[Surgical and combined treatment of patients with craniovertebral junction meningioma: a single-center retrospective study of 196 cases]. / Analiz rezul'tatov khirurgicheskogo i kombinirovannogo lecheniya patsientov s meningiomami oblasti kraniovertebral'nogo perekhoda: odnotsentrovoe retrospektivnoe issledovanie 196 sluchaev.

Treatment of craniovertebral junction meningioma is a difficult task. Surgical treatment is the gold standard for these patients. However, it is associated with high risk of neurological impairment, while combined treatment (surgery + radiotherapy) provides more favorable outcomes. OBJECTIVE: To present the results of surgical and combined treatment of patients with craniovertebral junction meningioma. MATERIAL AND METHODS: There were 196 patients with craniovertebral junction meningioma who underwent surgical or combined (surgery + radiotherapy) treatment at the Burdenko Neurosurgery Center between January 2005 and June 2022. The sample included 151 women and 45 men (3.4:1). Resection of tumor was performed in 97.4% of patients, craniovertebral junction decompression with dural defect closure - 2%, ventriculoperitoneostomy - 0.5%. As the second stage, 40 patients (20.4%) underwent radiotherapy. RESULTS: Total resection was achieved in 106 patients (55.2%), subtotal - 63 (32.8%), partial - 20 (10.4%), tumor biopsy was performed in 3 (1.6%) cases. Intraoperative complications occurred in 8 patients (4%), postoperative complications - in 19 (9.7%) cases. Radiosurgery was carried out in 6 (15%) patients, hypofractionated irradiation - 15 (37.5%), standard fractionation - 19 (47.5%) patients. Tumor growth control after combined treatment made up 84%. CONCLUSION: Clinical outcomes in patients with craniovertebral junction meningioma depend on tumor dimensions, topographic and anatomical localization of tumor, resection quality and relationship with surrounding structures. Combined treatment of anterior and anterolateral meningiomas of the craniovertebral junction is preferable compared to total resection.

[Sarcomas of the central nervous systems. Clinical observations]. / Sarkomy tsentral'noi nervnoi sistemy. Klinicheskie nablyudeniya.

Here we report three patients with rare primary intracranial sarcomas, two of them were CIC-sarcomas and one was a DICER1-sarcoma. Tumors were examined using DNA methylation. It is important to study of CIC fusions and DICER1 mutations in malignant brain tumors.

[Treatment of petroclival meningiomas: current state of the problem]. / Lechenie petroklival'nykh meningiom: sovremennoe sostoianie problemy.

Petroclival meningiomas (PCMs) are benign, slowly growing tumors. Surgery still remains the main treatment option for them. The desire for total resection of large extended PCMs often leads to the development or worsening of persistent neurological deficits. This paper presents a review of the world literature devoted to petroclival meningiomas. We discuss the issues of PCM classification, biology, diagnosis, and selection of the optimal algorithm for their treatment.

[Monitoring of adverse event triggers as a tool for managing the medical care quality at a neurosurgical clinic. Invitation to the discussion]. / Monitoring triggerov neblagopriiatnykh sobytii kak instrument upravleniia kachestvom meditsinskoi pomoshchi v neirokhirurgicheskoi klinike. Priglashenie k diskussii.

Management of the healthcare quality and safety is one of the priorities of state policy for protecting health of Russian citizens. We describe modern technologies for managing the quality of medical care and patient safety based on a systematic approach. Potential applications of these technologies in neurosurgical practice are defined. Quantitative, qualitative, and basic indicators are proposed for evaluation of outcomes (results) as part of implementation of an integrated quality management system in neurosurgical practice.

[Intraoperative fluorescence diagnostics in surgery of intracranial meningiomas: analysis of 101 cases]. / Intraoperatsionnaia fluorestsentnaia diagnostika v khirurgii intrakranial'nykh meningiom: analiz 101 nabliudeniia.

Fluorescence diagnostics has been extensively applied in surgery of malignant brain gliomas. However, the use of this technique in surgery of intracranial meningiomas has remained controversial. OBJECTIVE: The study objective was to assess the sensitivity of 5-aminolevulinic acid-based (5-ALA) fluorescence diagnostics in surgery of brain meningiomas and to clarify the clinical and biological factors that may influence the fluorescent effect. MATERIAL AND METHODS: The study consistently included 101 patients with intracranial meningiomas of various locations who were operated on using 5-ALA. There were 28 (27.72%) males and 73 (72.27%) females (median age, 54 years). In all patients, surgery was performed using an operating microscope equipped with a fluorescent module; in 24 of these, laser spectroscopy was used. For comparison of chances to observe the fluorescent effect of 5-ALA in patients having meningiomas with different WHO histological grades (Grade I vs Grade II-III), we performed a meta-analysis that included 10 studies (the largest series) on outcomes of surgical treatment of meningiomas using intraoperative fluorescence diagnostics. RESULTS: Of 101 patients included in this series, observable fluorescence was detected in 95 (94.1%) patients: weak fluorescence in 12 (11.9%), moderate fluorescence in 23 (22.8%) cases, and strong fluorescence in 60 (59.4%) patients. There was no statistically significant relationship (p>0.05) between the rate and intensity of observable fluorescence and the tumor growth pattern (primary/continued), location, WHO grade of malignancy, and histological subtype. In the absence of intraoperative bleeding, tumor fluorescence was statistically significantly brighter (p=0.02). Of 26 patients with hyperostosis, bone fluorescence was observed in 11 (42.3%) cases. There was no statistically significant relationship between administration of dexamethasone, its dose, administration of anticonvulsants, gastrointestinal tract diseases, as well as diabetes mellitus and the fluorescence intensity. There was also no significant relationship between the extent of tumor resection (Simpson scale) and the presence of fluorescence as well as its intensity. Comparison of the observable fluorescence intensity and the laser spectroscopy indicators revealed a significant correlation (r=0.75; p=0.005). CONCLUSION: Meningioma is a well fluorescent tumor, with the technique sensitivity being 94.1%. In some cases, the use of fluorescence diagnostics in surgery of meningiomas improves identification of residual tumor fragments and enables correction of a surgical approach. To assess the effect of fluorescence diagnostics on the recurrence rate and disease-free duration, further research is required.

[Surgical management of venous compression causing trigeminal neuralgia]. / Khirurgicheskaia taktika pri venoznoĭ kompresii kak prichina trigeminal'noĭ nevralgii.

Venous compression is a rare cause of trigeminal neuralgia (TN). Vascular decompression of the trigeminal nerve root, as the only etiopathogenetic treatment of trigeminal neuralgia, is a well-known procedure that is extensively used at various neurosurgical clinics. As the number of interventions for TN increases, the absolute number of surgeries for eliminating venous compression of the trigeminal nerve also grows. Five hundred TN patients underwent surgery at the Neurosurgical Institute in the period from 2000 to 2015. The diagnosis was made based on the criteria of the International Classification of Headache Disorders, the 3rd edition, (ICHD-3) and the Burchiel classification. The study included 211 males and 289 females. The median age was 57 years. All patients had typical TN pain with a unilateral distribution. Two or more branches were affected in 90 patients; one branch was predominantly affected in 10 patients. The median disease duration was 16 months. The median visual analog scale (VAS) score was 8 (very severe persistent pain). In all cases, the patients underwent surgery using the retrosigmoid suboccipital approach. The median postoperative follow-up was 36 months. The aim of this work is to summarize the first experience of the Neurosurgical Institute in surgical treatment for venous compression of the Vth nerve root and suggest methods increasing the efficacy of vascular decompression in patients with this disease.

[Surgical treatment of acoustic neuromas (vestibular schwannomas)]. / Khirurgicheskoe lechenie nevrinom slukhovogo nerva (vestibuliarnykh shvannom).

Clinical guidelines are topical systematically developed provisions designed to help the doctor make a decision about a treatment approach in certain clinical situations; they provide information on conducting diagnostic and screening tests, the amount of medical and surgical care, and other aspects of clinical practice. Vestibular schwannomas account for 8% of all intracranial lesions, up to 30% of posterior cranial fossa tumors, and 85% of cerebellopontine angle tumors. The incidence rate of acoustic neuromas is approximately 1 case per 100000 population per year. The paper addresses the issues of classification, diagnosis, and treatment of acoustic neuromas. The guidelines discuss in detail the key aspects of formulation of clinical diagnosis, classification features, definition of the indications for surgical or radiation treatment, and principles of expectant treatment in vestibular schwannomas. The article pays particular attention to surgical treatment of acoustic neuromas and describes the criteria for choosing a surgical approach, use of modern surgical equipment, and stages of tumor resection. On the basis of the accepted clinical classification, we propose the algorithms of action depending on the disease stage, pathological process dynamics, patient's age, and clinical manifestations. The key points of the clinical guidelines rely on evidence-based criteria. The work is intended for neurosurgery practitioners.

[A malignant peripheral nerve sheath tumor developed from the auditory nerve: a case report and a literature review]. / Zlokachestvennaia opukhol' obolochek perifericheskikh nervov, razvivshaiasia iz slukhovogo nerva: sluchai iz praktiki i obzor literatury.

We present a rare clinical case of a patient with a malignant peripheral nerve sheath tumor developed from the auditory nerve as well as a literature review, including 30 reported cases of this disease.

[Intracranial neurenteric cysts: experience of the Burdenko Neurosurgical Institute in the XXIth century]. / Intrakranial'naia neiroéntericheskaia kista: opyt Instituta neirokhirurgii im. akad. N.N. Burdenko, v XXI veke.

We present a series of cases of a rare pathology, intracranial neuroenteric cysts, a review of the international literature, and the experience in treating this pathology. MATERIAL AND METHODS: Seven patients with intracranial neuroenteric cysts underwent surgery at the Neurosurgical Institute in the period between 2000 and 2015. CONCLUSION: The main and only technique for treatment of intracranial neurenteric cysts is their resection.

[A technique of TachoComb application in dura mater reconstruction in surgery for posterior cranial fossa tumors]. / Metodika primeneniya materiala TakhoKomb dlya plastiki tverdoi mozgovoi obolochki v khirurgii opukholei zadnei cherepnoi yamki.

INTRODUCTION: Liquorrhea is a condition characterized by cerebrospinal fluid (CSF) leakage from the cranial cavity due to injury to the integrity of the dura mater (DM) and bone structures of the skull base. Surgery for posterior cranial fossa (PCF) lesions distinguishes wound CSF leakage when CSF leaks from a surgical wound as well as basal CSF leakage (nasal liquorrhea and, less often, otoliquorrhea). The main cause of basal CSF leakage is injury (including surgical injury) resulting in a defect in the DM and bone structures (cells of the mastoid process in the case of a suboccipital retrosigmoid approach). There are a variety of DM restoration techniques ranging from DM closure or placement of a synthetic or autologous patch to application of various synthetic adhesives in the form of adhesive compositions (Tissucol) and adhesive substances (TachoComb). This article describes the experience with application of a TachoComb® sponge gained at the 5th Clinical Department of the Burdenko Neurosurgical Institute. MATERIAL AND METHODS: The study included 176 patients with acoustic neurinomas. At the final stage of surgery, all the patients underwent DM reconstruction with a TachoComb® collagen sponge. CSF leakage occurred in 3 (1.7%) patients, with each of them having Koos grade 4 tumor. One (0.56%) patient had wound liquorrhea, and 2 (1.1%) patients had nasal liquorrhea. CSF leakage was managed by placement of a lumbar drain; postoperative wound revision was not required. CONCLUSION: Using the TachoComb® sponge for DM reconstruction in PCF surgery is an effective way to prevent postoperative CSF leakage, provided that the algorithm of manipulations described in the article is followed.

[Use of surgical approaches to the posterior cranial fossa in patients in a lying position]. / Primenenie khirurgicheskikh dostupov k zadnei cherepnoi yamke v polozhenii lezha.

BACKGROUND: Various suboccipital approaches are extensively used in modern neurosurgery for treatment of posterior cranial fossa disease. The main patient's positions on the operating table during surgery are half-sitting and lying ones. MATERIAL AND METHODS: The article provides a detailed description and methodology of retrosigmoid suboccipital and median suboccipital approaches in a lying position. CONCLUSION: The retrosigmoid suboccipital and median suboccipital approaches in a lying position, when used correctly, provide a good view of the operating field with the minimal risk of complications associated with the patient's position on the operating table.

[Cardiac arrest after induction of anesthesia in neurosurgical patients].

The paper reports two clinical cases observed with a time lag of four years. In both cases, there were severe clinical symptoms of intracranial hypertension before the surgery. Prompt full-scale resuscitation was required in both cases due to asystole that developed immediately after induction of anesthesia and tracheal intubation. In one case, cardiac activity was successfully recovered by complex resuscitation with the emergency drainage of the cerebral ventricles. The possible causes of complications and preventive measures were discussed.

[The successful treatment of a patient with Lhermitte--Duclos disease (A case report and literature rewiew)].

INTRODUCTION: Lhermitte--Duclos disease is a rare autosomal dominant inherited disorder characterized by the loss of the normal cerebellar cortex architecture and hamartoma formation in the cerebellar hemispheres. Most commonly, this disease manifests in the third and fourth decades of life. Approximately 220 cases of Lhermitte--Duclos disease have been reported in medical literature to date. MATERIAL AND METHODS: The authors describe successful two-stage surgical treatment of a young female patient with Lhermitte--Ducos disease. CONCLUSION: This case report familiarizes practitioners with the clinical manifestations and neuroimaging features of Lhermitte--Duclos disease that facilitates timely diagnosis and proper treatment of the condition.

[Cerebrovenous orthostatic reactivity in pathology of the craniovertebral junction (Chiari malformation)].

AIM: Chiari malformation is characterized by herniation of the cerebellar tonsils into the foramen magnum, which leads to disturbance of CSF circulation through the craniovertebral junction. Orthostatic stress, which leads to the movement of SCF through the craniovertebral junction, is an adequate method to detect these disorders. It is accompanied by changes in the intracranial pressure, affecting the cerebrovenous orthostatic reactivity (CVOR), which is noninvasively assessed in patients with Chiari malformation. MATERIAL AND METHODS: The study involved 35 patients with Chiari malformation (26 patients with Chiari I and 9 patients with Chiari II) aged 4 to 58 years (of them 12 males). Hydrocephalus was diagnosed in 4 examined patients and myelosyringosis was diagnosed in 6 patients. Transcranial Doppler sonography was used to record the venous blood flow in the tentorial sinus of the brain while changing body position on the fracture table from +90° to -30°. RESULTS: There is significant CVOR abnormality in most patients with Chiari malformation (more than 90%), which is characterized by either increased CVOR (sometimes 5-6-fold compared to the upper normal level (considerable hyperreactivity) or complete absence of any changes during the orthostatic load (areactivity). Before surgical treatment, CVOR of patients with Chiari malformation is often characterized by areactivity, as well as a moderate or significant hyperreactivity. After surgical treatment (decompression of the foramen magnum), patients with Chiari malformation demonstrate significant normalization of the craniovertebral volumetric ratios and CVOR if often characterized by normoreactivity (in 63%) or, more rarely, moderate hyperreactivity. The rate of venous blood flow in the tentorial sinus of the brain in patients with Chiari malformation can be increased before the surgery and normalizes after surgery. CONCLUSION: The high incidence of disturbance of CVOR (over 90%) in patients with Chiari malformation was revealed. After surgical treatment, complete normalization of CVOR was observed in more than half of these patients (63%).

[Surgical treatment of trigeminal neuralgia in patients with multiple sclerosis]. / Khirurgicheskoe lechenie nevralgii troinichnogo nerva pri rasseiannom skleroze.

OBJECTIVE: Trigeminal neuralgia occurs in 1-7% patients with multiple sclerosis (MS). We assessed the efficacy of microvascular decompression of the trigeminal nerve in MS patients. MATERIAL AND METHODS: We studied MS patients with trigeminal neuralgia who underwent microvascular decompression of the trigeminal nerve. Results and сonclusion. The superior cerebellar artery was compressed in 5 patients, the vein in 1. At the follow up of 3-5 years, no relapses of trigeminal pain syndrome were observed after the successful surgery. There were no complications of surgical treatment. Indications to this treatment should be made on the basis of MRI.