Echinococcosis and alveococcosis of the brain in the practice of a neurosurgeon (a review literature and clinical cases)

The article presents an overview of modern scientific publications on echinococcosis and alveococcosis of the brain, which occur in 1–4 % of cases among all volumetric formations of the central nervous system. Despite the fact that these parasitic diseases are more common in endemic areas of developing countries in Asia, South America, Australia and New Zealand, isolated clinical cases are observed everywhere, including due to population migration, and they must bedifferentiated, first of all, from intracerebral cysts, abscesses, cystic tumors. Clinical manifestations of echinococcosis and alveococcosis of the brain include the development of hypertensive symptoms, focal neurological deficit, convulsive syndrome (with cortical localization of cysts). The article presents the modern possibilities of diagnostic methods (among which the main role is played by neuroimaging methods, such as multislice computed tomography and magnetic resonance imaging using contrast/paramagnet), and surgical and medical treatment of patients with echinococcosis and alveococcosis of the brain. The article also describes two own clinical observations of patients who were hospitalized in the neurosurgical department of the Regional Clinical Hospital (Krasnoyarsk)

Subarachnoid hemorrhage due to rupture of very small aneurysms of the anterior part of the circle of Willis

Objective: To assess the frequency of ruptures of very small cerebral aneurysms, features of the perioperative period and outcomes, in comparison with the rupture of ordinarily sized aneurysms.Material and methods: A comparative analysis of the group of patients with ruptured cerebral miliary aneurysms (n = 18) and the group of patients with ruptured cerebral aneurysms of regular size (n = 308) was carried out. All patients underwent open surgery in the first 3 days after the rupture (osteoplastic craniotomy, microsurgical aneurysm clipping). We compared gender, age of patients, severity of the patient’s condition at the moment of admission, severity of subarachnoid hemorrhage, location of aneurysms, aspect ratio, duration of the operation, frequency of intraoperative ruptures, postoperative mortality.Results: It was found that miliary aneurysm rupture occurs in 5.5% of all patients with cerebral aneurysm rupture. The most common cases of rupture of very small aneurysms were in women (77.7%), with a mean age of 50.8 years. Aneurysms of the anterior communicating artery (66.6%) with a narrow neck (average aspect ratio – 2.1) were the most common. Patients with rupture of very small aneurysms were 7.9% more likely to be admitted in a state of subcompensation or decompensation (Hunt-Hess IV–V), they had massive subarachnoid hemorrhage (Fisher III) 19.6% more often than with ruptured aneurysms of regular size. On average, operations in cases of very small aneurysms lasted 30 minutes less than clipping of ordinary aneurysms, but were complicated by intraoperative rupture twice as often (38.8% and 16.5%, respectively). Postoperative mortality in the group of patients with ruptured miliary aneurysms was 5.7% higher than in patients with ruptured aneurysms of regular size.Conclusion: Rupture of cerebral miliary aneurysms is relatively rare. Women of 50–60 years old with very small aneurysms of the anterior communicating artery with a narrow neck constitute the main group of such patients. Massive subarachnoid hemorrhage and severe condition of patients on admission are more common with miliary aneurysms than with ordinarily sized aneurysms. The small size of the aneurysm and the work near the rupture determine the more frequent contact intraoperative rupture when the neck is exposed as compared to operations on larger aneurysms, which negatively affects the treatment outcomes in this group of patients

Development of DNA aptamers for visualization of glial brain tumors and detection of circulating tumor cells

Here, we present DNA aptamers capable of specific binding to glial tumor cells in vitro, ex vivo, and in vivo for visualization diagnostics of central nervous system tumors. We selected the aptamers binding specifically to the postoperative human glial primary tumors and not to the healthy brain cells and meningioma, using a modified process of systematic evolution of ligands by exponential enrichment to cells; sequenced and analyzed ssDNA pools using bioinformatic tools and identified the best aptamers by their binding abilities; determined three-dimensional structures of lead aptamers (Gli-55 and Gli-233) with small-angle X-ray scattering and molecular modeling; isolated and identified molecular target proteins of the aptamers by mass spectrometry; the potential binding sites of Gli-233 to the target protein and the role of post-translational modifications were verified by molecular dynamics simulations. The anti-glioma aptamers Gli-233 and Gli-55 were used to detect circulating tumor cells in liquid biopsies. These aptamers were used for in situ, ex vivo tissue staining, histopathological analyses, and fluorescence-guided tumor and PET/CT tumor visualization in mice with xenotransplanted human astrocytoma. The aptamers did not show in vivo toxicity in the preclinical animal study. This study demonstrates the potential applications of aptamers for precise diagnostics and fluorescence-guided surgery of brain tumors.peerReviewe