[Breast carcinoma metastasis to the optic nerve: case report and review of literature].

Metastatic tumours of the optic nerve are extremely rare. The review of literature revealed only 12 cases of breast carcinoma metastasis to the optic nerve. All patients survived less then 6 month after surgical treatment. We describe a case of metastatic breast carcinoma to the optic nerve that occurred 8 years after radical mastectomy followed by chemotherapy. The metastasis manifested with progressive decrease in visual acuity in the right eye during 3 month. CT and MRI demostrated enhancing lesion in the muscle cone apex of the right orbit with an extension to the optic canal. The presumable diagnosis was optic nerve sheath meningioma, and surgical resection was performed. The tumour involved the optic nerve and has been resected togeher with the nerve. Histology report confirmed metastatic tumour. Postoperatively, the patient received additional stereotactic radiotherapy. Patient died of tumour dissemination 2,5 years after surgery. Breast carcinoma metastases to the optic nerve usually have unfavorable prognosis both for survival and for visual acuity. Isolated metastatic tumors of the optic nerve remain a diagnostic challenge because of their clinical and radiological similarities to more common primary tumors of the optic nerve.

[Lung cancer metastases to the brain: clinical and morphological prognostic factors].

Brain metastases (BM) are the most frequent intracranial SOL and extremely heterogeneous group of tumours from morphological point of view. Nevertheless, studies devoted to BM up to now paid little attention to the histogenesis of the primary tumour. Lung carcinoma is the most common source of BM; morpologically this is a very heterogeneous group of tumors, and they demostrate different clinical pathway and outcome. The aim of present study was to evaluate clinical and morphological prognostic factors in 126 patients with lung carcinoma metastases to the brain, operated in 2004-2010 at Burdenko Neurosurgical Institute. Statistical analysis demonstrated that age, gender, amount and location of BM, primary operation and even histological tumour type were not significant prognostic factors, meanwhile absence of extracranial metastases and Karnofsky index above 70 were significant factors of the favorable prognosis.

[Primary and metastatic Ewing sarcoma of the skull base - case reports and comparative analysis].

UNLABELLED: The aim of the present study was to evaluate and compare diagnostic/and treatment modalities of primary and metastatic Ewing sarcoma (ES) of the skull base. MATERIAL AND METHODS: We analyzed nine cases of the skull base ES patients operated in Burdenko Neurosurgical Institute from 2003 to 2011. Among them there were five cases of primary ES, the other four were of metastatic origin. Clinical history, neuroimaging and pathology data together with IHC are presented. Treatment options and results are discussed. Seven patients were operated transcranially, in the other two cases endoscopic endonsnasal operations/were performed. Mean follow up was 11-92 months. RESULTS: We did not reveal arW pathological or IHC differences between primary and metastatic tumors. The labeling index Ki-67 was insignificantly higher in the metastatic tumors gro'Vip. In one case the patient developed relapse of the metastatic tumour in the temporal bone; he underwent second surgery and died 7 months after the operation. CONCLUSION: Despite both metastatic and primary ES of the skull base are of maMignant behavior, the long-term relatively good prognosis can be achieved when combined treatment, including surgery, chemotherapy and radiation is applied.

[Transformation of trigeminal nerve tumor into malignant peripheral nerve sheath tumor (MPNST)].

Malignant peripheral nerve sheath tumor (MPNST) is a rare entity with only 18 cases of trigeminal nerve MPNST described by now and only one report of malignant transformation of trigeminal nerve tumor into MPNST published up to date. One more case of malignant transformation of trigeminal nerve (1st division) tumor into MPNST is demonstrated.

[Differential diagnosis between melanotic schwannoma of gasserian ganglion and metastatic melanoma of middle cranial fossa].

We present a case of a rare tumor--melanotic schwannoma of trigeminal nerve root and gasserian ganglion. Differential diagnosis between metastatic melanoma and melanotic schwannoma (MS) is associated with serious difficulties and high responsibility. Metastatic melanoma is a high grade tumor while most MS are benign lesions with good outcome. By the date 105 cases of these tumors are described in the world literature, 3 of them originated from trigeminal nerve root and gasserian ganglion. MS predominantly occur in relatively young patients, they are characterized by presence of Carney's complex and psammomatous bodies and absence of primary focus. MS and metastatic melanoma have similar appearance on MRI due to presence of melanin granules. Indirect signs evident for MS include cystic structure and dumbbell-shaped growth. Metastatic melanoma of cranial nerves is more typical in people older than 40, primary focus in the face in the zone of innervation of affected nerve is common. In case of absence of the listed features differential diagnosis is based on immunohistochemical analysis and electron microscopy of tissue samples.

[Stereotactic radiotherapy for cerebral metastases using CyberKnife].

During recent decade development of frameless techniques of fixation enabled introduction of stereotactic radiation therapy in metastatic brain lesions and made possible irradiation of large foci involving or proximal to eloquent and critical brain areas. This paper focuses on comparative analysis of effectiveness of hypofractionation (HRST) and radiosurgery (SRS) using CyberKnife system in cerebral metastases. Since November 2009 till June 2011 54 patients with cerebral metastases were treated using CyberKnife system. Age of patients ranged between 25 and 77 years (mean 54 years). 16 patients received radiosurgical treatment (mean total dose was 22.5-35 Gy, number of fractions varied from 2 to 7, mean volume of irradiation was 22.69 cm3) and 8 patients were treated by HRST with RS of selected foci (mean total dose reached 23 and 30 Gy, mean volume of irradiation was 1.02 cm3 and 11.19 cm3, respectively). Indices of overall regression and stabilization of disease for HRST and SRS groups were 81% and 79%, respectively. With mean follow-up period of 12.3 (1-16.1) months median survival for SRS and HRST reached 6.38 (1-15.8) and 6.2 (0.2-16.1) months and median recurrence-free survival was 3.6 (1-13.6) and 5.5 (2-14.2) months, respectively. Obtained results confirmed biological advantages of fractionated stereotactic radiotherapy of large cerebral tumors in comparison with radiosurgery. Prospective studies with rigid criteria of inclusion are required to determine optimal dose/volume/fractionation interrelations in stereotactic radiation treatment of cerebral metastases.

[Metastatic skull base tumors (biology, clinical presentation and evaluation)].

Metastatic skull base tumors are rare and complicated lesions. They involve cranial nerves and craniobasal vascular structures causing multiform clinical presentation. Despite modern neurovisualization techniques, risk of preoperative diagnostic pitfall remains high. Final diagnosis and planning of further treatment are possible only after surgical removal of tumor with subsequent immunohistochemical verification.

[Trigeminal neuralgia and tentorial dural arteriovenous malformation].

Combination of trigeminal neuralgia and tentorial dural arteriovenous malformation is extremely rare. The authors present a case of 72-year-old male patient who suffered from left-side trigeminal neuralgia. MRI revealed numerous tortuous vessels in the left parapontine region. The trigeminal root entry zone was explored via retrosigmoid approach. Tentorial dural arteriovenous malformation localized in proximity to superior petrosal sinus with significant enlargement of leptomeningeal cerebellar vessels (Borden type III) was demonstrated. The fistula was clipped and transsected with immediate restoration of bluish color of cerebellar veins. The trigeminal root entry zone was compressed by the loop of superior cerebellar artery and vascular decompression was performed. After surgery patient became pain-free without any neurological complications. This case clearly demonstrated that trigeminal neuralgia associated with tentorial dural atreriofenous malformation may occur not only due to dilated arterialized cerebellar veins but also can be caused by tortuous loop of superior cerebellar artery.

[Microsurgical anterior cervical foraminotomy in spondylogenous cervical radiculopathy].

The authors present the results of microsurgical anterior cervical foraminotomy used in unilateral cervical radiculopathy caused by lateral disc herniation or foraminal stenosis. In 2000 to 2006, anterior cervical foraminotomy was performed at one or two adjacent levels in 44 patients (27 males and 17 females aged 18 to 64 years (mean age 43 years)) with cervical radiculopathy and myelopathy. All the patients underwent pre- and postoperative computed tomography, magnetic resonance imaging, and functional X-ray study. The surgical technique permitted anterior decompression of the affected nerve root from the site of its formation to the vertebral artery, by maintaining the stability and mobility of the involved vertebral segments. The immediate postoperative period was marked by excellent results with regression of radicular syndrome in 84% of the patients and by good results in 16%. A late (6-month-to-6-year) follow-up showed excellent (78%) and good (22%) results without additional surgery. The findings indicate that anterior cervical foraminotomy is an effective technique of nerve root decompression in patients with lateral disc herniation or foraminal stenosis.

[Endoscopic microdiskectomy in the treatment of lumbar disk herniation].

The authors present the results of endoscopic microdiskectomy (EMD) after J. Destandau in the treatment of lumbar disk herniation in 172 patients. After surgery, radicular pain regressed in all the patients. During EMD, dural damage with liquorrhea occurred in 4 patients. Spondylodiscitis developed in 2 patients. The mean duration of hospital treatment was 5 days. EMD could decrease the sizes of a skin incision and minimize traumatism of paravertebral soft tissues and nerve structures. It reduced the time of hospital treatment. The results of EMD are comparable with those of microsurgical diskectomy.

[Role of the blood kinin system in the pathogenesis of the hemorrhagic syndrome in hemorrhagic vasculitis]. / Rol' kininovoi sistemy krovi v patogeneze gemorragicheskogo sindroma pri gemorragicheskom vaskulite.

Total esterase activity of blood plasma from healthy persons was equal to 27.4 +/- 4.96 micrometer/ml/hr, activity of kallikrein--74.4 +/- 8.65 micrometer of hydrolysed substrate/hr/ml of blood plasma, inhibitory capacity of blood plasma towards kallikrein was 0.9 +/- 0.1 app. un. Total esterase activity of blood plasma, reflecting the activity of trypsin-like enzymes and kallikrein, was distinctly increased in patients with hemorrhagic vasculitis as compared with control group; content of prekallikrein and the inhibitory capacity of blood plasma towards kallikrein were decreased. In patients with severe forms of hemorrhagic vasculitis the most pronounced activation of blood kinine system was observed due to decrease in content of kallikrein and in the inhibitory capacity of blood plasma towards kallikrein.