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

Pilocytic astrocytomas (PA) are benign CNS tumors with high 5- and 10-year survival rates. Data on aggressive course of PA have occurred since the late 20th century. The purpose of this study was to summarize data on patients with aggressive course of PA. We analyzed own patients with conventional PA, PA with aggressive clinical course and literature data on HGAP. Aggressive group is highly heterogeneous without significant differences in anatomical location between groups. Patients with aggressive course and HGAP were older (M=41, 45.5, and 34 years). Overall 5-year survival in patients aggressive PA was 45%, while no deaths were recorded in the group of conventional PAs. Signs of anaplasia according to histological data and Ki-67 index >8 distinguish conventional PA and tumors with aggressive course. Next-generation sequencing and methylation profiling will improve detection of HGAP.

Glial cell-derived neurotrophic factor (GDNF), first purified from glial cell culture medium, immediately attracted the interest of researchers due to its ability to enhance survival of midbrain dopaminergic neurons. This property suggested its therapeutic potential for Parkinson's disease as a socially significant disease. Numerous academic and preclinical studies in animal models supported this hypothesis, but clinical trials yielded conflicting results. For this reason, GDNF is not currently used clinically. However, robust and perspective results in experiments justify further research and overcoming the causes of absent therapeutic effect. Research of GDNF gene alternative splicing products has emerged as a promising avenue. Several GDNF isoforms exhibit effects similar to those of GDNF and differ by smaller size and less dose-response relationship. This makes small GDNF isoforms potentially successful as therapeutic components for some CNS diseases.

Hypofractionated irradiation of meningiomas is a relevant fractionation regimen that occupies an intermediate position between radiosurgery and standard fractionation. This study analyzed the experience with this regimen in the Radiotherapy Department of the Burdenko National Medical Research Center of Neurosurgery to evaluate the method's efficacy and safety. A retrospective analysis included patients who underwent radiation therapy between 2017 and 2020. The study included 73 patients. The median age was 56, and the male-to-female ratio was 1:5. Nine patients were diagnosed with schwannomatosis (neurofibromatosis type 2), and 12 had multiple meningiomas. A total of 94 meningiomas were treated with hypofractionation in regimens of 3 and 5 fractions. Twenty eight tumors (29.8%) were previously verified as WHO grade 1 (25) and grade 2 (3). The median target volume was 5.6 cm³ (range 0.2 to 28.9 cm³). Data for analysis were available for 60 patients with 80 tumors, which did not differ significantly in baseline characteristics from the entire group. The local 3-year and 5-year control rate for meningiomas was 95%. Local control did not differ between sporadic tumors and those associated with schwannomatosis and multiple meningiomas. Tumor control was not influenced by volume, number of fractions, dose, treatment platform, histological verification status, or tumor location (skull base vs. convexity). Radiation reactions within 12 months after treatment were detected in 5 tumors (6.3%). The presence of pre-existing peritumoral edema significantly increased the risk of radiation reactions to 60%. A reduction in meningioma size was observed in 61.3% of cases. The median tumor volume reduction was 37% (range 8-84%). This study identified 2 cases (2.5%) of radiation-induced pathomorphosis in the form of appearance and prolonged existence/progression of cysts, which is generally an uncharacteristic clinical course for meningiomas. Thus, hypofractionation is an effective and sufficiently safe method of radiation therapy for meningiomas, enabling the more frequent use of shortened radiation treatment courses instead of prolonged standard fractionation regimens. Given the rare recurrence of meningiomas and the low complication rate, larger and longer-term studies are needed to clarify all factors influencing the outcomes of radiation therapy.

Morton's neuroma is one of the most common entrapment mononeuropathies of peripheral nerves. The main clinical manifestation is neuropathic pain syndrome in the foot. Currently, many methods of treatment are proposed. Despite the advantages of each method, the main disadvantages are low effectiveness, aggravation of symptoms due to scar-related complications, or relatively high incidence of complications following surgical invasion.

Objective: To evaluate the effectiveness of percutaneous ultrasound-guided neurolysis with local administration of betamethasone in patients with Morton's neuroma.

Material and methods: The study included 14 female patients aged 24-56 years (mean 44.7±6.4). We analyzed VAS scores of pain syndrome (mean 7.1±1.1) and DN4 scores of neuropathic pain (mean 4.9±0.9). Ultrasound imaging was performed to estimate localization and volume of neuroma. Mean volume of neuroma was 226±142 mm³.

Results: Mean follow-up was 12 months. In 12 out of 14 patients, there was a significant decrease in pain intensity to VAS score 1.1±0.6 and regression of neuropathic pain to DN4 score 0.5±0.5. In 2 cases, neuropathic pain recurred after 6 months with enlargement of neuromas (to 429 and 452 mm³). There were no complications in any patient.

Conclusion: Percutaneous ultrasound-guided neurolysis of Morton's neuroma with local administration of betamethasone is an effective and promising minimally invasive method. Selection criterion for this procedure may be small volume of neuroma. Further research is required to clarify the indications for this procedure.

Objective: To analyze the results of selective dorsal rhizotomy (SDR) in children with hereditary spastic paraplegia (Strumpell disease, HSP).

Material and methods: SDR was performed in 8 patients with genealogical or genetic verification of HSP between 2022 and 2024. Mean age of patients was 10.3±4.9 years. We analyzed the results via testing spasticity and goniometry before surgery, on the third postoperative day and in delayed postoperative period. Mean follow-up period was 11±7.5 months.

Results: All children improved lower limb movements. There was regression of spasticity in most cases. Three children had significant impairment of movements in some joints due to orthopedic deformities. No regression of the post-surgery movements level and even increase later in some cases was observed. There were no complications.

Conclusion: SDR is effective and safe in patients with HSP. Long-term follow-up of larger samples is required.

Intraoperative awakening with speech mapping is used to minimize the risk of irreparable neurological deficit in patients with tumors located near speech zones. However, the lack of staff neurolinguist or neuropsychologist in the majority of neurosurgical departments is one of the limiting factors.

Objective: To analyze surgical treatment of patients with glial tumors near speech and motor centers using intraoperative awakening with speech mapping by staff neurologist.

Material and methods: We analyzed postoperative outcomes in 15 patients with dominant hemisphere gliomas of functionally significant areas between 2020 and 2024. All surgeries were accompanied by multimodal neurophysiological monitoring including intraoperative awakening and mapping by staff neurologist without neuropsychologist or neurolinguist. Intraoperative contrast-enhanced MRI was performed in 3 (20.0%) patients (T2WI and T1WI). Postoperative MRI was performed on the first postoperative day in all patients for objective assessment of resection quality.

Results: Total resection was achieved in 13 (86.7%) cases, subtotal - in 2 (13.3%) cases. In 11 (73.3%) patients, no postoperative neurological deficit was detected. Three (20.0%) patients had transient speech impairment with regression throughout a month. Persistent deficit developed in 1 (6.7%) patient.

Conclusion: Standardized speech mapping methods and staff neurologist for cortical mapping during resection of gliomas near functionally significant speech zones maintain high extent of resection without higher risk of permanent speech disorders. Widespread speech mapping by staff neurologists of neurosurgical departments will increase the number of function-preserving surgeries in all regions of the Russian Federation.

Objective: To investigate realization of expectations of female neurosurgeons in professional and personal terms and influence of profession on the quality of life.

Material and methods: We surveyed 44 female neurosurgeons from 17 hospitals of the Russian Federation and CIS between 2020 and 2023. Survey was voluntary and anonymous.

Results: Mean age of women was 32 years (45% were younger than 30 years, 55% were older), more than half of them had more than 5-year experience. Almost half of female neurosurgeons were dissatisfied with results of their professional activity. Most of the women felt that they needed to work harder than their male colleagues to be recognized equally in professional environment. One third of respondents (32%) are considering quitting specialty completely and devoting themselves to their families in the future.

Conclusion: Female neurosurgeons often have to sacrifice personal life and family to achieve the results similar to those in men. This can lead to emotional burnout.

Background: Orbital cavernous venous malformation is a vascular malformation with slow blood flow velocity and common orbital lesion in adults.

Objective: To analyze surgical treatment of orbitocranial and orbital cavernous venous malformations and factors influencing the outcomes.

Material and methods: The study included 54 patients with apical orbital cavernous venous malformation extending into the cranial cavity (group I) and 31 patients with cavernous venous malformation of anterior and/or middle third of the orbit (group II) between 2004 and 2024.

Results: The following approaches were used for resection of malformations: osteoplastic lateral orbitotomy, supraorbital, orbitozygomatic, endoscopic transnasal, transconjunctival approach. In early postoperative period, 15 patients in the 1^st group had deterioration of visual function. Of these, 8 ones developed blindness due to occlusion of central retinal artery. Most often, deterioration of visual functions was associated with extension of malformation into the optic canal, moderate-to-severe visual impairment and late preoperative stage of visual impairment (p<0.05). There was no deterioration of visual functions in the 2^nd group. Deterioration of oculomotor function was noted in 70% and 24% of cases, respectively. Exophthalmos partially or completely regressed in both groups.

Conclusion: Spread of cavernous venous malformation into the optic canal, preoperative state of visual functions and stage of visual impairment influence visual functions after surgery. Oculomotor function in delayed postoperative period is restored more often than visual functions.

Skull base venous system is a variable anatomical formation in both health and pathology. Damage to venous structures during surgical treatment of craniobasal meningiomas can lead to formidable postoperative complications, such as hemorrhagic infarctions, cerebral edema and persistent neurological deficit. Despite the improvement of microsurgical techniques, methods of morphological and functional angiography, as well as modeling the mechanisms of compensation for venous hemodynamic disorders, the problem of preventing postoperative venous complications remains relevant.

Objective: To analyze available literature data on the role of venous system in surgery for skull base meningiomas and prevention of venous outflow disorders.

Material and methods: The PRISMA algorithm was used to search for publications on venous complications, venous outflow compensation and prevention of vein damage in skull base meningiomas. The PubMed and Google Scholar databases were reviewed.

Results: Thirty-six manuscripts were assessed. Statistics of venous complications in neurosurgery, venous system reorganization in craniobasal meningiomas, modern methods of X-ray diagnosis and minimization of venous complications during tumor resection are described.

Conclusion: Peculiarities of venous hemodynamics in skull base meningiomas are important in planning surgical treatment, as evidenced by many studies in recent years. Improvement of microsurgical techniques and highly informative methods of X-ray diagnosis reduce the likelihood of venous complications in neurosurgery. However, persistent risk of vein damage during resection of craniobasal meningiomas necessitates further improvement of diagnostic and treatment algorithms.

Background: The probability of cranial lesions in fibrous dysplasia reaches 50%. A pre-operative computer-assisted planning provides opportunities for precise radical bone resection and customized xenograft manufacturing.

Objective: To evaluate postoperative outcomes in patients with fibrous dysplasia of the cranial vault and base, achived by means of preoperative computer-assisted planning and modeling.

Material and methods: There were 32 patients with fibrous dysplasia of skull cranioorbital and vault localisation in Moscow National Medical Research Center for Neurosurgery named after Academician N.N. Burdenko from 2008 to 2024. All patients underwent a virtual lesion resection, a surgical template and a customized implant or its mold modelling. Implants were mostly manufactured from polymethylmethacrylate either before or during the surgery. The peculiarities of surgeries were application of template to dysplastic bone, resection within appropriate contour and subsequent cranioplasty with customized cranial implant. After surgery, we performed CT and analyzed deviations between postoperative and virtual skull. Reconstruction quality was assessed evaluating cranial asymmetry by means of craniometric analysis.

Results: Craniometric measurements of asymmetry proved the effectiveness of surgical skull correction. The part comparison analysis of skull models after a computer-assisted planning and operations revealed convenience and predictability of the chosen approach.

Conclusion: The developed complex of preoperative computer-assisted planning and modeling significantly improved resection and cranioplasty quality.