[Surgical anatomy of the peri-insular association tracts. Part I.The superior longitudinal fascicle system]. / Khirurgicheskaya anatomiya periinsulyarnykh assotsiativnykh provodyashchikh putei. Chast' I. Sistema verkhnego prodol'nogo puchka.

AIM: To study the peri-insular association tract anatomy and define the permissible anatomical boundaries for resection of glial insular tumors with allowance for the surgical anatomy of the peri-insular association tracts. MATERIAL AND METHODS: In an anatomic study of the superior longitudinal fascicle system (SLF I, SLF II, SLF III, arcuate fascicle), we used 12 anatomical specimens (6 left and 6 right hemispheres) prepared according to the Klingler's fiber dissection technique. To confirm the dissection data, we used MR tractography (HARDI-CSD-tractography) of the conduction tracts, which was performed in two healthy volunteers. RESULTS: Except the SLF I (identified in 7 hemispheres by fiber dissection), all fascicles of the SLF system were found in all investigated hemispheres by both fiber dissection and MR tractography. The transcortical approach to the insula through the frontal and (or) parietal operculum is associated with a significant risk of transverse transection of the SLF III fibers passing in the frontal and parietal opercula. The most optimal area for the transcortical approach to the insula is the anterior third of the superior temporal gyrus that lacks important association tracts and, consequently, a risk of their injury. The superior peri-insular sulcus is an intraoperative landmark for the transsylvian approach, which enables identification of the SLF II and arcuate fascicle in the surgical wound. CONCLUSION: Detailed knowledge of the peri-insular association tract anatomy is the prerequisite for neurosurgery in the insular region. Our findings facilitate correct identification of both the site for cerebral operculum dissection upon the transcortical approach and the intraoperative landmarks for locating the association tracts in the surgical wound upon the transsylvian approach to the insula.

[Malignant B-сell lymphoma of the anterior visual pathway].

This work was aimed at studying the optimal diagnosis methods and features of clinical signs of malignant B-cell lymphoma of the anterior visual pathways and choosing the most reasonable treatment method. Six immunocompetent patients with lymphomas in the chiasm-sellar region were examined. The outcomes of high-dose methothrexate chemotherapy and radiotherapy in these patients are analyzed.

[Intraparenchymal brainstem schwannomas: report of three cases and literature review]. / Intraparenkhimatoznye shvannomy stvola mozga: opisanie trekh sluchaev i obzor literatury.

We report three patients with intraparenchymal brainstem schwannomas that were confirmed by surgery and pathological examination: tumors originated from the midbrain parenchyma, the dorsal aspect of the pontomedullary junction and the medulla oblongata respectively. Two of the presented patients differed in age of disease presentation which may reflect different mechanisms of tumor development according to the current views on origin of intraparenchymal schwannomas. One of the cases illustrates treatment of non-communicating hydrocephalus associated with ventricular tumors by preventive stenting of the cerebrospinal fluid pathways.

[Methods of intraoperative control in resection of intraparenchymal brain tumors].

Primary CNS tumors represent 1.4% of all malignant neoplasias and 2.4% of total oncological mortality. The principal goal of tumor resection is maximally possible radical removal with minimal injury of normal brain tissue. This is due to correlation between intraoperative trauma of the brain and postoperative neurological deficit and quality of life. Recently intraoperative ultrasonic and fluorescent methods of guidance have been widely introduced in neurosurgical practice. In conditions of altered anatomy ultrasonographic guidance is intended to optimize approach to intracerebral tumors considering eloquent areas and main vessels. This allows decrease of neurological deficit in the postoperative period. Fluorescent guidance provides possibility of visual differentiation of tumor and normal tissue thus defining the borderline. Combination of these two techniques may lead to more radical resection of tumors and minimize injury of normal brain. We operated 70 patients with primary and metastatic intraparenchymal brain tumors. Intraoperative ultrasonographic guidance was applied in 58 cases, fluorescent guidance--in 21, both methods--in 9.

[Electronystagmographic evaluation of changes in vestibular reactions after administration of diverse substances into cerebral ventricles]. / Elektronistagmograficheskaia otsenka izmeneniia vestibuliarnykh reaktsii posle vvedeniia v zheludochki mozga razlichnykh veshchestv.

Vestibulo-oculomotor reflexes (nystagmus) were recorded by the method of electronystagmography in 33 neurosurgical patients before and after ventriculography. Cerebral ventricles were examined using water soluble compounds (conray, dimeriks, amipaque) in 18 patients or water soluble compounds combined with majodil emulsion in 15 patients. Ventriculography by means of water soluble compounds led to insignificant changes in nystagmic parameters while that by means of X-ray contrasting mixtures caused a frequent and noticeable enhancement of stem vestibular reactions as related to all nystagmic parameters and a significant increase of vestibulo-autonomic reactions.

[Objective evaluation of tolerance of ventriculography with different x-ray contrast media (according to the results of nystagmography)]. / Ob''ektivnaia otsenka perenosimosti ventrikulografii s razlichnymi rentgenokontrastnymi veshchestvami (po dannym élektronistagmografii).

The vestibulo-oculomotor reflex (nystagmus) was recorded by means of electronystagmography in 33 neurosurgical patients in dynamics prior to and after ventriculography. For contrasting the ventricular system a water-soluble medium (Conrey, dimer-X or Amipak) was used in 18 patients and contrast mixtures of water-soluble agents in combination with Myodil emulsion in 15. It was established that after ventriculography with water-soluble media the nystagmus hardly changed, while after the use of mixtures of radiocontrast media the trunk vestibular reactions in all types of nystagmus grew frequently and sharply and the vestibulovegetative reactions increased markedly.

[Positive ventriculographic signs of cerebral hemisphere glioma extension into the ventricular system]. / Priznaki vrastaniia gliom bol'shikh polusharii v zheludochkovuivu sistemu po dannym pozitivnoi ventrikulografii.

A positive ventriculography with fatty and water soluble contrast substances (myodil, conray, dinner - x, amipaque) was performed in 87 patients with gliomas of the frontal lobe 36 cases), temporal (22 cases) and parietal (29 cases) lobes. Gliomas of the frontal and temporal lobes penetrating into the cavity of the lateral ventricles from an "amputation" of the anterior or inferior horn. Gliomas of the parietal lobe penetrated into the upper--outer wall of the triangle of the lateral ventricle and creates a defect of filling around which a certain "plication" develops. A common symptom of glioma penetration into the brain ventricles is its tuberous polycyclicity, an uneveness of the edges of the ventricles. The author describes some diagnostical signs of a penetrating glioma into the corpus callosum and subcortical nodes.