[Alternative ways of collateral venous flow in occlusion of superior sagittal sinus].

The authors demonstrated alternative ways of bloodflow from occluded superior sagittal sinus through hypertrophic dural veins (middle meningeal veins) and sphenoparietal sinus. Parameters of bloodflow were evaluated using triplex ultrasonography. The possibility of venous drainage into anterior segment of superior sagittal sinus proximal to the site of occlusion with further retrograde flow towards dural venous anastomosis is verified. Possibilities of spiral CT-venography and standard time-of-flight MR-venography for assessment of collateral venous flow were estimated.

[Metastatic glioblastoma in a submandibular lymph node (a rare case)].

Extraneural metastases from glioblastoma are rare. A case of metastatic right parietal lobe glioblastoma in cervical node after repeat craniotomy is presented.

[Long-term results of treatment in patients with oligodendrogliomas and oligoastrocytomas of the cerebral hemispheres].

BACKGROUND: the current approach to treating patients with cerebral oligodendrogliomas and oligoastrocytomas involves surgical treatment with the maximum tumor resection in reasonable ranges, by taking into account the anatomic and physiological availability, followed by chemo- and radiotherapy. Nevertheless, it should be recognized that criteria for choosing the optimum regiment for the treatment of these tumors have not conclusively established. MATERIALS: the long-term results of treatment were analyzed in 80 patients with oligoglial tumors (oligodendrogliomas and oligoastrocytomas in 31 and 49 patients, respectively) treated at the A.L. Polenov Russian Institute of Neurosurgery in 1990 to 2004. The patients' mean age was 18.9 years. 38.5% of tumors were located in the frontal lobe. In 67 (83.75%) patients, Karnoffsky score was 70-90. Radiotherapy was used in the treatment of 71 patients and postoperative chemotherapy in 52 (87,5%) patients. RESULTS: After complex therapy, the mean survival was 80.6 months in patients with oligodendrogliomas, 63.3 months in those with anaplastic oligoastrocytomas, and 42 months in those with anaplastic oligodendrogliomas.

[Modern classification approach to central nervous system tumors].

Central nervous system (CNS) tumors cannot be, for a number of reasons, organically included into the existing tumor classification system - TNM. This hampers the registration and systematization of CNS tumors, the acquisition of valid data on their prevalence, and the organization of treatment in patients with CNS tumors. A variant of a classification of CNS tumors is proposed, which takes into account the specific features of this group of neoplasms.

[Accelerated postoperative chemoradiotherapy for malignant cerebral glioma].

Procedure of accelerated immunotherapy for cerebral glioma is presented. Large fractions of radiation ranged from 3 Gy, 5 times a week, to a total focal dose of 51 Gy. After accumulation of total doses of 18, 33 and 48 Gy, vincristine was injected intravenously. Urea derivatives were given on reaching 21, 36 and 51 Gy. Treatment with the immunomodulator roncoleukine was carried out on completion of radiotherapy. An evaluation of the immediate end results of accelerated immunotherapy showed improved survival as compared with standard treatment.

[Invasive giant pituitary adenomas].

7 cases of pituitary adenomas with the pronounced signs of invasive growth, confirmed by MRI, clinical and intraoperative observations. Invasive growth of adenomas was related to neither the structure of the tumor, the degree of anaplasia, or the nature of a generated hormone.

[Pituitary apoplexy in giant cell adenoma].

Hemorrhage in giant cell adenomas of the pituitary gland was detected in 20.8%. It occurred mostly in supracellular mixed multi-nodular tumors. The course of the disease was symptom-free, acute, subacute or mild. There was a relationship between pituitary apoplexy course, on the one hand, and age and tumor growth, on the other. Since postoperative complication and lethality rates were relatively higher in younger patients, it is suggested that differentiated approach be taken to the diagnosis and management of the disease.

[The diagnosis of cerebral meningiomas at the stage of early clinical manifestation].

Presented are the results of the analysis on efficacy of cerebral meningiomas diagnosis at the stage of early clinical manifestation. The case-history data of 277 patients (95.5%) examined at the early stage of clinical manifestation have been analyzed. Type and frequency of referrals to the doctor at different periods of the disease and their dynamics, the set of curative and diagnostic procedures used for patients' examination during the referrals and timeliness and degree of diagnosing intracranial meningiomas at different stages of examination have been established. Factors responsible for the clinical manifestation of the existing tumor have been determined. Diagnosis of cerebral meningiomas at the stage of early clinical manifestation remains unsatisfactory: 24.6% of patients (68) did not seek medical aid despite the presence of clinical symptoms of the tumor and 40.9% attended the doctor repeatedly. In primary examination, cerebral meningioma was diagnosed in 30.7% of outpatients and in 47.3% of in-patients.

[Treatment of cancer metastasis in the brain].

Surgery for brain metastases is an effective treatment for most cancer patients. It involves low post-operative lethality (2.9%) and causes neurological symptoms to regress in most patients. 12-month survival occured in 48.5%, 5 years--10.8%; mean survival duration with good quality of life--11.8 months. Survival basically depended on tumor pattern, metastases to other organs, multiple foci in the brain and habitus.

[Malignant central nervous system tumors are susceptible to specific antibodies]. / Zlokachestvennye opukholi tsentral'noi nervnoi sistemy mogut byt' dostupny dlia ataki spetsificheskimi antitelami.

The binding of circulating specific IgG to glioblastoma cells from brain tumor biopsies was shown using fluorescence conjugate Protein A-FITC and Western blotting. Blood-brain barrier permeability for antitumor antibodies in vivo in glioblastoma patients is suggested.

[The collateral venous blood flow and the surgical procedure in parasagittal meningiomas]. / Kollateral'nyi venoznyi krovotok i khirurgicheskaia taktika pri parasagittal'nykh meningiomakh.

Peculiarities of the collateral venous bloodflow were analysed in 242 cases of parasagittal meningiomas (PM). The cerebral veins participated in collateral bloodflow in 52.1% of cases with tumours of the anterior third of the superior sagittal sinus (SSS), whereas in 39% of such cases the retrograde flow through proximal SSS have been found. Neoplasms of the middle/posterior third of SSS led to the collateral venous bloodflow through the anastomoses of the cerebral veins in 67% of cases. In 56% of patients the collateral flow was through extracerebral veins. The absence of strict conformities in the development of the collateral venous bloodflow leads to necessity of its intraoperative control by EEG monitoring. Severe changes of bioelectrical activity (14.9% of cases) are an indication for division of the surgical procedure into several stages.

[The surgical treatment of meningiomas of the superior sagittal sinus (the surgical approach and technic)]. / Khirurgicheskoe lechenie meningiom verkhnego sagittal'nogo sinusa (taktika i tekhnika operatsii).

The authors analyze the results of surgical management of 242 patients with upper sagittal sinus meningiomas who have been treated in the past 20 years. All the patients were divided into 3 groups in accordance with the surgical policy and techniques of interventions and anesthesiological support. The type of sinus wall tumor lesion and its associated cerebral blood outflow disorders detected by electrophysiological studies in pre- and intraoperative periods determined surgical policy which along with microsurgical technique of recovery of the intact sinus and superficial veins of the brain enhanced the efficiency of operations up to 92.2% and reduced fatal outcomes to zero.

[Microsurgical revascularization of the brain with an autograft of the greater omentum (experimental research)]. / Mikrokhirurgicheskaia revaskuliarizatsiia golovnogo mozga autotransplantatom bol'shogo sal'nika (éksperimental'noe issledovanie).

The paper deals with improvement of procedures for autografting a greater omental fragment to the vascular layer of the brain in its experimental ischemic lesions. The findings suggest that a functional vasculature has formed between the omentum and the meninx vasculosa just at hour 24 postautografting. This provides evidence to recommend the method for clinical application to compensate cerebral circulatory disorders in tumor-induced and vascular abnormalities in the brain.