[Recurrent petrosal tumor: meningioma or solitary fibrous tumor?] / Retsidivnaya petrozal'naya opukhol': meningioma ili solitarnaya fibroznaya opukhol'?

Intracranial meningeal solitary fibrous tumors (SFT) originating from mesenchymal tissue are much less common than those with lesions of the visceral pleura or liver and were isolated as a nosological form only in 1996. These tumors are identical in clinical manifestations, MRI and light microscopy data to meningiomas. The pathognomonic difference of SFT, according to the 5th edition of the WHO classification, is the detection of overexpression of the protein encoded by the STAT6 gene. Estimation of other immunohistochemical markers is variable. At the same time, SFT has a tendency to more frequent recurrence and delayed malignancy. Transitional forms are possible. To form a clearer nosological outline of the SFT, it is necessary to accumulate clinical observations. A case of a giant meningioma of the posterior cranial fossa, which recurred 18 years after total removal at a 5-year annual control, is presented. Light microscopy of both primary and recurrent tumors revealed fibrous meningioma (WHO GI). Immunohistochemically revealed diffuse overexpression of CD34 and CD99. Determining the expression of the STAT6 protein was not technically possible. This case is regarded as a meningioma of the posterior surface of the pyramid of the temporal bone, growing into the cavity of the IV ventricle, with late recurrence without malignancy, with specific immunohistochemical profile.

[Giant petrosal meningioma invading the fourth ventricle: total removal of a recurrent tumor after eighteen years. Neurosurgical nuances. Case report and literature review]. / Gigantskaya meningioma zadnei poverkhnosti piramidy visochnoi kosti s porazheniem IV zheludochka: total'noe udalenie retsidiviruyushchei opukholi cherez 18 let. Neirokhirurgicheskie nyuansy. Sluchai iz praktiki i obzor literatury.

The authors present a patient and neurosurgical nuances of total resection of recurrent meningioma of posterior surface of petrous bone 65´35´30 mm. The tumor captured two critical zones of posterior cranial fossa with unusual frontal growth and spread from the surface of petrous bone to the fourth ventricle. The neoplasm filled the ventricle without lesion of ependyma. Extensive fibrous meningioma of posterior surface of petrous bone was totally excised 18 years ago. MRI was annually carried out for 5 years. Surgical nuances that ensured total extraction of tumor without cytoreduction were as follows: 1) en-bloc resection of tumor from the fourth ventricle due to smooth surface of tumor and minimum number of adhesions with cerebellum; MR-confirmed CSF strip between the tumor edges and walls of the ventricle; no signs of hydrocephalus in subtotal ventricular tamponade; 2) unusual frontal tumor growth under 45º required appropriate angular traction of tumor with minimal rotation; 3) traction was followed by sequential appearance of 3 segments of tumor: petrous, apertural and ventricular; 4) topography of the area of lateral eversion of the fourth ventricle was established by identifying the narrowing (constriction) of tumor; 5) in extracting the tumor from the fourth ventricle, we performed minimal rotation to avoid damage to ventricular walls and lateral aperture due to difference between the larger and smaller diameters (by 6 mm) of ovoid ventricular segment of tumor; 6) no CSF leakage following appearance of ventricular segment (tumor enlargement) indicated integrity of ependyma of the fourth ventricle. Histological examination confirmed fibrous meningioma. Fast and complete regression of focal symptoms was observed after surgery. A 3-year follow-up after surgery revealed no signs of tumor recurrence.

[Surgical management of brain metastases following female reproductive system cancers: analysis of 37 cases]. / Opyt khirurgicheskogo lecheniya tserebral'nykh metastazov opukholei organov zhenskoi reproduktivnoi sistemy: analiz 37 sluchaev.

Background. Previously, treatment of women with brain metastases following reproductive system cancers was palliative and included whole brain radiotherapy. Currently, treatment approaches have changed and life expectancy has increased. Nevertheless, the role of surgical treatment in these patients is still discussed. OBJECTIVE: To demonstrate an appropriateness and role of neurosurgical care in the complex management of women with brain metastases following reproductive system cancers. MATERIAL AND METHODS: There were 78 women with brain metastases following reproductive system cancer. All patients were treated at the Blokhin National Cancer Medical Research Center for the period 2004-2019. We have also reviewed the literature data for the last 30 years.Results and discussion. Resection of brain metastases in complex treatment of endometrial, ovarian and cervical cancer ensured favorable long-term survival in our material. Thus, mean life expectancy after resection of brain metastases was 16.3 months in patients with ovarian cancer, uterine cancer - 15.6 months, cervical cancer - 10.25 months. Obviously, surgery is not indicated in all cases. However, this approach improves local control and should be used in combination with other treatment methods for improvement of life expectancy and its quality in certain patients. CONCLUSION: Selective surgical approach should be essential in the treatment of patients with brain metastases following reproductive system cancer. A multidisciplinary approach ensures the best treatment outcomes.

[Peculiarities of sporadic motor neuron disease associated with D90A and G12R mutations in Russian population]. / Osobennosti sporadicheskoi bolezni dvigatel'nogo neirona, assotsiirovannoi s mutatsiiami D90A i G12R, v rossiiskoi populiatsii.

Fifty-one blood samples of Russian patients with sporadic motor neuron disease were examined for mutations in Cu/Zn superoxide dismutase (SOD-1) gene. One female patient with amyotrophic lateral sclerosis (ALS) was heterozygous for G12R mutation. This patient suffered from ALS with cervical cord onset, pyramidal variant and fast progression. Mutation was also detected in her healthy son. Earlier, such mutation was described in 5 Italian patients with slow progressive ALS. Also, D90A SOD-1 gene associated haplotypes of the female ALS patients previously examined by the authors have been analyzed. A homozygous female patient with ALS was characterized by typical lumbar onset and extremely slow progression, as well as a female patient with heterozygous mutation and moderate progression carried so-called "Scandinavian" haplotype. To our knowledge, it is the first report on the finding of the haplotype considered as a "protective" one in the subjects heterozygous for D90A mutation with clinical symptoms of ALS. Mechanisms of "protective" influence of this haplotype on ALS course are not yet elucidated. Our finding suggests that the presence of "Scandinavian" haplotype does not completely protect from the disease development in patients exposed to other more pathogenic causative factors. This assumption is in line with modern conceptions on motor neuron disease as a complicated multifactor disorder.

[Association of homozygosity for short allele (S) of heavy neurofilament subunit gene with motor neuron disease and oxidative stress development]. / Assotsiatsiia gomozigotnosti po korotkomu alleliu (S) gena tiazhelykh neirofilamentov s bolezn'iu dvigatel'nogo neirona i razvitiem oksidantnogo stressa.

We analyzed distribution of heavy neurofilament (NF-H) gene S/L-polymorphic variants in 51 patients with idiopathic motor neuron disease (MND) vs control group and in relation to superoxide dismutases (SODs) activity and thiobarbituric acid reactive substances (TBARS) level in cerebrospinal fluid (CSF), erythrocytes and blood serum. We found that individuals with homozygosity for NF-H gene short allele (S/S-genotype carriers) in MND group predominate significantly over those in control one (p < 0.001). We revealed significant increase of oxidative markers in CSF and blood serum in MDN patients vs controls (p < 0.05), but not in patients with spondylogenic myelopathy, conforming non-specific role of oxidative stress in MND pathogenesis. There were no differences between TBARS level in CSF and serum in relation to the rate of MND progression, suggesting that oxidative stress does not influence the MND course. We showed normal SOD-1 activity in erythrocytes and CSF of MND patients that argued for the absence of these antioxidant enzymes deficiency in MND without SOD-1 gene mutations. We found significant association between homozygosity for short allele (S) and increased TBARS level in CSF (p < 0.02). These findings specify the role of NF-H with lower molecular weight in MND pathogenesis and make expedient antioxidants administration to MND patients homozygous for S-allele of NF-H gene.

[Prefrontal epilepsy]. / Prefrontal'naia épilepsiia.

Prefrontal epilepsy was considered as one variation of frontal-lobar epilepsy with prefrontal location of the focus. 14 verified cases were selected as the basis of the analysis of etiological factors, clinical peculiarities and possible pathogenetic mechanisms of epileptic fits in prefrontal epilepsy: generalized convulsive attacks, seizures of sudden fall, fits of stillness and pseudofits.

Operative spinal endoscopy: stereotopography and surgical possibilities.

The polyprojective microstereotopography of spinal canal structures at the cerebello-spinal, cervical, thoracic, lumbosacral and cauda equina levels on 20 fresh cadavers is presented using flexiscopes 3.7-3.9 mm diameter. This is possible due to the space between spinal cord-vertebral canal which is about 10 mm at all levels. This also allows one to insert the endoscopic tube by posterior or interradicular approach. The subdural and subarachnoid endoscopic examinations have been performed through small foraminotomic openings with resection of the base of the spinous process. The anterior and posterior roots, the spinal cord, dural root sleeves, cerebellar tonsils, orifice of the IV ventricle, vertebral artery and its lower branches can be visualised. On the stereotopographic basis the first operations in patients with severe spinal cord injury (detection of multilevel cord compression, removal of massive subarachnoid bleeding), syringomyelia and haemorrhage into the IV ventricle (clot removal by the ascending cervical route) were undertaken. More than 10 real and probable indications for operative spinal endofiberoscopy are discussed.

New kinds of microneuroprotectors for microsurgery and endoscopy of cerebellopontine angle neurovascular decompression.

New microsurgical devices for neurovascular decompression--microneuroprotectors (MNP)--are described. Four constructive kinds of MNP have been developed according to topographic peculiarities of pathological neurovascular contacts. The hydrodynamic and biological testing of MNP has been concluded. The methods of microsurgical and endoscopic techniques of MNP insertion on the cranial nerves or posterior fossa vessels are reported.

Endoscopic surgery of traumatic intracranial haemorrhages.

The results of endofiberscopic removal of traumatic intracranial haematomas and hygromas in 180 patients are analysed. Peculiarities of the surgical techniques using flexiscopes and original devices in epidural, subdural, intracerebral, intraventricular haemorrhages of various consistencies, size and location are reported. A technique of the trephination access and delayed cranioplasty for endoscopic removal of extensive subdural and intracerebral haematomas is presented. Indications, contra-indications for endoscopic haematoma surgery, advantages, disadvantages, failures of the techniques are discussed.

Endofiberscopic intracranial stereotopography and endofiberscopic neurosurgery.

The possibilities of endoscopic operative procedures in preformed and artificial intracranial and intracerebral cavities are described. Endoscopic investigations were carried out on 166 cadavers; death was due to extracranial pathology and severe brain injury. 132 patients with intracranial lesions were operated on endoscopically. An extended description of endofiberscopic intracranial topographical relationships and endofiberscopic neurosurgical approaches is given. Endoscopic stereotopography of more than 130 intracranial structures is studied.

[Experience using intracranial endoscopy in neurologic traumatology]. / Opyt ispol'zovaniia vnutricherepnoi éndoskopii v neirotravmatologii.

The endoscopic anatomy of the subdural space structure and endoscopic semiotics of intracranial lesions are presented. The direct vision of the lesion substrate outside projection of a small trepanation opening raised the reliability of diagnosis, provides a wide and atraumatic access for the removal of spreaded hematomas and other foci, allows surgery to be fulfilled even in critical patients. The application of intracranial endoscopy in neurotraumatology is considered as a technical principle.

[Endoscopic anatomy of the superior petrosal vein]. / Endoskopicheskaia anatomiia verkhnei kamenistoi veny.

The structural topographic features of a constantly present surgically significant formation--the superior petrosal vein--were disclosed on the basis of postmortem examination of the region of the cerebellopontile angle (204 cases) by means of fine endofibroscopes introduced through a small trephination opening behind the mastoid process of the temporal bone. The method provides for detailed appraisal of the microtopography of the vessel in three-dimensional space without disturbing the regional structural relationships, and makes it possible to disclose more exactly the character of the connection of the vein with the meninges and to determine the variants of the topography of its orifice and the types of formation of the main venous collector without damaging this easily injured vessel. The surgical significance of the recorded features of the structure of the superior petrosal vein is shown.