[Stereotactic photodynamic therapy for recurrent glioblastoma. Case report and literature review]. / Stereotaksicheskaya fotodinamicheskaya terapiya v lechenii retsidiva glioblastomy. Sluchai iz praktiki i obzor literatury.

We report a patient with recurrent glioblastoma in eloquent brain area. Stereotactic fluorescence biospectroscopy and stereotactic photodynamic therapy of tumor in opercular area of the left frontal lobe under neurophysiological monitoring were carried out. Literature data on this issue were analyzed.

[Clinical guidelines for the use of intraoperative fluorescence diagnosis in brain tumor surgery].

In this paper, we present a review of current literature on the application of intraoperative fluorescence diagnosis and fluorescence spectroscopy using 5-aminolevulinic acid in surgery for various types of brain tumors, both alone and in combination with other neuroimaging methods. Authors' extensive experience with these methods allowed them to develop a set of clinical guidelines for the use of intraoperative fluorescence diagnosis and fluorescence spectroscopy in surgery of brain tumors.

[Surgical resection in combination with stereotaxic cryodestruction in patients with supratentorial gliomas in functionally significant areas of the brain: possibilities of using combined surgical treatment and its results].

A combined method of surgical treatment of glial tumors of the brain is proposed for decreasing risk of complications. The method includes microsurgical ablation of the main volume of the neoplasm and stereotaxic cryodestruction of the residual part of the tumor. Combined surgical treatment was used in 12 patients. The results obtained show that the proposed method elevates the efficacy of surgical method, facilitates increased indices of survival rate and maintenance of quality of life of the patients at the tolerant level.

[Technique of stereotactic cryodestruction in management of patients with cerebral gliomas].

Aim of the study was to evaluate the safety and efficiency of stereotactic cryodestruction of supratentorial astrocytomas that were located deeply in the brain and/or within eloquent areas.We examined 74 patients aged 18-64 years with supratentorial gliomas of different grade located in deep or eloquent brain areas. All the patients underwent stereotactically guided cryodestruction of the tumor. The survival rate was evaluated by the Kaplan-Meier method. The chi-square method was used for comparative analysis of results of this study with available data from the literature. For the analysis of the prognostic importance of various factors the Cox proportional hazards model was applied. The average survival period was 12.4 months for glioblastoma (control group--6.4 months, p=0.04), and 46.9 months for anaplastic astrocytoma (control group--18 months, p=0.006). For patients with fibrillar-protoplastic astrocytoma the 5-year survival rate was 95.7%. The frequencies of complications did not exceed those of the routine surgical interventions in patients with brain tumors. We found that stereotactic cryodestruction as well the Karnofsky performance score were statistically reliable prognostic factors (p=0.0377 and p=0.0006, respectively), while the extent of cryodestruction and the residual tumor mass did not influence the survival rate. Stereotactic cryodestruction is a safe surgical procedure, which results in statistically significant improvement of survival in patients with supratentorial gliomas located within deep and/or eloquent areas of brain.

[Choice of approach trajectories in stereotaxic surgery in patients with intracerebral tumors].

An analysis of factors was made which influence the choice of approach trajectories in preoperative planning the diagnostic and medical stereotaxic interventions in patients with intracerebral tumors. Stereotaxic operations were planned and fulfilled on 124 patients with glial tumors of different supratentorial localizations. In planning trajectories with using MRI the passage of stereotaxic cannula through the pial folds and functionally significant zones of the brain were avoided. At the postoperative period no parenchymatous hemorrhages were noted in the approach zone, even with great number of trajectories. It was also noted that in passing the stereotaxic instrument through the lateral venticles of the brain the risk of complications was minimal.

[The course of the postoperative period in patients with cerebral gliomas after different volumes and kinds of surgery].

The investigation included 340 patients with cerebral gliomas. Under analysis there were age, gender, neurological status and Karnovsky status before and after operation, localization of the tumor, type and volume of surgical intervention, postoperative complications. It was shown that radical extirpation of glial formations facilitated more favorable course of the postoperative period. Partial ablation of gliomas is associated with greater risk of the development of postoperative complications and neurological dysfunctions. As the main method of surgical treatment of patients with gliomas located in the functionally significant and deep areas of the brain stereotaxic cryotomy is thought to be indicated.

[Clinical and morphological risk factors for epilepsy in patients with glial and metastatic brain tumors]. / Kliniko-morfologicheskie faktory riska razvitiya epilepsii u bol'nykh s glial'nymi i metastaticheskimi opukholyami golovnogo mozga.

OBJECTIVES: To estimate the incidence of epileptic seizures in patients with glial and metastatic brain tumors and to identify clinical and morphological risk factors for epileptic seizures in patients with glial and metastatic brain tumors. MATERIAL AND METHODS: The study included 225 (88.6%) patients with glial brain tumors and 29 patients (11.4%) with metastatic tumors. RESULTS: Statistically significant differences in the incidence of epileptic seizures depending on age, histological characteristics of the tumor, degree of malignancy, tumor localization, involvement of the cerebral cortex, the presence of the midline shift were obtained. CONCLUSIONS: Epilepsy and epileptic seizures was found to develop in 51.11% and 24.14% of cases in glial and metastatic brain tumors, respectively. Risk factors for developing epileptic seizures include younger age (up to 57 years), histological characteristics corresponding to diffuse astrocytomas, anaplastic astrocytomas, oligodendrogliomas, oligoastrocytomas, grade I-III malignancy, lesion of the temporal lobe, involvement of the cerebral cortex. Factors that reduce the risk for attacks include age over 57, histological characteristics corresponding to glioblastomas and metastatic tumors, grade IV malignancy, subcortical localization of the tumor, damage to the occipital lobe, involvement of the commissural pathways, subtentorial localization of the tumor, the absence of lesions of the temporal and frontal lobes of the brain, the involvement of both brain hemispheres, damage to two or more brain lobes, the presence of a midline shift.

[Cerebrospinal fluid sorption in the system of complex treatment of chronic cerebral ischemia]. / Likvorosorbtsiia v sisteme kompleksnogo lecheniia khronicheskoi tserebral'noi ishemii.

The cerebrospinal fluid was investigated in 16 patients with chronic cerebral ischemia. Reactions of the local immune system of the liquor was shown to change by the autoimmune type. Medical efficiency of cerebrospinal fluid sorption was proved and it can be considered a method of detoxication aimed at breaking the pathogenetic chain: formation of abundance of the autoantibodies--increased amount of the circulating immunocomplexes--damage of the cell membranes--discharge of deep antigens--appearance of a new generation of autoantibodies. Using cerebrospinal fluid sorption as a test for the detection of latent functional reserves of the neurons not changed irreversibly in the zone of reduced perfusion of the cerebral tissue is thought to be a perspective method.