[Short-lasting tentorial herniation may cause cortical blindness. A case report and systematic literature review]. / Neprodolzhitel'noe tentorial'noe vklinenie mozhet vyzyvat' korkovuyu slepotu. Sluchai iz praktiki i sistematicheskii obzor literatury.

INTRODUCTION: Cortical blindness occurs with bilateral damage to the visual cortex. It can be caused by various reasons, including the posterior cerebral arteries stroke due to the tentorial herniation. MATERIAL AND METHODS: A case of a 40-year-old patient with a large right-sided sphenoidal meningioma. A systematic review on the problem of cortical blindness after tentorial herniation according to the PRISMA guideline. RESULTS: Subtotal removal of dense meningioma. At night after the operation, there was an acute headache, then a coma. Immediately dehydration therapy, tracheal intubation, mechanical ventilation. CT scan showed a small hemorrhage in the tumor bed and subarachnoid space, brain edema and dislocation. After 53 minutes, ventricular drainage was installed, intracranial pressure was normal and ranged from 6 to 14 mmHg. After sedation withdrawal, cortical blindness was detected, which did not regress for 1.5 years. There are no other neurological symptoms, the patient walks, serves herself. Radiation therapy in a total of 54 Gy for the remainder of the grade 1 meningioma ensured tumor control. DISCUSSION: The time window for restoration of the cerebral blood flow, according to the European Stroke Organization guidelines, is 4.5 hours. In this case, compression of the posterior cerebral arteries lasted less than 53 minutes, however, irreversible ischemia developed in their territory; the outcome on the modified Rankine scale was 4 points. Similar cases are not described in the literature. CONCLUSION: Patients should be warned about even the non-obvious risks of neurosurgical intervention, since even timely measures taken do not always avoid complications.

[Convexity hyperostotic meningioma en plaque: a systematic review]. / Ploskostnye giperostoticheskie meningiomy svoda cherepa. Sistematicheskii obzor literatury.

BACKGROUND: Planar hyperostotic meningiomas account for 2-9% of intracranial meningiomas. They are characterized by planar node following the contours of the inner surface of the skull. Hyperostosis is present in most cases. Timely diagnosis of skull base tumors is usually simple due to early involvement of the cranial nerves. However, convexity meningiomas en plaque usually reach large dimensions that complicates surgery and radiotherapy. OBJECTIVE: To analyze the current state of diagnosis, molecular biology and surgical treatment of hyperostotic meningiomas en plaque. MATERIAL AND METHODS: A systematic review was performed in accordance with the PRISMA guidelines. Searching for literature data included the following keywords: «planar meningioma¼, «hyperostotic meningioma¼, «meningioma en plaque¼, «infiltrative meningioma¼. We reviewed the PubMed and Google Scholar databases until May 2023 and enrolled only full-text Russian-, English- or French-language reports. RESULTS AND DISCUSSION: Among primary 332 reports, 35 references met the inclusion criteria. We found less severity or absence of focal neurological symptoms, comparable incidence of intracranial hypertension and no histological differences between planar and nodular meningiomas. Analysis of molecular biological features of planar meningiomas, including cell cultures, is feasible. There is no consensus regarding surgical treatment and radiotherapy. Most publications are case reports. CONCLUSION: The results of treatment of planar hyperostotic meningiomas, especially large and giant ones, are unsatisfactory. There is no a generally accepted algorithm for treating patients in the literature. This problem requires further research.

[Comparison of methods of treatment of meningiomas invading the superior sagittal sinus]. / Sravnitel'naya otsenka metodov lecheniya meningiom, invaziruyushchikh verkhnii sagittal'nyi sinus.

There are various approaches to the treatment of patients with parasagittal meningiomas. OBJECTIVE: To optimize treatment strategy for meningiomas invading the superior sagittal sinus. MATERIAL AND METHODS: The study included 87 patients with benign parasagittal meningiomas between 2010 and 2012. Of these, 34 patients underwent surgery alone, 27 - radiotherapy, 26 - surgery and subsequent radiotherapy. Both groups were comparable in male-to-female ratio, age and localization of tumors in relation to superior sagittal sinus. The follow-up period was at least 5 years. We analyzed the effect of treatment on neurological status, Karnofsky score and tumor growth control. RESULTS: Mean volume of tumors was 43.3 cm3 in patients undergoing surgery and 6.7 cm3 in the radiotherapy group. In the combined treatment group, mean volume was 65.8 cm3 before surgery and 8.8 cm3 before irradiation. General cerebral symptoms (84%), epileptic seizures (37%) and movement disorders (31%) prevailed. Surgery provided the best results in patients with small meningiomas (<14 cm3) causing focal neurological symptoms. Isolated radiotherapy was the most effective in asymptomatic patients. Large tumors required surgery with adjuvant irradiation. CONCLUSION: Benign parasagittal meningiomas followed by focal neurological symptoms require surgical intervention regarding the best functional outcomes and tumor growth control. Radiotherapy without surgery is advisable for progressive asymptomatic tumors. Resection followed by irradiation is preferable if total resection without the risk of damage to veins and cortex is impossible.

[New classification and approaches to the treatment of schwannomatosis]. / Novaya klassifikatsiya i podkhody k terapii shvannomatozov.

Schwannomatoses is a new classification unit for all the hereditary diseases caused by chromosome 22 damage followed by multiple benign neoplasms of the peripheral and central nervous system. Schwannomatosis occurs as a result of damage to different genes: NF2, SMARCB1, LZRT1, loss of heterozygosity of the long arm of chromosome 22. Nevertheless, clinical manifestations are similar. Molecular diagnostics not only confirms the diagnosis, but also predicts the course of disease. Thus, the most severe clinical manifestations are observed in patients with violation of semantic sequences and reading frame shift in exons 2-13 of the NF2 gene. A more favorable course with less number of tumors is observed in patients with somatic mosaicism. Stereotactic irradiation and surgery are the main treatment options for schwannomatosis. However, there is evidence of effective targeted therapy with bevacizumab (inhibitor of vascular endothelial growth factor). Bevacizumab is used in patients with bilateral vestibular schwannomas and high risk of hearing loss, as well as for intramedullary tumor growth control.

[Bone defect closure after resection of sphenoorbital meningioma]. / Rekonstruktsiya kostnykh defektov posle udaleniya kranioorbital'nykh meningiom.

Sphenoorbital meningiomas (SOM) are a subgroup of skull base tumors with soft tissue component in the orbit and anterior and/or middle cranial fossa. According to different authors, SOMs account for 2-12% of all intracranial meningiomas. Reconstruction of bone defects after resection of SOM has own nuances. Along with cranial vault repair, patients encounter with cosmetic defects following facial skull lesion, ophthalmic symptoms due to orbital defects, dental and functional problems associated with opening of the mouth in case of damage to maxilla and mandible. Predominant infiltrative growth of tumor and common large bone defects involving various anatomical regions require multiple implants or implants with complex shape. Moreover, contact of implantation area with nasal cavity and paranasal sinuses requires additional impermeability of soft tissue reconstruction and inertness of materials. OBJECTIVE: To summarize available modern data on bone defect closure after resection of SOM. MATERIAL AND METHODS: The authors reviewed available data on bone defect closure after resection of SOM. Effectiveness of modern methods of reconstruction and safety of materials were assessed. RESULTS: We analyzed 96 available references. Technical features of tumor resection, materials used for bone defect closure and modern possibilities of 3D technologies in reconstructive surgery were described. The authors proposed the algorithms for selecting the materials for bone defect closure after resection of SOM. CONCLUSION: Improvement of surgical technique and development of new materials and technologies significantly improve cosmetic and functional results. A large percentage of negative ophthalmologic outcomes and high risk of complications in SOM surgery require further studies and elaboration of modern techniques.

[Dural defect closure after resection of cranioorbital meningiomas]. / Rekonstruktsiya defektov tverdoi mozgovoi obolochki posle udaleniya kranioorbital'nykh meningiom.

Dural defect closure after resection of cranioorbital meningiomas has its own specifics. Extended malignant lesions and common large bone defects involving various anatomical regions require multiple implants or implants with complex geometry. The features of this stage of reconstruction were described in the previous issue of the Burdenko Journal of Neurosurgery. At the same time, contact of implant with nasal cavity and paranasal sinuses dictates additional requirements for tightness of soft tissue reconstruction and inertness of material. In this review, we describe modern and historically interesting methods of reconstruction of soft tissue defects following resection of cranioorbital meningioma. OBJECTIVE: To summarize and analyze available literature data on reconstruction of soft tissue defects following resection of cranioorbital meningioma. MATERIAL AND METHODS: The authors reviewed available data on reconstruction of soft tissue defects after resection of cranioorbital meningiomas. Effectiveness of reconstruction techniques and safety of materials were analyzed. RESULTS: The authors analyzed 42 available full-text articles. Features of growth and natural course of cranioorbital meningioma, methods of soft tissue defects closure, modern materials and sealing compositions are described. Considering these data, the authors proposed the algorithms for selecting materials for dural reconstruction after resection of cranioorbital meningioma. CONCLUSION: Improvement of surgical technique, development of new materials and technologies increase the efficiency and safety of dural defect closure. Nevertheless, high incidence of complications associated with dura mater repair necessitates further research in this area.

[Perifocal edema and glymphatic system dysfunction: quantitative assessment based on diffusion tensor magnetic resonance imaging]. / Peritumoroznyi otek i disfunktsiya glimfaticheskoi sistemy golovnogo mozga: kolichestvennaya otsenka na osnove diffuzionno-tenzornoi MRT.

BACKGROUND: Pathogenesis of peritumoral cerebral edema is unclear and potentially associated with glymphatic system dysfunction. Diffusion tensor MRI (DT-MRI) with analysis of ALPS (Analysis along the Perivascular Space) index may be valuable for assessment of edema. This approach visualizes fluid flow along perivascular spaces of deep cerebral veins. OBJECTIVE: To assess glymphatic system function in supratentorial tumors and healthy volunteers using DT-MRI. MATERIAL AND METHODS: There were 52 patients (59% men) aged 43 (28-64) years with supratentorial tumors (meningioma - 20, grade 3-4 glioma - 15, metastases - 9, lymphoma - 8). Tumors and perifocal edema did not involve deep cerebral veins. The control group included 6 healthy volunteers aged 34-66 years. MRI protocol (Signa HDxt, 3 T) contained standard T1, T2, T2FLAIR, DWI and post-contrast T1 (3D BRAVO). DT-MRI had the following parameters: TR=10 000 ms, TEmin=102 ms, FOV=240 mm, isotropic voxel size 3×3×3 mm3, 60 directions of diffusion gradients. Measurements were carried out at b-factor 0 and 1000 s/mm2. Analysis was carried out in the ReadyView software. RESULTS: Right- and left-sided ALPS indices were similar in the control group (p=0.917). Perifocal edema (regardless of histological type of tumor) in the ipsilateral hemisphere was accompanied by significantly lower ALPS index (p<0.005), while these values in contralateral (intact) hemisphere were similar in both groups (p=0.7). CONCLUSION: We found significantly lower ALPS index in deep parts of the affected hemisphere in patients with perifocal edema. These data can indicate the role of glymphatic system dysfunction in pathogenesis of this pathology.

[Factors influencing peritumoral edema in meningiomas: CT- and MRI-based quantitative assessment]. / Peritumoroznyi otek pri meningiomakh i faktory, vliyayushchie na ego formirovanie: kolichestvennaya otsenka na osnove KT i MRT.

Background. Meningiomas may be accompanied by peritumoral edema. Incidence and pathogenesis of edema are nor clearly established. Prevalence and severity of edema vary significantly in patients with meningiomas similar in various parameters. OBJECTIVE: To assess peritumoral edema in intracranial meningiomas and factors influencing incidence and severity of this process. MATERIAL AND METHODS: There were 126 patients (69% women) aged 19-76 years (median 53), who were diagnosed with 142 meningiomas. Patients underwent surgery (n=111) and radiotherapy (n=15) in 2016-2018. The MRI protocol included T1, T2, T2-FLAIR, DWI and post-contrast T1-weighted images in three projections, diffusion tensor MRI in 27 cases and MR spectroscopy in 21 patients. RESULTS: Peritumoral edema was detected in 46% (n=66) of cases including 21 (31%) patients with severe edema. The ALPS index was 1.510±0.1931 in meningiomas without edema and 1.308±0.19 in those with edema (p=0.014). There was positive correlation between edema, dimensions and uneven contours of meningioma, as well as negative correlation with CSF cleft sign. Blood flow velocity was higher in atypical and anaplastic meningiomas with edema (p=0.03). Other signs (localization, histological variant, malignancy grade, characteristics of MR signal, peaks of the main metabolites, diffusion and perfusion parameters of tumor) did not significantly affect peritumoral edema in patients with meningiomas (p>0.05). CONCLUSION: Diffusion tensor tomography with ALPS index revealed significant effect of glymphatic system dysfunction on peritumoral edema. Large meningioma with uneven contours increased the risk of peritumoral edema, while CSF cleft sign reduced this risk. Other factors did not affect cerebral edema in meningiomas.

Evaluation of the influence of the analytical characteristics of the microbiological blood study in bacteremia in a multidisciplinary hospital.

The culture method continues to be the "gold" standard for microbiological diagnosis of bloodstream infections. This is primarily due to the fact that the definition of the etiology of a generalized infectious process determines the etiotropic antibiotic therapy. To do this, it is necessary to conduct periodic microbiological monitoring of the prevailing microflora. To do this, in the present study, a retrospective analysis of the results of a microbiological blood test for sterility was performed in case of suspected bloodstream infections in a multidisciplinary hospital to assess the influence of analytical stage factors on the laboratory data obtained. Automatic hematological cultivators were used, identification was carried out based on the biochemical characteristics of microorganisms, as well as using time-of-flight mass spectrometry with matrix-activated laser desorption / ionization (MALDI-TOF MS). More than 10,000 research results were analyzed, the average microflora seeding rate was 15.1%. The analysis of the isolated microflora was carried out in 2 groups of positive results: at the beginning, the data obtained in the presence of growth in two vials at once were evaluated, then the positive results of blood cultures obtained in any one vial from a pair were studied. The predominance of gram-positive flora in the structure of microorganisms isolated from whole blood was revealed, the influence of cultivation conditions and the composition of thenutrient medium on the isolated flora was not found, however, a number of microorganisms, due to the specific characteristics of metabolism, were characterized by growth under strictly defined cultivation conditions. The presented study actualizes the need for constant microbiological monitoring in order to determine the prevailing hospital microflora, which can contribute to a timely response in order to limit the spread of highly virulent, aggressive, resistant strains of microorganisms leading to the development of generalized bloodstream infections.

[Changes in treatment paradigm for neurosurgical patients in the era of stereotactic irradiation. By the 15th anniversary of the Neuroradiosurgery in Russia]. / Izmenenie paradigmy lecheniya neirokhirurgicheskikh patsientov v epokhu stereotaksicheskogo oblucheniya. K 15-letiyu neiroradiokhirurgii v Rossii.

INTRODUCTION: Stereotactic method and new irradiation techniques ensured radiosurgical treatment with high precision and conformity and significantly expanded the indications for stereotactic irradiation in neurosurgery. MATERIAL AND METHODS: Over 15-year period, 29 976 patients underwent irradiation in various modes of fractionation on linear accelerators and Gamma Knife system at the first national radiosurgery center. RESULTS: Stereotactic radiotherapy and radiosurgery are followed by minimal number of complications and side reactions. At the same time, 5-year control of tumor growth for skull base meningioma was 96.8%, neuroma - 97%, glomus tumor - 94%, pituitary adenoma - 96-98%, craniopharyngioma - 95% in overall 10-year survival 86%, pilocytic astrocytoma - 97.5% in overall 5-year survival 99%. In intracranial metastases, median overall survival after radiosurgery was 10.1 months, 24- and 36-month overall survival - 25.9% and 19.2%, respectively. In patients with recurrent high-grade glioma, overall survival was 27.4 months. In case of metastatic spine lesions, control of tumor growth within 1 year was achieved in 90% of patients, pain relief - in more than 50% of cases. Obliteration of AVM and dural fistula was found in more than 80% of patients in years after treatment. Reduction or disappearance of pain was also observed in 80% of patients with trigeminal neuralgia. CONCLUSION: Stereotactic irradiation is effective and safe in patients with various pathologies of the central nervous system and characterized by high socio-economic indicators. Our own data indicate more significant role of stereotactic irradiation in the treatment of neurosurgical patients and make it possible to revise the existing treatment standards.

[Brainstem arachnoid cyst: case report and review]. / Arakhnoidal'naya kista stvola mozga: opisanie klinicheskogo sluchaya i obzor literatury.

There are no literature data on brainstem arachnoid cysts in humans. OBJECTIVE: To describe the clinical case of brainstem (pontomesencephalic) arachnoid cyst and to analyze classification, pathogenesis, differential diagnosis and treatment of this pathology considering literature data and own experience. MATERIAL AND METHODS: A 29-year-old patient with pontomesencephalic arachnoid cyst is reported. The disease manifested in childhood with a headache aggravated by bending and pushing. Later, syncope, vegetative-visceral paroxysms, mild oculomotor disturbances, transient paresthesia and numbness of the left half of the face occurred. Headaches became significantly more severe and resulted nausea and vomiting. Magnetic resonance imaging (MRI) revealed a two-chambered arachnoid cyst. A smaller chamber was localized in interpeduncular cistern, a larger one - in brainstem. RESULTS AND DISCUSSION: Differential diagnosis included cystic glioma and Virchow-Robin space enlargement. Fenestration of the cyst wall within interpeduncular cistern was performed via right-sided pterional approach. The diagnosis was verified by histological examination. The follow-up period was 14 months. We observed postoperative cyst reduction confirmed by MR data and regression of all symptoms except for minimal signs of medial longitudinal fasciculus dysfunction. CONCLUSION: Correct surgical approach for brainstem arachnoid cyst complicated by progressive neurological deterioration is confirmed by postoperative regression of cyst and symptoms.

Newborns from women infected with COVID-19: somatic and metabolic status.

To date, there are limited data regarding manifestations of new coronavirus infection in infants born of SARS-CoV-2 infected mothers, so the aim of this study is to investigate somatic and metabolic status of newborn infants born to mothers diagnosed with COVID-19. The investigation was carried out on the bases of Laboratory Diagnostic Department of Samara Regional Clinical Hospital named after V.D. Seredavin and the Department of Fundamental and Clinical Biochemistry with Laboratory Diagnostics of Samara State Medical University. Under observation were 85 newborns, including 35 born of healthy mothers and 50 born of COVID-19 mothers.The somatic status of all newborns was assessed using the Apgar scale at the 1st and 5th minutes after birth. Also all newborns had general and biochemical blood tests and newborns from mothers with COVID-19 were tested for the presence of SARS-CoV-2 RNA in oral and nasopharyngeal swabs. Thus, the study of somatic status revealed that of 50 neonates from women infected with COVID-19, only 18% were practically healthy, the rest had signs of prematurity, hypotrophy, perinatal CNS damage, diabetic fetopathy, pulmonary atelectasis, delayed intrauterine development, asphyxia. The metabolic state is characterised by decreased haemoglobin and platelets, increased concentration of total protein, including C-reactive protein, high transaminase activity, decreased sodium and chloride content. These parameters of general and biochemical blood tests can be considered as indicators for the evaluation of the condition of newborns from mothers with COVID-19.

[Glioblastoma in the region of previously resected meningioma. Case report and literature review]. / Glioblastoma, voznikshaya v oblasti udalennoi meningiomy. Klinicheskoe nablyudenie i obzor literatury.

Combination of meningioma and glioblastoma within the same anatomical region is casuistry. We found only 13 case reports in the available literature. Some of the authors reported induced nature of the second tumor, i.e. development under the influence of the primary neoplasm. We report a patient with glioblastoma of the right frontoparietotemporal region in 3 years after previous resection of benign right-sided meningioma of sphenoid wings. Mathematical analysis of the discovered pattern resulted conclusion about its random nature, i.e. no causal relationship between both neoplasms.

[Radiation-induced meningiomas: analysis of 33 cases]. / Radioindutsirovannye meningiomy: analiz 33 nablyudenii.

BACKGROUND: Development of meningiomas correlating with irradiation has been described in the last century. Different biological features of radiation-induced meningiomas depending on dose and type of irradiation have been observed in recent years. MATERIAL AND METHODS: There were 8848 patients (women - 74.3%) with intracranial meningiomas for the period from 2000 to 2014 who underwent surgery at the Burdenko Neurosurgical Center. Radiation-induced meningiomas were identified in 33 patients (13 (38%) men and 20 (62%) women) aged 16-76 years (median 56 years). Medical data were retrospectively analyzed. Follow-up period ranged from 5 to 22 years (median 12) after verification of histological diagnosis. Meningiomas were preceded by X-ray irradiation of the scalp for ringworm (microsporia or trichophytosis) in 26 cases (79%) (group A). Group B enrolled 7 (21%) patients after previous radiotherapy for other tumors (retinoblastoma, chiasmal glioma, pituitary adenoma, basalioma). Data were compared using Mann-Whitney and Fisher's exact tests. RESULTS AND DISCUSSION: Incidence of radiation-induced meningiomas was 0.37% in our sample. Meningioma diagnosis dates after X-ray epilation (median 52 years) significantly differed from that after radiotherapy (median 22 years) (Mann-Whitney test, p=0.0003). Primary multiple meningiomas were diagnosed only in the 1st group (Fisher's exact test, p=0.0005). Recurrent meningiomas after the first surgery were more common in the first group (58%) compared to the second one (14%) (Mann-Whitney test, p=0.0003). CONCLUSIONS: The latency period is shorter after radiotherapy (median 22 years compared to 52 years after X-ray epilation). Incidence of atypical and malignant meningiomas directly correlates with irradiation dose. Approximately equal incidence of radiation-induced meningiomas after X-ray epilation in women and men can indicate other mechanisms of development of these tumors in comparison with spontaneous ones. Radiotherapy is followed by occurrence of meningiomas within the irradiated area. These tumors are usually single. In case of X-ray epilation, the tumors may be localized anywhere within the intracranial space (convexital and/or parasagittal localization in 77% of cases). Multiple neoplasms occur in 42% of cases. Refusal of head X-ray epilation for the treatment of a ringworm for the last 50 years may be followed by reduced incidence of radiation-induced meningiomas, especially multiple ones. However, extended indications for radiotherapy of various brain diseases can result an increase of the incidence of meningiomas within the irradiated area.

[Mycobacterium abscessus complex representatives in patients with bronchopulmonary pathology: prevalence, peculiarities of cultivation and identification.]

More and more publications appear in the modern literature on the increase in the prevalence of non-tuberculous mycobacteria (NTMs), in particular, representatives of M. chelonae / Mycobacterium abscessus complex (MABSc). The paper presents data on the current classification of M. chelonae / Mycobacterium abscessus complex and its main representatives. The main data on the possible sources and ways of infection of MABSc patients in hospital are presented. The main features of cultivation on various nutrient media and their possible identification using modern methods are also indicated. The main risk factors for the development of mycobacteriosis in patients and the possible clinical picture are described. The prevalence of MABSc representatives in the structure of non-tuberculous mycobacteria isolated from clinical material from 483 patients from the Samara region was assessed for examination for tuberculosis, and the prevalence from 933 patients with cystic fibrosis (CF) from 55 regions of the Russian Federation from 2016 to 2019 was estimated. In total, as a result of the study, 316 NTM strains (65.4%) were isolated and identified in the first group of patients. M.abscessus was isolated and identified 10 strains and 5 strains - M.chelonae, which amounted to 3.2% and 1.6%, respectively, of all NTMs. In general, MABSc representatives were isolated in 3.1% of the examined patients. As a result of a screening study of patients with CF, 14194 microorganism strains from 933 patients were isolated and identified. Altogether M. abscessus was isolated and confirmed from 14 patients of different ages. Thus, the prevalence of MABSc among the examined patients with CF in the Russian Federation was 1.5%.

[The structure of conditionally pathogenic microflora, isolated from the urogenital tract of women with pathological course of pregnancy.]

The structure of the microflora of the urogenital tract of a woman is variable and diverse, changing its qualitative and quantitative composition can affect various physiological processes in the body of a woman, including the course of pregnancy. In this study, the results of cultures of 1415 samples of urine and cervical canal discharge of pregnant women were analyzed. Species identification was carried out by MALDI-ToF mass spectrometry using Microflex LT (Bruker) mass spectrometer. Gram-positive bacteria (69.5%) dominated the structure of the cervical canal microflora, among which Staphylococcus spp prevailed., Enterococcus spp. and Lactobacillus spp. Among gram-negative bacteria most often encountered microorganisms of the order Enterobacteriales, the predominant species among which was E. coli. Also, yeast-like fungi were isolated from the material of the cervical canal, their number was 11% of the total number of crops. Qualitative microbiological composition of urine was represented by gram-positive flora (68.7%), gram-negative flora (30.1%) and Candida fungi (1.2%). There is a significant predominance of coagulase-negative staphylococci (97.3%) over coagulase-positive (2.7%) in the structure of gram-positive microorganisms. The composition of gram-negative flora is mainly represented by bacteria of the order Enterobacteriales (71.4%). The study identified microorganisms that can cause postpartum complications and the development of inflammatory diseases of the newborn, which suggests the need for regular microbiological examination for pregnant women.

[The orbitozygomatic approach. History, technique, and modifications]. / Orbitozigomaticheskii dostup. Istoriia, tekhnika, modifikatsii.

The orbitozygomatic approach (OZA) has been used in neurosurgical practice since the 1980s. Many approach modifications have been proposed; anatomical and clinical developments have been conducted in many clinics. However, there is no algorithm for choosing an approach option, depending on the type and topographo-anatomical features of pathology. MATERIAL AND METHODS: We searched for publications in the PubMed and Medscape databases using the keywords 'orbitozygomatic'. RESULTS: A total of 447 publications matching the search terms were found. In most of them, the approach was either not actually orbitozygomatic or was mentioned in the description of a clinical case. One hundred and nineteen full text Russian or English papers were available for detailed analysis. Of these, we selected 72 most relevant publications. DISCUSSION: There were no studies demonstrating disadvantages of the OZA compared to traditional craniotomies. Orbitozygomatic approaches are widely used in routine neurosurgical practice. Existing approaches are not without disadvantages. The publications are based on small material. The recommendations on choosing the optimal OZA option are based on the authors' opinion, i.e. they satisfy the minimum level of evidence. There are no studies comparing the efficacy of OZA options in different types and topographo-anatomical variants of neurosurgical pathology of the anterior and middle skull base. CONCLUSION: The reasonability of using the orbitozygomatic approach in neurosurgical practice is obvious. There are a large number of orbitozygomatic approaches and their modifications. The modern literature lacks an algorithm for choosing the optimal OZA option for specific types and topographo-anatomical variants of the pathological process.

[Comprehensive treatment of patients with parasagittal meningiomas]. / Kompleksnoe lechenie bol'nykh s parasagittal'nymi meningiomami.

For many years, radical surgery was considered the only effective method for treating meningiomas, including parasagittal meningiomas (PSM). However, accumulated experience makes it evident that extensive resections in the parasagittal region lead to impaired venous outflow and involve high rates of disability and mortality. In recent decades, stereotactic radiotherapy has been developed and widely implemented in practical neurosurgery, its role in the treatment of PSM patients is discussed in this work. MATERIAL AND METHODS: A sample of publications in the PubMed search system was taken using the following keywords: meningioma, parasagittal, superior sagittal sinus, stereotactic radiosurgery, stereotactic radiation therapy. No publications of evidence levels 1 and 2 have been found. Out of 123 works, 32 most relevant were selected. RESULTS AND DISCUSSION: Currently, both neurosurgeons and radiologists are involved in the treatment of PSM. An analytical review of the literature on the treatment of PSM is presented. Both surgical treatment and radiation therapy have their pros and cons. No general approach to the treatment of these tumours has been developed to date. A comprehensive treatment is considered to be effective - the maximum possible removal of the tumor without damaging functionally significant structures, including venous outflow pathways, followed by radiotherapy for tumor residues. CONCLUSION: In the existing literature, it was not possible to identify a single decision-making algorithm for the tactics of multimodality therapy for PSM patients, including the one for manipulations on the superior sagittal sinus and with regard to the role of ir irradiation radiation methods.

[Results of surgical treatment of skull-base primary malignant tumors with intracranial invasion]. / Rezul'taty khirurgicheskogo lecheniia pervichnykh zlokachestvennykh opukholei osnovaniia cherepa s intrakranial'nym rasprostraneniem.

OBJECTIVE: Analysis of factors affecting life expectancy at patients with primary malignant tumors of anterior and middle parts of the skull base with intracranial invasion. MATERIAL AND METHODS: 139 patients (47 women and 92 men) with primary malignant tumors of the anterior and middle parts of the skull base with intracranial invasion (stage T4 according to TNM classification or stage C according to Kadish classification for estesioneuroblast ) were treated at the NMRCN Burdenko for the period from 2004 till 2018. The study was conducted by the method of total sampling. The observations are divided into 2 groups: primarily operated (group I) and repeatedly operated (group II). RESULTS: The average age in both groups was 50 years. In most (64.7%) cases, the tumor affected the medial sections of the base of anterior and middle cranial fossae, and in 35.3% of cases it was localized laterally. All tumors were classified to T4 stage according to TNM classification or (9 olfactory neuroblastomas) to stage C according to Kadish classification. DISCUSSION: The impact on life expectancy was largely provided by postoperative radiation therapy, the repeated nature of operation, and the presence of brain infiltration. In the total cohort of patients 5-year OS, 5-year RVS, 5-year-old IDF and 5-year LC were 50.7, 35, 54.2 and 36.4%, respectively. In group I, the medians OS and IDF were equal and amounted to 138.3 months. The median RVS was 43.8 months. 5-year OS equal to 63.6%, 5-year RVS - 40.8%, 5-year-IDF - 64.8%, 5-year LC was up to 65.7%. The survival rate in the analyzed cohort for 1, 2, 3 years was 81.4, 71.8 and 67.8%, respectively. In group II, the treatment results for the group of repeatedly treated patients were significantly worse. There were no cases of 5-year survival. The 1-, 2-, and 3-year survival rates were 59.3, 50.8 and 31.8%, respectively. The median OS was 27.1 months, IDF was 27.1 months, RVS was 18.2 months, and LC was 9.1 months. CONCLUSION: The results and analysis of literature justify the feasibility of surgical treatment of patients with malignant tumors of craniofacial localization at T4 stage. The purpose of surgical intervention should be: elimination of the immediate threat to the patient's life due to edema and dislocation of the brain; the maximum possible removal of tumor tissue (cytoreduction); if possible, the elimination of the most significant symptoms for the patient (pain, nasal breathing disorders, cosmetic defect). If there are special reserves, it is obligatory to include radiation and chemotherapy in the treatment process.

[Diagnostic possibilities of modern biochemical study of sputum from patients with cystic fibrosis (literature review).]

The review presents the pathobiochemical and molecular mechanisms of sputum formation in patients with cystic fibrosis associated with the pathophysiological features of the disease. Statistical data on the prevalence of this pathology in the world and in the Russian Federation are presented. The mechanisms of sputum formation and disorders of the mucociliary apparatus, leading to the accumulation of viscous bronchopulmonary secret in cystic fibrosis, are considered. The principles of the relationship between the rheological properties of sputum and the formation of inflammation in the lungs with the addition of a concomitant specific microflora in the bronchopulmonary system in patients with cystic fibrosis are presented. Describes the opportunities for biochemical studies of sputum of patients with this pathology: determining the activity of enzymes (myeloperoxidase), the content of proteinase inhibitors (α2-macroglobulin and α1-antitrypsin) and proinflammatory cytokines (IL-8 and TNFa), concentrations of iron and ferriferous proteins (lactoferrin and ferritin), which makes biochemical studies of sputum available, non-invasive, quick and cost-effective method of diagnosis, which can be widely used as an auxiliary laboratory method and makes it possible to use these metabolites as diagnostic markers to assess the severity of inflammation and infection of the lower respiratory tract and predict the development of respiratory complications in patients with cystic fibrosis.