How I do it: decompressive hemicraniectomy supplemented with resection of the temporal pole and tentoriotomy for malignant ischemic infarction in the territory supplied by the middle cerebral artery.

Malignant ischemic infarction in the territory supplied by the middle cerebral artery is an extremely severe form of ischemic stroke associated with development of massive uncontrollable postischemic edema of the affected cerebral hemisphere; the end result of which is development of transtentorial herniation and death. METHOD: The surgical technique of performance of decompressive hemicraniectomy involves removal of an extensive bone flap in the fronto-temporo-parieto-occipital zone with resection of the temporal squama and of the greater wing of the sphenoid bone to visualize the level of entrance of the middle meningeal artery to the cranial cavity, which, in its turn, allows resection of the upright margin of the middle cranial fossa. Decompressive hemicraniectomy is supplemented with resection of the temporal pole and tentoriotomy. CONCLUSION: Performance of decompressive hemicraniectomy in combination with resection of the resection of the temporal pole and tentoriotomy is an effective surgical method of treatment of malignant ischemic stroke in the territory supplied by the middle cerebral artery, capable of reducing the lethality rate during the postoperative period.

Survey of diagnostic and treatment practices for multiple sclerosis in Russian Federation in comparison to European data.

INTRODUCTION: The data of the survey of European (EU) neurologists on the methods of diagnosis and treatment of multiple sclerosis in Europe were compared with the data of the similar survey of neurologists of the Russian Federation (RF). METHOD: Seventy-five neurologists specialized in MS from RF completed questionnaires on radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), relapsing-remitting (RRMS), secondary progressive (SPMS), and primary progressive (PPMS) multiple sclerosis. RESULTS: In the case of RIS, only 46% of neurologists from the RF recommended CSF analysis for oligoclonal IgG and only 54.3% performed magnetic resonance imaging (MRI) of the spinal cord, which is significantly lower than in the EU (78% and 80%, respectively). In the case of CIS, significantly more neurologists from the Russian Federation would have tested for antibodies to disorders of the optical spectrum of neuromyelitis (57% in the EU and 94% in the RF). In case of typical RRMS, more neurologists from the RF preferred to start with the second line of disease-modifying therapy (DMT), a lower percentage would choose dimethyl fumarate as the first line DMT (9% in the RF and 25% in the EU). In case of escalating therapy, the majority of EU respondents (68%) indicated that one relapse would be sufficient (only 28% in RF), while in RF, 58% indicated that two relapses would be sufficient (22% in EU). Fewer neurologists from RF would use fingolimod, natalizumab or mitoxantrone for SPMS. 91% of neurologists in RF would like to prescribe ocrelizumab for PPMS. CONCLUSION: MS specialists from RF are less active in monitoring RIS than MS specialists from EU. CIS is not indication to use any DMT in RF. MS specialists in RF are more conservative in changing DMT as escalation in cases with breakthrough RRMS. The products without indication to be used in SPMS are rarely prescribed in RF in comparison to EU. Most cases of PPMS in RF would be treated with ocrelizumab.

Ultrastructural evidence for presenсe of gap junctions in rare case of pleomorphic xanthoastrocytoma.

The phenomenon of unstable expression of gap junction's proteins connexins remains a "visiting card" of astrocytic tumors with various degrees of malignancy. At the same time, it stays unclear what is detected by the positive expression of connexins in astrocytic tumors: gap junctions, hemi-channels, or connexin proteins in cytosol. In the present work, for the first time, we demonstrate an ultrastructural evidence of gap junctions in pleomorphic xanthoastrocytoma, a rare primary brain tumor, the intercellular characteristics of which are poorly studied and remain very discursive and controversial. The primary tumor mass was resected during craniotomy from a 57-old patient diagnosed with pleomorphic xanthoastrocytoma Grade II based on the histopathological analysis. The immunohistochemical study was conducted with primary antibodies: Neurofilament, Myelin basic protein, Glial fibrillary acidic protein, and Synaptophysin. For electron microscopic examination fragments of tumor tissue were fixed in a glutaraldehyde, postfixed in a 1% OsO4, dehydrated and embedded into resin. After the detailed clinical, histological, and immunohistochemical study we revealed some ultrastructural characteristics of the tumor, as well as the first evidence of direct intercellular connection between the tumor cells via gap junctions. Regularly arranged gap junctions connected the somas of xanthastrocytes with dark cytoplasm containing lipid drops. Besides the localization between the cell bodies, from one to several gap junctions were found between the branches of xanthoastrocytoma in tumor intercellular space in close proximity to tumor cell. Our results may indicate gap junctions as a possible structure for intercellular communication between pleomorphic xanthoastrocytoma cells.