[Our first experience with endoscopic ear surgery]. / Opyt primeneniia éndoskopicheskoi tekhniki v otokhirurgii u detei.

INTRODUCTION: For the last decades endoscopic ear surgery has become a common practice. Advantages of the endoscopic technique in middle ear surgery are high definition and magnification of the endoscope with a modern camera and the ability to 'look around the corner' with the angled scope. MATERIAL AND METHODS: From March 2017 to November 2019 in NSRC PHOI named after Dmitry Rogachev in the Department of Oncology and Pediatric Surgery 53 patients (81 surgeries) have undergone endoscopic-assisted ear surgery: 3 biopsies for middle ear neoplasm with the transcanal endoscopic approach, 1 endoscopic tympanoplasty for attic retraction pocket with cholesteatoma, 2 endoscopic removal of middle ear tumors (including 1 combined approach) and 32 endoscopic myringoplasties, 22 canal wall down mastoidectomies for extensive middle ear and mastoid cholesteatoma, 21 second-look surgery with ossiculoplasty with overall good outcome. Age of the patients varied from 2 months to 16 years. Follow up period varied from 1 month to 3 years. RESULTS: Two cases of middle ear tumor removal via endoscopic transcanal approach are described. In one case endoscopic transmeatal approach was used as an addition to the middle fossa approach for removal of facial nerve neurinoma located on the upper surface of petrous bone with expansion to the middle ear cavity. In the second case endoscopic transmeatal approach was used alone for removal of benign tumor (salivary gland choristoma) of middle ear cavity with extension to pneumatic system of petrous bone. In both cases endoscopic approach allowed to biopsy the tumor first and then to remove the tumor in a less invasive way, which lead to faster patient recovery. CONCLUSION: In the majority of cases endoscopic technique is a method of assistance in otologic surgery, but sometimes could be a used a single method in middle ear surgery, allowing less traumatic approach and the implementation of high-definition camera for more precise disease control. In our preliminary experience endoscopic technique could be used in pediatric practice independently of the patient's age.

[Placement of a ventricular catheter into narrow lateral ventricles. Popular navigation]. / Ustanovka ventrikuliarnogo katetera v uzkie bokovye zheludochki. Navigatsiia dlia vsekh.

Placement of a ventricular catheter is the most common and easiest procedure in neurosurgery. Usually, the procedure is performed using anatomical landmarks. However, despite the apparent ease of this manipulation, its results are not always satisfactory. According to the literature data, the rate of improperly placed ventricular catheters amounts to 10-40%, which is directly correlated with the risk of shunt dysfunction. The use of special equipment, such as ultrasound scanners, endoscopes, stereotactic devices, and neuronavigation systems, significantly increases success of surgery. However, the high cost and complexity of equipment confine its use at neurosurgical centers, and increased surgery time limits routine use of the equipment. A Thomale guide provides the accuracy comparable to that of modern navigation systems and, at the same time, is a cheap and easy-to-use device. AIM: To determine capabilities and master a technique of using the Thomale guide during placement of ventricular catheters. MATERIAL AND METHODS: Twenty seven surgeries wich Thomale guide were performed at the Rogachev Federal Research Center of Pediatric Hematology, Oncology, and Immunology in the period from April 2015 to November 2016. The Ommaya reservoir was placed in 23 cases; there were 2 ventriculoperitoneal shunting procedures; external ventricular drainage was placed in 2 cases. In 19 cases, the catheter was placed into narrow lateral ventricles. RESULTS: In all 27 cases, the ventricular catheter was successfully placed, at the first attempt, into the anterior horn of the lateral ventricle. CONCLUSION: The Thomale guide is a simple but reliable device for accurate and quick placement of a ventricular catheter into the lateral ventricles, regardless of their size.

[Neurosurgical aspects of the treatment of neuroblastoma patients]. / Neirokhirurgicheskie aspekty lecheniya bol'nykh s neiroblastomoi.

Neuroblastoma (NB) is the most common extracranial solid tumor in children. The neoplasm grows from progenitor cells of the sympathetic nervous system and can be detected anywhere along the sympathetic neurological circuit: retroperitoneally, mediastinally, cervically, and pelvically. Examination of children with suspected neuroblastoma is comprehensive and performed in strict compliance with a therapeutic protocol. A decision on the treatment regimen is made based on the tumor staging and the risk group of the patient. The diagnosis and treatment of NB patients are comprehensive and can be fully carried out only at the pediatric oncology department. In 10-15% of cases, an hourglass tumor spreads to the intervertebral foramina or spinal canal at one or more levels. A tumor node is always located extradurally with respect to the spinal cord. Symptoms of spinal cord compression of various severity are observed in 5-7% of patients. We present several cases of patients with neuroblastoma with intraspinal extension. Despite apparent benefits of primary surgical decompression of the spinal cord, modern experience of treatment of children with intraspinal tumor extension does not reveal advantages of surgery over chemotherapy. Neurological disorders of various nature and severity persist in the majority of patients in the long-term period, regardless of primary treatment. A higher level of spinal deformities after surgical tumor resection is observed. The issue of spinal cord decompression should be discussed by the neurosurgeon and pediatric oncologist, and the most common method of choice may be chemotherapy. The article discusses the indications and contraindications for neurosurgical interventions in NB patients and addresses the issues of NB metastasis to the brain and cranial bones as well as the opsoclonus-myoclonus syndrome.

[MRI diagnosis of spinal metastasis of medulloblastoma. A clinical case and literature review].

OBJECTIVE: the study objective was to improve the quality of detection of medulloblastoma metastases. MATERIAL AND METHODS: Magnetic resonance imaging (MRI) of the spinal cord in a child with medulloblastoma of the posterior cranial fossa, which was performed on the first day after surgery, detected contrast-positive thickenings of the meninges in the cervical, thoracic, and lumbar spinal cord that might be erroneously diagnosed as metastasis. These lesions spontaneously regressed within 3 weeks, which was verified by control MRI. CONCLUSION: In the case of misinterpretation of a MRI picture of contrast-positive thickenings of the meninges, a patient is erroneously regarded as having tumor metastases and is subject to more intensive treatment. However, the lesions spontaneously disappear or greatly reduce after 2-3 weeks. The article presents a case of this phenomenon, describes the putative mechanisms of its development, and provides recommendations for its differential diagnosis from metastases.

[Simultaneous operations in patients with kidney cancer with simultaneous brain tumor lesion].

Three clinical cases of simultaneous operations upon synchronous identification of brain tumor and kidney cancer are described. A metastatic lesion of the brain was detected in two of them, and a combination of a primary CNS tumor (glioblastoma) with kidney cancer was identified in one case.