most important tasks of modern neurology. Various types of structural changes occur in drug-resistant epilepsy (DRE); however, they are described as distinct phenomena. OBJECTIVE: To provide a comprehensive characterization of structural changes in the cortex and adjacent white matter in the electrophysiological activity zone (in the epileptic focus) in patients undergoing surgery for DRE. MATERIAL AND METHODS: Biopsy material of fragments of the temporal lobe and hippocampus from 16 patients aged 21 to 54 years (mean age, 25 years) with DRE were intraoperatively obtained at the Prof. A.L. Polenov Russian Research Institute of Neurosurgery. The investigators studied histological sections stained with H&E, toluidine blue according to the Nissl method and the Spielmeyer method, as well as the results of immunohistochemical reactions with glial fibrillary acidic protein (GFAP), vimentin, and neurofilaments (NF) (Dako antibodies, Denmark). RESULTS: Histological examination revealed a set of heterogeneous changes, reflecting the complex pathogenetic interactions that developed during the formation of an epileptic focus. Structural brain damage involved both gray and white matter. Focal cortical dysplasia was diagnosed in 14 (87.5%) cases; white matter neuronal heterotopia in 100%; neuronal reactive and destructive changes in 100%; epileptic leukoencephalopathy (vascular demyelination, microcysts, sclerosis and dystonia, gliosis) in 100%, cortical atrophy in 12.5%, and hippocampal sclerosis in 20% (in 2 out of the 10 examinees). CONCLUSION: The morphopathological heterogeneity in the structure of epileptic foci reflects the complexity of etiopathogenetic interactions, the polymorphism of epileptic manifestations, and the individual nature of formation of the epileptic system, which requires an integral approach to understanding the pathogenesis and morphogenesis of formation of the epileptic system and provides a direction for a personalized approach to epilepsy treatment.

[Complex treatment of a patient with neurofibromatosis type 2]. / Kompleksnoe lechenie patsienta s neirofibromatozom 2-go tipa.

Neurofibromatosis type 2, a rare disease, the most characteristic manifestation of which is the presence of bilateral vestibular schwannomas, less often schwannomas of other cranial, spinal and peripheral nerves. Much less frequent are meningiomas (intracranial, including meningiomas of the optic nerves, and spinal), epindymomas and gliomas. As a rule, in one patient several formations occur simultaneously, which creates a certain difficulty in treatment tactics. The authors present a case of type 2 neurofibromatosis in a 22-year-old female patient with multiple schwannomas of spinal roots and an atypical intraventricular meningioma.

Functional Imbalance of Glutamate- and GABAergic Neuronal Systems in the Pathogenesis of Focal Drug-Resistant Epilepsy in Humans.

The mechanisms of the formation of pharmacological resistance in temporal focal epilepsy remain poorly understood, and effective treatment strategies that can suppress epileptogenesis do not currently exist. We studied the imbalance between the glutamatergic (stimulating) and GABAergic (inhibitory) neuronal systems, as well as the role of apoptotic processes in the pathogenesis of drug-resistant epilepsy. To this end, the expression of Gad65, Vglut2, NR2B, Bcl-2, and caspase-8 proteins was analyzed in the gray and white matter of the temporal cortex of human brain. It was shown that pathological processes in the glutamatergic and GABAergic systems related to drug-resistant epilepsy are accompanied by changes in the content of apoptotic proteins, which can be the cause of neuronal death.

[Tanatogenetic role of type 2 diabetes in neurosurgical patients]. / Tanatogeneticheskaia rol' sakharnogo diabeta 2-go tipa u neirokhirurgicheskikh bol'nykh.

The idea of diabetes in the aspects of its impact on the course of different diseases and tanatogenesis remains little investigated. OBJECTIVE: To define the tanatogenetic significance of 2 type diabetes in neurosurgical patients. SUBJECT AND METHODS: Forty-three patients aged 22-75 years, who had died after neurosurgery, were examined. Case histories and the time course of changes in blood glucose levels were analyzed. The manifestations of macroangiopathy were taken into account at autopsy; those of microangiopathy were considered at microscopy of the internal organs and tissues; Van Gieson and periodic acid-Schiff staining was additionally applied. The expression of insulin, glucagon, synaptophysin, S100 proteins, and neurofilament protein was found in the pancreas. The number and volume of islets and an insulin-to-glucagon ratio were morphometrically estimated. RESULTS: Type 2 diabetes mellitus was identified in 28 (65.1%) patients: 11 (25.6%), 8 (18.6%), and 9 (20.9%) with clinically obvious, subtle, and latent types, respectively; while it was as a background underlying disease in 3 (7.0%) patients. Among the immediate causes of death, there was a preponderance of local angiogenic complications (hemorrhages, infarctions, swelling, and displacement of the brain) (64%). Indurative pancreatitis was not inferior to cardiovascular diseases among complications and concomitant diseases and was detected in most diabetic patients (n=24, or 85.7%) and in 6 (a quarter) patients with acute pancreatic necrosis, which was the immediate cause of death in 2 cases. In the places of paravasal sclerosis, there was a reduction in the terminals of nerve fibers as a manifestation of diabetic neuropathy. CONCLUSION: Type 2 diabetes mellitus was much more frequently encountered in the most critically ill and dead neurosurgical patients than in the general population and was embodied in the pattern of immediate causes of death. Diabetic neuropathy with a reduction in the terminals of nerve fibers can serve as a substantial basis not only for vascular, but also for ductal dystonia and dyskinesia, which can become an important factor in the pathogenesis of chronic pancreatitis in patients with diabetes mellitus.

[The intraoperative prophylaxis of local ischemical brain damage in neurosurgical patients with cerebral aneurysm]. / Intraoperatsionnaia profilaktika lokal'nogo ishemicheskogo povrezhdeniia golovnogo mozga u neirokhirurgicheskikh patsientov s tserebral'noi anevrizmoi.

AIM: To study the effectiveness of intraoperative administration of Cytoflavine for the prevention of ischemic brain injury during cerebral aneurysm (CA) clipping with temporary occlusion of the leading artery under general anesthesia. MATERIAL AND METHODS: The prospective cohort single-center study included 40 patients with CA ( the main group - 27 patients with intraoperative administration of cytoflavine; the comparison group -13 patients without use of cytoflavine), who underwent aneurism clipping with temporary occlusion of the afferent artery. We assesed the intraoperative state of the brain, the time of awakening and extubation of patients after surgery, neurological deficit and local ischemic changes in the area of surgery according to the CT of the brain in the early postoperative period, resuscitation bed-day and the relationship of these indicators with the duration of temporary occlusion of the afferent artery in the selected groups of patients. RESULTS: In intergroup comparison, patients of the main group treated with intraoperative cytoflavin showed a reduction in the time of awakening (p=0.013) and the time of extubation (p=0.01) both with temporary occlusion of the afferent artery and in patients without temporary occlusion (p<0.05). The duration of resuscitation bed-day decreased in the main group of patients receiving intraoperatively cytoflavine (p=0.01), as well as in patients in the comparison group without temporary occlusion (p<0.05). CONCLUSION: Temporary occlusion of the afferent artery with short intervals of vessel occlusion in combination with intraoperative intravenous administration of cytoflavine expands the tolerability to artery occlusion in patients operated in the 'cold' period, reduces the possibility of neurological deficit, reduces the recovery period and resuscitation bed-day after surgical clipping CA.

[Extrapontine myelinolysis developed after aneurysmal subarachnoid hemorrhage (a case report and literature review)]. / Ekstrapontinnyi mielinoliz, razvivshiisya posle anevrizmaticheskogo subarakhnoidal'nogo krovoizliyaniya (sluchai iz praktiki i obzor literatury).

TOPICALITY: Central pontine and extrapontine myelinolysis is a rare and dangerous form of the demyelinating process of undefined origin, the development of which is associated with a very low sodium level in the blood (hypernatremia). OBJECTIVE: To describe a rare case of extrapontine myelinolysis as a complication occurring in the hemorrhagic period of anterior communicating artery aneurysm rupture as well as to demonstrate that this condition can be diagnosed intravitally. CONCLUSION: Clinical vigilance of extrapontine myelinolysis may promote the timely diagnosis and treatment of this disease, which is a potential cause of death. Pulse-therapy with glucocorticoids provides the opportunity to achieve regression of neurological symptoms and to stabilize the patient's condition.