[Treatment outcomes in patients with central nervous system germinoma (neuro-ophthalmic aspects)]. / Rezul'taty kompleksnogo lecheniya bol'nykh s pervichnoi germinomoi TsNS (neirooftal'mologicheskie aspekty).

OBJECTIVE: The analyze the neuro-ophthalmic outcomes in patients with pineal and suprasellar germinoma after complex treatment. MATERIAL AND METHODS: There were 125 patients (88 males, 37 females) with primary CNS germinoma for the period 2008-2017. All patients were divided into 3 groups depending on the tumor localization: pineal area - 62 patients, suprasellar neoplasm - 38 patients, bifocal germinoma - 25 patients. Treatment was performed in accordance with the «Germinoma-2008¼ protocol. Tumors were histologically patients (partial - 32 cases, subtotal - 16 cases). Surgery was followed by postoperative chemotherapy and stereotactic radiotherapy. The results were evaluated by neuro-ophthalmological examination at all stages of complex treatment. RESULTS: Pineal germinoma resulted oculomotor and pupillary disorders (58 patients - 94%) and papilledema. The last one completely regressed under the treatment. Partial reduction of oculomotor and pupillary abnormalities occurred throughout chemotherapy (6 patients - 10%). More than half of patients (n=24, 63%) with suprasellar germinoma had visual impairment. Improvement of visual functions including severe visual disturbance was observed in 14 patients (58%). Predominantly, functional recovery occurred under chemotherapy (12 patients - 86%). Bifocal germinoma was followed by various combinations of oculomotor, pupillary and/or visual impairments. We observed regression of only mild visual disorders. Stereotactic radiotherapy did not ensure any changes in neuro-ophthalmic symptoms in all groups.

[Reproductive disorders and preservation of fertility in males with benign and malignant brain tumors]. / Narusheniia reproduktivnoi funktsii i vozmozhnosti sokhraneniia fertil'nosti muzhchin s dobrokachestvennymi i zlokachestvennymi opukholiami golovnogo mozga.

Brain tumors rank third in the incidence rate among cancer nosologies. However, improvement of neurosurgical treatment methods and the use of modern regimens of chemotherapy and radiotherapy have increased survival of patients with benign and malignant brain tumors. A significant proportion of patients with brain tumors are young people in the reproductive age who are interested in maintaining their fertility. Surgical removal of tumors, mainly in the hypothalamo-pituitary area as well as the use of chemotherapy and radiotherapy for malignant brain tumors of any localization may be complicated by hypogonadism and infertility. At present, a simple and reliable method of preserving male fertility is sperm cryopreservation. Neurosurgeons as well as oncologists and radiologists should inform patients with brain tumors about a potential risk of hypogonadism and infertility after treatment and about opportunities of sperm cryopreservation, which increases the chances of having future genetic progeny.

[The 2016 WHO classification of primary central nervous system tumors: a clinician's view]. / Klassifikatsiia VOZ pervichnykh opukholei tsentral'noi nervnoi sistemy 2016 g.: vzgliad klinitsista.

This article is devoted to the latest edition of the 2016 WHO classification of primary CNS tumors. The authors, who are clinicians and not morphologists, have tried to analyze and briefly present the main changes to the new edition of the WHO classification of primary CNS tumors, the main difference of which from the previous 2007 classification is inclusion of the molecular genetic features of primary CNS tumors in the classification criteria. The article focuses mainly on the classification issues of diffuse gliomas and glioblastoma, with assessment of the role of IDH-1,2, ATRX, TERT, and MGMT mutations as well as a 1p/19q co-deletion. The article briefly describes some new nosological forms (e.g., Grade III anaplastic pleomorphic xanthoastrocytoma) and presents a new approach to the classification of embryonic (medulloblastoma) and glial childhood tumors as well as tables of the main differences between 2016 and 2007 WHO classifications of primary CNS tumors. Based on their own clinical experience, the authors dispute with the described classification and suggest their own ideas for improving the classification of primary CNS tumors in the future.

[Awake craniotomy].

Awake craniotomy is a neurosurgical intervention aimed at identifying and preserving the eloquent functional brain areas during resection of tumors located near the cortical and subcortical language centers. This article provides a review of the modern literature devoted to the issue. The anatomical rationale and data of preoperative functional neuroimaging, intraoperative electrophysiological monitoring, and neuropsychological tests as well as the strategy of active surgical intervention are presented. Awake craniotomy is a rapidly developing technique aimed at both preserving speech and motor functions and improving our knowledge in the field of speech psychophysiology.

[Outcomes of application of modern first-line chemotherapy regimens in complex treatment of glioblastoma patients]. / Rezul'taty primeneniya sovremennykh rezhimov khimioterapii pervoi linii v kompleksnom lechenii patsientov s glioblastomoi.

OBJECTIVE: To describe a procedure and outcomes of comprehensive first-line treatment in glioblastoma patients. MATERIAL AND METHODS: We analyzed 107 glioblastoma patients operated on in 2010-2011. Seventy five patients underwent combined chemoradiotherapy (CRT) with simultaneous administration of 75 mg/m2 temozolomide (TMZ), followed by chemotherapy with 200 mg/m2 TMZ for 5 days, every 28 days. Separately, we examined 32 patients with large tumors who received alternative treatments. RESULTS: The median time to progression was 11.7 months in the study group and 7.2 and 8.1 months in groups of alternative therapy. The one-year progression-free survival rate was 37%. Overall survival was 29.2 months. CONCLUSION: The chemoradiotherapy regimen involving TMZ followed by one-year TMZ monotherapy is the appropriate treatment for patients with resected glioblastoma. With this approach, no tumor progression occurs in one third of patients during the first year. A careful study of the clinical and radiological findings in the course of treatment makes it possible to achieve the maximum efficacy, avoid unreasonably early switch to second-line therapy, and timely detect tumor recurrence signs. The Response Assessment in Neuro-Oncology (RANO) criteria should be used for assessment of MRI detected changes in the tumor size. The rates of overall and recurrence-free survival were significantly lower in patients with inoperable or partially resected tumors. The applied approaches provide only a slight advantage in control of tumor growth, which necessitates searching for more efficient treatment options for these patients. One of the approaches may be addition of bevacizumab to the first-line therapy regimen.