Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko最新文献

Brain metastases occur in approximately 20% of all cancer patients. Stereotactic radiosurgery alone and in combination with surgical resection is one of the approaches to treating patients with brain metastases.

Objective: To evaluate the effectiveness of stereotactic radiosurgery regarding local control, overall survival and complications; to compare stereotactic radiosurgery alone and preoperative stereotactic radiotherapy.

Material and methods: A retrospective study included 85 patients with single brain metastasis. The first group comprised 45 patients who underwent stereotactic radiosurgery, while the second group included 40 patients who underwent preoperative stereotactic radiotherapy and subsequent surgical treatment. Mean age was 59 and 56 years (p=0.2), radiation volume - 4.4 and 15.9 cm³, respectively (p<0.05).

Results: Local growth control after preoperative stereotactic radiotherapy followed by resection was 100%, 97.5%, and 87.5% after 3, 6, and 12 months, respectively. After stereotactic radiotherapy alone, these values were 100%, 95.6% and 88.9%, respectively (p=0.4). One-year survival was 87.5% after preoperative radiotherapy and 64.4% after stereotactic radiosurgery alone (p<0.05). Among 85 patients, 16 (18.8%) ones had long-term surgical and post-radiation complications.

Conclusion: Stereotactic radiotherapy alone is effective. However, there are limitations in tumor size (up to 2.5 cm) and volume (9.5 cm³). Preoperative stereotactic radiotherapy followed by surgical resection is advisable for larger tumors (up to 4.5 cm and 18.9 cm³) with high rates of overall survival and local growth control.

In 2021, a new type of tumor was defined according to the new WHO classification (high-grade astrocytoma with piloid features, HGAP). Morphological and neuroimaging differences of HGAP from pilocytic astrocytoma complicate diagnosis. Now, significant detection of this tumor is possible only using molecular genetic testing, in particular, methylation profile analysis.

Objective: To present a patient with HGAP and perform a systematic review of studies devoted to adults with HGAP regarding clinical course, diagnosis, protocols and treatment outcomes.

Material and methods: Selection of studies was carried out in accordance with the PRISMA recommendations. The authors analyzed the studies independently of each other. All data were systematized. A case report was described jointly with attending physicians and pathologists.

Results and discussion: HGAP is characterized by rapid progression and resistance to therapy. This case illustrates the importance of awareness of neurosurgeons and necessitates molecular genetic tests to identify this group of tumors.

Conclusion: HGAP is a rare and aggressive tumor. Treatment algorithm for such patients has not yet been developed. The world experience of treatment is presented by individual series. Analysis of methylation profile is necessary for patients with atypical course of tumors similar to pilocytic astrocytoma.

Introduction: The majority of meningiomas - benign tumors with an extremely low metastasis tendency. Only singular observations of extracranial metastasis of WHO Grade I benign meningiomas are described in the literature. Despite the intensive study of meningiomas' molecular biology, there are currently no reliable markers indicating the possibility of their metastasis.

Objective: To describe the clinical case report of a patient with meningothelial meningioma of the wings of the sphenoid bone and extracranial metastasis into the pulmonary parenchyma.

Material and methods: Patient with sphenopetroclival meningioma on the left was observed in the clinic. Operations were performed in 2003, 2005 and 2008. In 2009, radiation treatment of the tumor residue in the medial portions of the middle cranial fossa and on the clivus was carried out in a total focal dose of 56.0 Gy. In 2022, multiple lung metastases were detected in presence of a satisfactory condition on CT performed due to suspicion of viral pneumonia.

Results: Histological diagnosis of primary tumor and thoracoscopically resected metastase - WHO Grade I meningothelial meningioma, Ki-67 labeling index amounted to 3%. As of May 2025, the patient's well-being is satisfactory, the Karnofsky index - 80, on the ECOG scale - 1. The primary tumor after radiation treatment in 2009 is stable, metastases in the lungs also have not been progressing since detection in 2022 despite the absence of special treatment.

Conclusion: The presented clinical observation confirms the possibility of distant metastasis of WHO Grade I meningioma and a relatively favorable course of metastatic disease in this case.

Background: Ionizing radiation and radiotherapy/radiosurgery are widely used in modern medicine. Stereotactic approach and new irradiation techniques have enabled radiosurgical treatment with high precision and conformity. This significantly expanded the indications for radiotherapy in neurosurgical patients.

Objective: To present more than 42 000 patients were treated at the first Russian center for stereotactic radiotherapy and radiosurgery at the Burdenko Neurosurgical Center over the past 20 years.

Material and methods: Over 20 years, we have used linear accelerators and GammaKnife system for various CNS diseases.

Results and conclusion: Stereotactic radiotherapy and radiosurgery have been shown to be highly effective treatments with minimal complications and adverse reactions for meningiomas, neurinomas, glomus tumors, hemangioblastomas, pituitary adenomas, craniopharyngiomas, pilocytic astrocytomas, recurrent high-grade gliomas, secondary metastatic tumors and melanoma; AVM and dural fistula; trigeminal neuralgia, and other diseases with high socioeconomic impacts. These results indicate the role of stereotactic irradiation in the treatment of neurosurgical patients today and allow for revision of existing neurosurgical treatment standards.

Background: The incidence of arterial aneurysms associated with moyamoya angiopathy (AA-MMA) is five times higher than in general population. The risk of AA-MMA rupture can reach 90%. AA-MMA clipping is accompanied by postoperative complications in 25% of cases, and endovascular treatment leads to a forced change of surgical tactic in 26% of cases. In this regard, it is relevant to discuss the features of surgery for AA-MMA and effective treatment algorithm.

Objective: To present rare clinical cases of AA-MMA and surgical treatment options.

Material and methods: The authors present two patients with ruptured AA-MMA. In the first case, there was a distal aneurysm of the right lenticulostriate artery associated with MMA (Suzuki III). The patient underwent aneurysm embolization followed by combined revascularization three months later. In the second case, aneurysm of ACA-AcomA complex was associated with contralateral MMA. The patient underwent microsurgical clipping of aneurysm and combined revascularization 1.5 months later.

Results: These clinical cases demonstrate successful endovascular embolization and microsurgical treatment combined with delayed revascularization for the treatment of AA-MMA. In both cases, aneurysms were successfully removed. Perfusion improved after revascularization in both cases. There were no recurrent strokes throughout 2 years in the first case and 9 years in the second case.

Conclusion: AA-MMA is a complex pathology requiring special attention. Standard methods of surgical treatment are often associated with high risk of postoperative complications. Preoperative planning and consideration of pathogenic features of MMA are important.

Moyamoya disease is a rare cerebrovascular disorder, and appropriate studies focus primarily on techniques and outcomes of anterior revascularization (MCA and ACA). However, posterior cerebral arteries are also affected in some cases. The authors presented a patient who has suffered from Moyamoya disease since 7-year-old age with 10-year progression of disease and involvement of anterior circulation, as well as posterior circulation after 5 years. There were surgical interventions. PCA revascularization using augmented reality technology is the first such case presented In Russian literature.

Aptamers can increase human glioblastoma cell death rate after exposure to radiotherapy. Cell cultures derived from human glioblastomas allow for selection of effective combined therapy.

Objective: To analyze viability of human glioblastoma cell cultures exposed to EGFR-specific aptamers U31, GR20, and GR200 compared to combination of these aptamers and radiotherapy (20 Gy).

Methodology: G22 and SusfP2 cell cultures were harvested from tumor tissue. They were exposed to aptamers (10 μM, 72 hours) and irradiated once with 20 Gy. We analyzed viability using flow cytometry.

Results: In G22 cell culture, aptamer U31 reduces apoptosis by 45.8%, but increases necrosis by 67.5%, while GR20 and GR200 increase two types of death (apoptosis and necrosis). In SusfP2 culture, all three aptamers significantly increased apoptosis while proportion of necrosis decreased. The most significant decrease in the number of necrotic cells was observed for aptamer U31 (by 77.7%). Radiotherapy combined with aptamers was followed by the following effects for G22 cell culture: U31 and GR200 enhance apoptosis (by 59.4%) and necrosis (by 57.7%), aptamer GR20 increases necrosis by 28.3%. In SusfP2 culture, U31 aptamer enhances apoptosis by 132.9% and necrosis by 52.9%, GR20 - 125.4% and 17.7%, GR200 - 27.4% and 30.6%, respectively.

Conclusion: Aptamers have different effects on glioblastoma cell cultures. For SusfP2, a combination of radiotherapy with GR20 aptamer is optimal. Either a single application of U31 aptamer or combination of radiotherapy and GR200 aptamer is optimal for G22 cell culture. This result demonstrates the importance of combined therapy and preliminary studies in cell cultures for individualized approach to each CNS tumor.

Brain injury is accompanied not only by primary neurological disorders, but also secondary complications, including organ dysfunction, immunosuppression with infections and disorders of homeostasis. One way or another, all of them are associated with cerebral dysfunction.

Objective: To determine the risk factors of adverse outcomes in patients with severe traumatic brain injury.

Material and methods: We performed post hoc analysis of a randomized controlled trial at the Sklifosovsky Research Institute for Emergency Care. Patients with severe traumatic brain injury underwent intensive therapy aimed at normalizing intracranial pressure. In the main group, sevoflurane (AnaConDa) was used for sedation. Sevoflurane can dose-dependently increase cerebral blood flow. However, parallel decrease in brain metabolism leads to cerebral vasoconstriction and decrease in intracranial pressure. Propofol was used in the control group. This drug reduces intracranial blood filling through suppression of metabolism. Manifestation of pneumonia and 30-day mortality were studied. Predictors: drug for sedation, age, gender, body mass index, fact of aspiration, transfusions, acute renal failure, acute respiratory distress syndrome (ARDS), seizures, meningitis. We performed ROC analysis of the SOFA (Sequential Organ Failure Assessment), APACHE II (Acute Physiology and Chronic Health Evaluation), VIS (Vasoactive Inotropic Score), and GCS (Glasgow Coma Scale) scales, as well as oxygen extraction ratio (OER) and age.

Results: Risk factors of 30-day mortality: older age (p=0.011), pneumonia (p=0.038), ARDS (p=0.011), decreased OER, negative dynamics according to the MACCE (incidence of major adverse cardiovascular events), VIS, SOFA, APACHE II, GCS scales. The risk of pneumonia is associated with propofol (p=0.028), ARDS (p=0.001), high MACCE score (p=0.038), APACHE II (p=0.040), and GCS (p=0.012) scores, blood transfusion.

Conclusion: Early detection of predictors of unfavorable outcomes is valuable to optimize therapy and increase the effectiveness of treatment.

According to the order of April 15, 1935, the opening of the Department of Neurosurgery, the first head of which was Nikolai N. Burdenko, laid the foundation for the development of neurosurgical activity and training of neurosurgical personnel in the USSR within the walls of the Russian Medical Academy of Medical Sciences (TsIUV). N.N. Burdenko was an outstanding Soviet surgeon, one of the founders of neurosurgery, academician of the Academy of Sciences of the USSR (1939) and the Academy of Medical Sciences of the USSR (1944-1946), Hero of Socialist Labor, honorary member of the British Royal Society of Surgeons and the Paris Academy of Surgery, Colonel General of Medical Service.

Despite the progress in understanding the pathogenesis of diffuse brainstem tumors, treatment of these neoplasms is usually empirical and conducted without morphological and molecular verification. Liquid biopsy is a minimally invasive technique providing data on tumor biology without standard biopsy. This method is based on analysis of cell-free nucleic acids (predominantly, extracellular DNA) in biological fluids with detection of specific mutations. Despite wide implementation in diagnosis and disease monitoring in extracranial malignancies, it is infrequently applied in neuro-oncology.

Objective: To estimate diagnostic value of liquid biopsy in detecting H3K27 and BRAF V600E mutations in patients with diffuse brainstem tumors.

Material and methods: Lumbar puncture with cerebrospinal fluid sampling was performed in 16 patients (5 children and 11 adults) with diffuse brainstem tumors verified by neuroimaging data. Cell-free DNA (cfDNA) was used in digital droplet PCR for determination of H3F3A K28M and BRAF V600E oncogenic missense variants. In 14 patients, investigation of cfDNA was performed in parallel with analysis of correspondent mutations in DNA derived from tumor tissue.

Results: None patient had BRAF V600E mutation. H3F3A K28M variant was detected in 5 CSF samples and 6 tumor specimens from patients who underwent surgical biopsy. Thus, overall sensitivity of the method in determination of H3F3A K28M variant was 92.9% (13/14).

Conclusion: Liquid biopsy is highly informative for identifying the specific mutation H3F3A K28M and often verifies diffuse brainstem glioma without standard biopsy.