МЕТАСТАЗЫ В ГОЛОВНОЙ МОЗГ И ОСНОВАНИЕ ЧЕРЕПА КАРЦИНОМ, РЕДКО МЕТАСТАЗИРУЮЩИХ В ЦНС. КЛИНИКО-МОРФОЛОГИЧЕСКИЙ АНАЛИЗ 51 НАБЛЮДЕНИЯ И ОБЗОР ЛИТЕРАТУРЫ

Metastases of malignant tumors to the brain represent a severe manifestation of far gone oncological disease. Modern possibilities of combined treatment dictate the requirements for understanding the epidemiology, etiology, pathogenesis and morphology of brain metastases. It has been long observed that certain tumors: breast, lung, colon and kidney cancer and melanoma - are the most frequent origins of the brain metastases. However, other tumors, much less, but are also capable to metastasize to the CNS. In this paper, a detailed clinical and morphological investigation of the brain metastases from the origins different from the most common metastatic tumors of the brain is presented. Karnovskiy index before surgery and presence of non-brain metastases are significant criteria of the prognosis. Literature review is presented in this article.Метастазы злокачественных опухолей в головной мозг представляют собой тяжелое проявление далеко зашедшего  онкологического процесса.  Современные  возможности  комбинированного  лечения  диктуют требования к пониманию эпидемиологии, этиологии, патогенеза и морфологии метастазов в головной мозг (МГМ). Издавна замечено,  что определенные  опухоли: рак молочной железы, легкого, толстой кишки, почки и меланома — наиболее частые источники  МГМ. Однако другие опухоли, хотя и гораздо реже, также способны метастазировать в ЦНС. В работе проведено подробное клинико-морфологическое исследование метастазов в головной мозг из источников, не относящихся к наиболее  частым метастазирующим  в мозг опухолям. Индекс Карновского до операции и наличие внемозговых метастазов — досоверные критерии прогноза. Приводится обзор литературы по теме

Topographic anatomy of two-piece orbitozygomatic, modified orbitozygomatic and transzygomatic approaches: A comparative analysis of neurosurgical options

Aim – to measure and compare the vertical and horizontal angles of attack on different intracranial surgical targets provided by the transzygomatic, modified orbitozygomatic and classic two-piece orbitozygomatic approaches, to determine the most optimal approaches to different surgical targets. Material and methods. The study was conducted on 8 sides of en bloc specimens of human head and neck. The marking was performed with BrainLAB Kolibri navigational station (Germany) to highlight the surgical landmarks and measure the angles. The dissection was started macroscopically with standard instruments and photographic fixation of every stage of the approach. The craniotomy was performed with Stryker high speed drill (USA). After that, the microscopic stage was carried out with the ZEISS OPMI Vario/S88 surgical microscope (Germany). On each side, the following steps were completed: soft tissues dissection, cutting the zygomatic arch, fronto-temporal craniotomy, orbitozygomatic osteotomy, opening of the dura mater and dissection of structures of the cranial base, measurement of angles of attack with their apex located on skull base structures Results. The angles of attack on different intracranial surgical targets were measured and compared for two-piece orbitozygomatic, modified orbitozygomatic and transzygomatic approaches. Conclusion. The two-piece orbitozygomatic craniotomy is the most universal and optimal to approach the basilar artery bifurcation and lesions located in both anterior and middle cranial fossae. However, to minimize the surgical trauma and the risks of complications when exposing exclusively anterior cranial fossa, the modified orbitozygomatic approach is more adequate. When the lesion is small and located exclusively in middle cranial fossa, performing the transzygomatic approach is recommended

SKULL BASE LEIOMYOSARCOMA METASTASIS MANIFESTING ITSELF AS OCCIPITAL CONDYLE SYNDROME. A CASE REPORT

The occipital condyle syndrome (OCS) is a rare and little-known neurological syndrome pathognomonic of metastatic involvement of the occipital condyle. OCS is the first significant sign of secondary involvement of the atlantooccipital joint in patients with a history of cancer. The early detection of skull base metastases permits timely use of radiation treatments and avoidance of surgical interventions

[Surgery of skull base tumors extending into the orbit, paranasal sinuses, nasal cavity, pterygopalatine and infratemporal fossas: treatment principles in certain types of tumors]

Following the paper focused on surgery of skull base tumors invading the orbit, paranasal sinuses, nasal cavities, pterygopalatine and infratemporal fossae, the authors discuss particular issues of surgical treatment of the most common craniofacial mass lesions, including meningiomas, juvenile angiofibromas, trigeminal nerve tumors, chondroid tumors, and others

Predictive model for preoperative risk calculation of cerebrospinal fluid leak after resection of midline craniofacial mass lesions

Background: Complex anterior skull base defects produced by resection of mass lesions vary in size and configuration and may be extensive. We analyzed the largest single-center series of midline craniofacial lesions extending intra- and extracranially. The study aims at the development of a predictive model for preoperative measurement of the risk of the postoperative cerebrospinal fluid (CSF) leak based on patients' characteristics and surgical plans. Methods: 166 male and 149 female patients with mean age 40,5 years (1 year and – 81 years) operated for benign and tumor-like midline craniofacial mass lesions were retrospectively analyzed using logistic regression method (Ridge regression algorithm was selected). The overall CSF leak rate was 9.6%. The ROSE algorithm and ‘glmnet’ software suite in R were used to overcome the cohort's disbalance and avoid overtraining the model. Results: The most influential modifiable negative predictor of the postoperative CSF leak was the use of extracranial and combined approaches. Use of transbasal approaches, gross total resection, utilization of one or two vascularized flaps for skull base reconstruction were the foremost modifiable predictors of a good outcome. Criterium of elevated risk was established at 50% with a specificity of the model as high as 0.83. Conclusions: The performed study has allowed for identifying the most significant predictors of postoperative CSF leak and developing an effective formula to estimate the risk of this complication using data known for each patient. We believe that the suggested web-based online calculator can be helpful for decision making support in off-pattern clinical situations

Preop endovascular embolization in juvenile nasal angiofibroma management

Introduction. Juvenile nasal angiofibroma (JNA) is an aggressively expanding fibro-vascular benign tumor, which occurs in male adolescents. Surgical management of JNA is considered as one of the most difficult in rhinology, because it very often has accompanied with profuse, streaming bleeding. Endovascular embolization has successfully used for reducing the operative blood loss since 2000th. Nevertheless, there is no consensus in the literature about its expediently using because of complications, which may occur.Objective is to evaluate the effectiveness of selective angiography and endovascular embolization in reducing bleeding when removal of JNA of different stages.Materials and methods. In the N.N. Burdenko National Medical Research Center of Neurosurgery 134 patients with JNA had been treated surgically.Results. 110 patients with JNA, who underwent embolization, managed to perform total, subtotal or partial devascularization of the tumor. Total devascularization was achieved in JNA blood supply variant only from the external carotid artery (ECA) system from 1 or 2 sides  (in primary patients or in patients who had not previously been embolized) (n = 39); subtotal devascularization, if the blood supply was carried out from the ECA system, internal carotid artery (ICA) on the 1 side (n = 52) and partial, if there was blood supply from the ECA and significant from the ICA system from 2 sides (in patients with relapse after previous embolization with microspirals or the ECA ligations from 1 or 2 sides, as well as with giant JNA (n = 19). Since the vast majority of patients admitted to our clinic were previously operated on, and JNA blood supply in relapses was more pronounced, we performed the comparison of the degree of tumor devascularization depending on its blood supply in primary patients and patients with relapse. It turned out, as could be expected, that with the primary JNA often managed  to execute a total devascularization than with JNA with continued increase, the difference was statistically significant (p = 0.009).Conclusion. It accurately proved that embolization decreases intraoperative blood loss and reduce surgical risks even in later stages JNAs  (r = –0,51, p <10–7). Ligation of ECA as well as proximal occlusion of its branches leads to rapid reconstruction blood supply from ICA and inability of its embolization if recurrence of JNA occurs

One-step orbit reconstruction using PMMA implants following hyperostotic sphenoid wing meningioma removal: Evolution of the technique in short clinical series

Purpose: To report our experience with patient specific implants for one-step orbit reconstruction following hyperostotic SWM removal and to describe the evolution of the technique through three surgical cases. Methods: Three cases of one-step SWM removal and orbit reconstruction are described. All cases are given consecutively to describe the evolution of the technique. Hyperostotic bone resection was facilitated by electromagnetic navigation and cutting guides (templates). Based on a 3D model, silicone molds were made using CAD/CAM. Then PMMA implant was fabricated from these molds. The implant was adjusted and fixed to the cranium with titanium screws after tumor removal. Results: Following steps of the procedure changed over these series: hyperostotic bone resection, implant thickness control, implant overlay features, anatomic adjustments, implant fixation. The proptosis resolved in all cases. In one patient the progressive visual acuity deterioration was recognized during the follow-up. No oculomotor disturbances and no tumor regrowth were found at the follow-up. Conclusion: CAD/CAM technologies enable creation of implants of any size and configuration, and thereby, to increase the extent of bony resection and lower the risk of tumor progression. The procedure is performed in one step which decreases the risk of postoperative morbidity