[Cerebral low T3 syndrome]. / Mozgovoi sindrom nizkogo T3.

The authors studied the time course of changes in the parameters of the cerebral thyronergic system (total and free triiodthyronine (T3) and thyroxin (T4), thyroxine-binding globulin (TBG), thyroid-stimulating hormone (TSH) by radioimmunoassay (Immunotech, Czechia; CIS, France), proinflammatory cytokine of TNF-alpha by enzyme immunoassay (Innogenetic, Belgium) in the blood and cerebrospinal fluid (CSF) in 59 patients (37 males and 22 females whose age ranged from 21 to 64 years) in acute subarachnoidal hemorrhage due to arterial aneurysmal rupture. On admission, the condition of 47 (79.7%) was rated as grades III-VI according to the Hunt-Hess scale, which was responsible for high mortality rates (33.89% in the assessment of outcomes according to the Glasgow outcome scale). The causes of death were ischemic and hemorrhagic insults, edema of the brain, cerebral stem wedging. Laboratory findings were analyzed in relation to the clinical condition of patients, outcomes, and the degree of secondary vasospasm assessed by Doppler transcranial study by the average blood flow velocity in the middle cerebral artery. They revealed a significant depression of thyroidal metabolism with developed the total low T3 syndrome just before surgical treatment in patients with deterioration in the early postoperative period. The significant correlations found by the authors between the decreased blood T3 and TSH levels and 1) the severity of neurological disorders; 2) the degree of vasospasm, and 3) the outcome of disease, as well as negative correlations of elevated TNF-alpha levels not only in the blood, but also in CSF with the content of CT3, CT4 and with the severity of neurological symptomatology are indicative of the development of isolated syndrome in the brain, which is characterized by specific thyroidal metabolic disorders, which the author propose to call the cerebral low T3 syndrome (by taking into account the presence of the autonomic systems of thyroidal homeostatic provision).

[Anastomoses between the meningeal arteries and the cavernous sinus: the clinical picture, diagnosis and treatment]. / Soust'ia mezhdu meningeal'nymi arteriiami i kavernoznym sinusom: klinika, diagnostika, lechenie.

The findings of 106 patients with arteriosinus anastomoses formed by the meningeal arteries and cavernous sinus were analyzed. The clinical symptoms, the specific features of the course of this abnormality and the principle of its diagnosis are summarized. Based on angiographic data, 4 types of anastomoses were identified by X-ray and anatomic signs: 1) the anastomoses formed by the meningeal branches of the internal carotid and cavernous sinus (45.4%); 2) those formed by the branches of the external carotid and cavernous sinus (9.3%); 3) the branches of both the internal and external carotids are involved in anastomotic blood supply (38.1%); 4) a combination of carotid-cavernous and arteriosinus anastomoses (7.2%). According to the sources of blood supply, the patients received endovascular treatment (external carotid branch embolization, fistula balloon occlusion), radiation surgery or combined treatment. The differential approach to treating patients with arteriosinus anastomoses at the site of the cavernous sinus yielded good results in 78.9% of cases.

[The combined treatment of patients with primary gliomas of the lateral ventricles and the septum pellucidum]. / Kombinirovannoe lechenie bol'nykh s pervichnymi gliomami bokovykh zheludochkov i prozrachnoi peregorodki.

The authors' material was based on the analysis of 49 patients with primary gliomas of the lateral ventricles and transparent septum who were treated from 1988 to 1992. The main method of patients' selection was to analyze clinical and topographic data obtained from computed and magnetic resonance tomographic studies. In 39 (79.6%) cases, the tumors were found in the cavity of the lateral ventricles, in 10 (20.4%) cases there was a partial paraventricular growth when the bulk of the tumors was located in the lumen of the lateral ventricles. Out of the 49 patients examined, 46 (93.3%) were operated on, while 3 (6.1%) patients were found inoperable. In 37 (80.4%) cases, an external ventricular drain was set at the end of an operation. The operative material was histologically studied in 46 cases. Following the operation, 24 (52.2%) patients underwent split fractional radiation therapy with a total focal dose of 60 Gy. The postoperative mortality was 15.2%. The follow-up of patients was from 1 to 4 years. The combined treatment of patients substantially prolonged the relapseless period of the disease. At the same time, the postoperative longevity of patients with malignant gliomas of the lateral ventricles and transparent septum becomes similar to that of the relapseless period in patients with low-grade gliomas untreated with radiation rays.

[The role of radiation therapy in treating hypophyseal adenomas]. / Mesto luchevoi terapii v lechenii adenom gipofiza.

The article reviews various methods for the exposure of pituitary adenomas to the effect of radiation applied either as the only measure or in combination with surgery and drug therapy. The indications for radiotherapy are discussed according to the size and hormonal activity of the tumor.

[The place of radiotherapy in the treatment of pituitary adenomas]. / Mesto luchevoi terapii v lechenii adenom gipofiza.

The paper is devoted to an analysis of the present-day role of radiotherapy of pituitary adenomas with relation to tumor spreading and the patient's neuroendocrine status. The authors made use of data obtained from the N. N. Burdenko Research Institute of Neurosurgery, USSR Academy of Medical Sciences. They analyzed the results of gamma-beam therapy, proton-beam therapy and radiosurgical implantation of 90Y granules used alone as well as in combination with surgical intervention. Based on the analysis of the clinical data on 320 patients, a conclusion is made on the indications for one or another method depending on the stage and course of the disease.

[Proton therapy in clinical neurosurgery]. / Protonnaia terapiia v neirokhirurgicheskoi klinike.

The use of proton beam irradiation in neurosurgical clinical practice helps to find a solution to the problem of the treatment of inoperable malformations employing this method in some cases as an alternative to surgical intervention. Hypophyseal tumors, tumors of the cavernous sinus, arteriosinusal anastomoses in the cavernous sinus area, and arteriovenous malformations are irradiated at the N. N. Burdenko Institute of Neurosurgery, USSR, AMS using the medical proton beam of the Institute of Theoretical and Experimental Physics. Methods of "piercing" irradiation and methods with the use of Bragg's peak are being developed. At present over 200 patients with hormonally active hypophyseal tumors, 30 patients with tumors of the cavernous sinus, 23 patients with deep seated arteriovenous malformations, and 10 patients with spontaneous arteriosinusal anastomoses in the cavernous sinus area have been irradiated. This method seems to hold promise in neurosurgical practice. Extension of the range of clinical applications of proton beam therapy in neurosurgery requires the development of various techniques of irradiation, all possible approaches to various targets on the basis of contemporary methods of computerized diagnosis, topometry and irradiation design.

[Effect of proton irradiation of Tolosa-Hunt syndrome]. / Effekt protonnogo oblucheniia pri sindrome Tolosy-Khanta.

The authors have analysed a case of Tolosa-Hunt syndrome with a persistent recurring course and a gradual development of resistance to steroid therapy. Computerized tomography revealed a high density zone in the affected cavernous sinus of the patient. Differential diagnosis between a tumor and Tolosa-Hunt syndrome was made. The patient received 3 fractions of proton beam irradiation by the "piercing" method (the beam being 15 mm in diameter) at a dose of 60 Gy. After irradiation computerized tomography showed complete recovery of disturbed functions and disappearance of the focus. Four-year remission was observed. In our experience, it was the first case of the use of radiation therapy in Tolosa-Hunt syndrome.

[Proton irradiation of spontaneous arterio-sinus anastomoses in the cavernous sinus region]. / Protonnoe obluchenie spontannykh arteriosinusnykh soustii oblasti kavernoznogo sinusa.

Altogether 10 patients with spontaneous arteriosinusal anastomoses in the cavernous sinus area have been irradiated at the N. N. Burdenko Institute of Neurosurgery, USSR AMS. since 1983 using the synchrotron of the Institute of Theoretical and Experimental Physics. A "piercing" method with a proton beam of 12 mm in diameter (in one case 10 mm) was employed. Nine patients had unilateral anastomoses with the blood supply from branches of the internal and/or external carotid arteries, and one patient had a bilateral anastomosis. Irradiation was given in 2 fractions, in 2-3 days, the maximum total dose was 50-60 Gy. Regression of ophthalmological symptoms was noted 2-3 months after irradiation. Convalescence was noted in 8 patients, a follow-up period in 2 patients was insufficient. Of 7 patients examined by angiography complete thrombosis of the anastomosis was noted in 4, considerable reduction of the blood flow was noted in 3.

[Pre-radiation care in proton irradiation of tumors of the cavernous sinus]. / Predluchevaia podgotovka pri protonnom obluchenii opukholei kavernoznogo sinusa.

The authors described methods of the individual precision anatomodosimetric planning of proton-beam irradiation of tumors of the cavernous sinus. The results of computerized tomography in 2 planes (axial and frontal) were used for planning. Manual tumor reconstruction with subsequent dose planning was done on direct and lateral telecraniograms. The procedure was tested in 25 patients. Complications and noticeable radiation reactions in adjacent tissues were undetectable during 3.5 yrs.

[Proton therapy of pituitary adenomas]. / Protonnaia terapiia adenom gipofiza.

The authors present the results of proton therapy in 59 patients with different hypophyseal adenomas. The period of observation lasted from 6 mos. to 5 yrs. Irradiation was done using a multifield-convergent method and a proton beam of the ITEF synchrotron. The beam energy was 200 MeV, the beam diameter 7-15mm. Radiation response and immediate results were evaluated for all the patients. The least favorable results were noted in the patients with prolactinomas, for which, in addition to irradiation, parlodel therapy is needed. No marked radiation reactions, neurological complications and manifestations of hypopituitarism were observed with the chosen doses and schemes of irradiation.