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Eliava SS, Likhterman LB, Tissen TP, Yakovlev SB, Usachev DY, Shekhtman OD, Pilipenko YV, Konovalov AN. [The history of surgery for brain and spinal cord vascular pathology at the Burdenko Neurosurgical Institute (to the 50th anniversary of foundation of the First Neurovascular Department)]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2016; 80:5-14. [PMID: 27801394 DOI: 10.17116/neiro20168055-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Vascular Department of the Burdenko Neurosurgical Institute is one of the country's first dedicated departments engaged in treatment of patients with cerebrovascular diseases. The modern vascular service of the Institute is represented by several departments and groups: the Department of Microsurgical Treatment of Vascular Diseases, a group of Reconstructive Brachiocephalic Surgery, and the Department of Endovascular Surgery and Neurodiagnosis that is also engaged in intra-arterial chemotherapy and angiographic diagnosis. The neurovascular service of the Institute is a rightful leader of Russia in the number operations and their complexity: patients with the most serious and unusual pathologies are referred to the Institute from across the country. The achievements of the service are based on science and clinical practice that underlie progressive improvement in the diagnosis, surgical methodology, and recovery of neurovascular patients. On November 02, 2016, the Vascular Department of the Burdenko Neurosurgical Institute will celebrate the 50th anniversary of its foundation.
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Shekhtman OD, Eliava SS, Yakovlev SB, Pilipenko YV, Konovalov AN. [The modern role of microsurgery in treatment of large and giant aneurysms of the internal carotid artery]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2016; 80:51-61. [PMID: 27801399 DOI: 10.17116/neiro201680551-61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Large (1.5-2.5 cm) and giant (>2.5 cm in diameter) aneurysms of the internal carotid artery (ICA) remain one of the complex neurosurgical pathologies in terms of microsurgery. In recent years, endovascular techniques for treatment of paraclinoid aneurysms, in particular ICA reconstruction using flow-diverting stents, have become a priority. However, surgery of flow stents has a number of limitations, therefore the choice of treatment in each case is individual. PURPOSE To analyze the results of direct surgery in patients with large and giant aneurysms of the ICA and to determine the role and place of modern microsurgical techniques in the treatment of this vascular disease. MATERIAL AND METHODS The study included 260 patients with large and giant ICA aneurysms who were operated on at the Institute using microsurgical techniques in the period between 2001 and 2015. The mean age of patients was 45.1 years. The male/female ratio was 1:2.5. One hundred sixty four (63.1%) patients were operated on after hemorrhages, of whom 15 (5.7%) patients were operated on in the acute period; 69 (26.5%) patients had a pseudotumoral course of the disease; 9 (3.5%) patients had a mixed course of the disease; aneurysms were incidentally found in 18 (6.9%) patients. The aneurysm localization was as follows: paraclinoid aneurisms in 158 (60.7%) patients, supraclinoid aneurisms in 77 (29.6%) patients, and ICA bifurcation aneurisms in 25 (9.6%) patients. Microsurgical clipping was performed in 228 (87.7%) patients, including 158 (60.7%) patients in whom an intravascular blood aspiration technique was used. Aneurysm trapping using a flowmetry probe was performed in 16 patients, with creating vascular anastomoses in 4 (1.5%) cases. In 16 (6.2%) patients, interventions were completed by gauze strengthening. We performed a comparative analysis of the results of endovascular treatment of paraclinoid aneurysms reported in recent publications and obtained in the present series. RESULTS Treatment outcomes (Glasgow Outcome Scale) were favorable (Grade 4-5) in 224 (86.2%) patients and satisfactory in 29 (11.1%) patients. Two patients (0.7%) developed diencephalic (electrolyte) disturbances that were successfully corrected using replacement therapy. The mortality was 2.7% (7 patients); the treatment completeness was 94.3%. Comparison with the literature data demonstrated comparable results for both treatment techniques. CONCLUSION Microsurgical techniques in treatment of large and giant ICA aneurysms are the methods of choice in complex non-standard cases where endovascular treatment is ineffective or contraindicated. Planning of microsurgical treatment should include the possibility of revascularization surgery. Treatment of these patients should be carried out at large dedicated centers having appropriate expertise and facilities.
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Konovalov AN, Pitskhelauri DI, Melikyan AG, Shishkina LV, Serova NK, Pronin IN, Eliseeva NM, Shkatova AM, Samborskiy DY, Bykanov AE, Golovteev AL, Grinenko OA, Kopachev DN. [Supracerebellar transtentorial approach to tumors of the posterior portions of the medial temporal region]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2016; 79:38-47. [PMID: 26529621 DOI: 10.17116/neiro201579438-47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Despite the advances in microsurgery, the choice of the most adequate approach to the posterior part of the medial temporal region (MTR) remains a very controversial issue. The supracerebellar transtentorial approach (STA) is considered as the most preferable one, since it provides the optimal balance between retraction, incision, and resection of the brain tissue. Here, we present our consecutive series of 20 patients who underwent STA surgery. MATERIAL AND METHODS Twenty patients with glial tumors affecting the posterior MTR underwent STA surgery between 2006 and 2014. The mean age of the patients was 20 years. Benign tumors were predominant (18 out of 20 cases). RESULTS Resection of the posterior and middle MTRs was conducted in 16 cases. The anterior MTR was accessed through STA in 1 patient only; in 2 patients, STA was combined with the infraoccipital approach. Cerebellar edema occurred in 4 patients, with hemiparesis persisting in one of the cases for 1 year after surgery. Of 8 patients with drug resistant epilepsy, the Engel class 1 or 2 outcome was achieved in 6 cases within 1 year after surgery. CONCLUSION STA provides an excellent surgical route to the posterior and middle MTR portions; however, the anterior MTR portions cannot be reached safely. The operative risks of STA increase as the surgeon proceeds with resection of the anterior MTR portions. Anterior MTR structures can be removed using a combination of the supracerebellar and infraoccipital transtentorial approaches or two-stage resection.
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Savateev AN, Konovalov AN, Gorelyshev SK, Satanin LA, Khukhlaeva EA, Shishkina LV, Ozerova VI, Valiakhmetova EF, Medvedeva OA. A giant hyperostotic parasagittal meningioma in a child with neurofibromatosis type II (a case report and literature review). ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2016; 80:66-73. [PMID: 28139575 DOI: 10.17116/neiro201680666-73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Large parasagittal meningiomas, in particular hyperostotic ones, in children are rare and problematic in the differential diagnosis. The literature reports only single clinical cases related to this issue; opinions about the indications, surgical treatment options, and prognosis are contradictory. This paper presents a clinical case of a hyperostotic parasagittal meningioma with intra-extracranial growth in a 10-year-old boy with neurofibromatosis type II significantly worsening the prognosis. We discuss the epidemiological and clinical features of childhood meningiomas and issues of their diagnosis, treatment, and prognosis.
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Konovalov AN, Kadyrov SU, Tarasova EM, Mazerkina NA, Gorelyshev SK, Khukhlaeva EA, Kobyakov GL, Trunin YY, Sanakoeva AV, Kholodov BV, Shishkina LV, Panina TN, Ryzhova MV. Basal ganglia germinomas in children. Four clinical cases and a literature review. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2016; 80:71-82. [PMID: 27029333 DOI: 10.17116/neiro201680171-82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Basal ganglia germinomas are a specific group of intracranial germinomas. Their early diagnosis is complicated due to their atypical localization and diversity of neuroimaging and clinical signs. MATERIAL AND METHODS We describe 4 cases of basal ganglia germinoma in boys of 13, 14, 15, and 16 years of age. The medical history data, clinical features, neuroimaging and histological characteristics of basal ganglia germonomas, and preliminary results of the treatment are presented. CONCLUSION Basal ganglia germinomas are usually verified at the late stage of the disease when patients are detected with extended lesions of the basal ganglia and severe neurological and neuroendocrine deficits. This situation is due to clinical and imaging signs that are untypical of common germinomas.
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Konovalov AN, Belousova OB, Pilipenko YV, Eliava SS. [Decompressive craniotomy in patients with intracranial aneurysmal hemorrhage]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2016. [PMID: 28635699 DOI: 10.17116/neiro2016805144-150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Decompressive craniotomy (DCT) has been used for treatment of patients with acute aneurysmal subarachnoid hemorrhage (SAH) for more than 20 years. But so far, the attitude to this surgery is controversial, and the indications and contraindications for it are not clearly defined. The article reviews the domestic and foreign literature devoted to the issues of validity and efficacy of DCT in treatment of cerebral edema and intracranial hypertension in patients with aneurysmal SAH.
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Konovalov AN, Filatov YM, Tissen TP, Eliava SS, Yakovlev SB, Pronin IN, Usachev DY, Golanov AV, Lukshin VA, Arustamyan SR, Kheyreddin A, Shekhtman OD, Sazonov IA, Maryashev SA, Belousova OB, Korshunov AE, Pilipenko YV, Shmigelsky AV. [Surgical treatment of cerebral vascular diseases]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:4-21. [PMID: 26356510 DOI: 10.17116/jnevro2015115714-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Theoretical and practical aspects of the complex treatment of brain and spinal vascular diseases using microsurgical, endovascular and radiosurgical methods are considered. Authors present the data demonstrating that, due to the implementation of the program of development of vascular centers in the Russian Federation, considerable progress was made in the treatment of cerebral aneurisms and hemorrhagic stroke. In author's opinion, wide introduction of surgical methods in the treatment of occlusive lesions of the blood vessels supplying the brain is needed.
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Shekhtman OD, Maryashev SA, Eliava SS, Yakovlev SB, Golanov AV, Shishkina LV, Pilipenko YV, Okishev DN, Bocharov AV, Bukharin EY, Mikeladze KG, Kisar'ev SA, Vinogradov EV, Kaftanov AN, Konovalov AN. [Combined treatment of cerebral arteriovenous malformations. Experience of the Burdenko Neurosurgical Institute]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2015; 79:4-18. [PMID: 26529618 DOI: 10.17116/neiro20157944-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Despite the achievements of recent years, cerebral AVMs continue to pose a challenge to treatment. The objective of this work was the development of recommendations for combined treatment of AVMs based on analysis of the available material and published data. MATERIAL AND METHODS The study included 93 patients hospitalized at the Neurosurgical Institute for combined treatment of cerebral AVMs in 2010-2014. A group of combined surgery (removal of an AVM with preoperative embolization) consisted of 40 patients, and a group of combined radiotherapy (radiation after partial embolization or partial removal of an AVM) included 53 patients. 36 patients underwent radiosurgery, and 17 patients received stereotactic radiation therapy. Both groups were analyzed in terms of outcomes, complications, and follow-up results. RESULTS In the group of combined surgery, according to the Glasgow outcome scale, good results (grade 4-5) were achieved in 35 (87.5%) patients at discharge and in 27 (90%) patients during follow-up. Treatment outcomes, surgery duration, and the amount of blood loss were not significantly different from those in the control group. Complete AVM obliteration was achieved in 29 (80.6%) patients 3 years after radiosurgery and in 8 (47%) patients after stereotactic radiotherapy. In discussion, these findings are compared to the published data, and recommendations for AVM treatment are suggested. CONCLUSION The combined treatment of AVMs is effective management for patients with complex AVMs (Spetzler-Martin grade III-IV AVMs). Successful treatment of AVMs requires careful planning and teamwork of vascular and endovascular neurosurgeons, radiologists, and neurologists.
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Zheludkova OG, Shishkina LV, Konovalov AN, Ryzhova MV, Kislyakov AN, Ozerov SS, Trunin YY, Mazerkina NA, Klimchuk OV, Tarasova EM. [Growing teratoma syndrome in a patient with intracranial germ cell tumor]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2015; 79:69-74. [PMID: 26529536 DOI: 10.17116/neiro201579369-74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A six-year-old patient with non-germinomatous germ cell tumor of the chiasmatic-sellar area developed polyuria and polydipsia as the first symptoms of the disease. Then there were signs of precocious puberty and vision impairment. MRI examination revealed a shiasmatic sellar tumor and occlusive hydrocephalus. Tumor marker levels in blood serum were elevated. The alpha-fetoprotein level was increased 5-fold; human chorionic gonadotropin 20-fold. These levels increased over time. The patient received 2 cycles of PEI multiagent chemotherapy (Ifosfamide 1.5 g/m(2), Cisplatin 20 mg/m(2), Etoposide 100 mg/m(2)) during 5 days and 1 cycle of second-line multiagent chemotherapy (Cisplatin 100 mg/m(2) for 1 day and Endoxan 1500 mg/m(2) for 2 days). Despite the decrease in tumor marker levels to normal values, the patient's vision still deteriorated. MRI examination revealed that tumor size increased and its structure changed. Total tumor resection led to vision improvement and regression of intracranial hypertension. Histological analysis of tumor tissue only revealed a mature teratoma. This phenomenon, known as growing teratoma syndrome, is very rare among patients with intracranial non-germinomatous germ cell tumors.
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Maryashev SA, Golanov AV, Konovalov AN, Gorlachev GE, Yakovlev SB, Dalechina AV, Antipina NA, Kuznetsova AS, Fil'chenkova NV, Eliava SS, Bukharin EY, Vinogradov EV, Trunin YY. [The outcomes of stereotactic radiotherapy in patients with cerebral arteriovenous malformations]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2015; 79:14-32. [PMID: 25909742 DOI: 10.17116/neiro201579114-32] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Cerebral arteriovenous malformations (AVMs) are the congenital anomalies of development of cerebral vessels during the embryonic period. The conventional therapy for AVMs currently includes endovascular management, microneurosurgical resection, and stereotactic irradiation. MATERIAL AND METHODS A total of 315 patients with brain AVMs were subjected to stereotactic radiotherapy in 2005-2011. 238 (76%) patients had previous subarachnoid hemorrhage (SAH) within different time (6 months to 5 years) before the therapy; 214 (68%) patients had headaches; 113 (36%) patients had focal neurological symptoms caused by localization; and 82 (26%) patients had seizures. Twenty-three patients were subjected to surgical resection of an intracerebral hematoma prior to radiotherapy and 119 (36%) patients received endovascular treatment including partial embolization of the stroma of AVM. 267 patients received single-fraction radiosurgical irradiation. In patients with large AVMs, we used the hypofractionation technique consisting in target irradiation with several (usually 2-7) fractions; the radiation dose per fraction exceeds 2 Gy. Forty-six patients were irradiated in the hypofractionation mode; two patients had a course of stereotactic radiotherapy in the standard fractionation mode. The marginal dose of radiosurgical irradiation was 13-30 Gy (the average dose was 24 Gy). The main group of patients (38 individuals) with large AVMs was treated using hypofractionation of 35 Gy per 5 fractions. RESULTS Control angiography was carried out in 225 patients who had been followed up for at least 2 years after therapy showed that complete obliteration was achieved in 83% of cases. The rate of symptomatic radiation reactions was less than 10%. The higher risk of developing obliteration was observed for AVMs less than 2 cm3 in size at marginal doses more than 24 Gy. In the hypofractionation group consisting of 27 patients with complete follow-up data, obliteration was observed in 10 (37%) patients. The rate of symptomatic reactions was less than 35%. CONCLUSIONS The radiosurgical method is a minimally invasive choice of treatment for patients with brain AVM, which allows one to achieve sufficiently high degree of obliteration with the minimum complication rate. The hypofractionation procedure is the method of choice for treating large AVMs. Stereotactic irradiation using the Novalis linear accelerator makes it possible to treat patients with AVMs of virtually any location and volume.
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Konovalov AN, Konovalov NA, Pronin IN, Shishkina LV, Zolotova LI, Yakovlenko YG, Korolishin VA, Onoprienko RA, Timonin SY. Multiple primary liponeurocytoma of the central nervous system. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2015; 79:87-96. [PMID: 26146048 DOI: 10.17116/neiro201579287-96] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report a unique case of primary multiple liponeurocytoma. Liponeurocytoma is a rare benign tumor (Grade II) of the posterior cranial fossa with neural- or probably astrocytic-lineage cells; the tumor stroma contains mature adipocytes. This case is the thirty-eighth case of this pathology reported in the world literature and the first case of multiple form of this disease. We have provided a sufficiently thorough neuroradiological and histological picture that allows one to differentiate between a liponeurocytoma and other histological variants. Recommendations for the tactics for managing patients with this rare disease are proposed based on the analysis of treatment of this pathology reported in the world literature.
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Konovalov AN, Kalinin PL, Shimanskii VN, Shapirov OI, Kutin MA, Fomichev DV, Kadasheva BA, Turkin AM, Kurnosov AB. Experience of surgical management of trigeminal schwannomas that simultaneously spread to the middle and posterior cranial fossae. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2014; 78:23-32. [PMID: 25406905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION trigeminal schwannomas account for 0.07-0.36% of all intracranial tumors and 0.8-8% of all intracranial schwannomas. Different surgical approaches are used depending on the topographic anatomical variant of the tumor. Dumbbell-shaped tumors that spread both to the middle and posterior cranial fossae are the most challenging ones in terms of their resection. MATERIAL AND METHODS Five patients with dumbbell-shaped trigeminal schwannomas were operated on at the Burdenko Neurosurgical Institute in 2011-2013. In four cases, tumor resection comprised two stages using the retrosigmoid suboccipital approach (RSA) and lateral extended transsphenoidal endoscopic approach (LETEA); in one case, the tumor was resected in a single session through the LETEA. If there were pronounced symptoms affecting the brainstem and/or cerebellum, tumor resection from the posterior cranial fossa through RSA was resected at the first stage (3 cases). If no symptoms were observed, tumor resection from the middle cranial fossa through LETEA was used as the first stage (2 cases). RESULTS After two surgical stages, total, subtotal, and partial tumor resection was performed (one case each). Total tumor resection from the middle cranial fossa was achieved through LETEA in two cases. Aggravation of ipsilateral paresis of the craniocerebral nerve VI was observed after the surgery in two cases. No cases of nasal liquorrhea were observed after transnasal surgery. In one case, the cavernous segment of the internal carotid artery was damaged during LETEA, thus requiring endovascular occlusion of the damaged vessel to be performed. CONCLUSION LETEA is an effective approach that allows resection of tumors from the middle cranial fossa and the cavernous sinus. Combined with RSA, this approach can be used for two-stage resection of dumbbell-shaped trigeminal schwannomas.
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Pavlova GV, Baklaushev VP, Ivanova MA, Goriaĭnov SA, Rybalkina EI, Kopylov AM, Chekhonin VP, Potapov AA, Konovalov AN. [Modern molecular approaches to diagnosis and treatment of high-grade brain gliomas]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2014; 78:85-100. [PMID: 25874291 DOI: 10.17116/neiro201478685-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review analyzes the current state of the problem of diagnosis and therapy of high-grade gliomas on the basis of the most promising present-day approaches. The diagnostic and treatment perspectives of the molecular genetic analysis of glioblastoma markers located on the tumor cell surface are considered. Gene therapy and the use of dendritic cells and oncolytic viruses are considered as the most interesting approaches to therapy of high-grade gliomas.
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Konovalov AN, Kalinin PL, Kutin MA, Fomichev DV, Kadashev BA, Astaf'eva LI, Semenova ZB, Golanov AV, Trunin II. Transsphenoidal surgery of craniopharyngioma: form palliative surgery to radical removal. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2013; 77:3-12. [PMID: 23866572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The paper presents basic principles of transsphenoidal craniopharyngioma surgery. Stages of methodology development. Steps of methodology development of such operations in the Institute are described--from palliative interventions to the high-tech modern radical surgery with the use of anterior extended approach. Additional stereotactic irradiation provides reliable control of the disease for a long period. The article mainly describes operative technique and contains preliminary analysis of the surgical results showing effectiveness and safety of endoscopic removal of craniopharyngioma.
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Mariashev SA, Golanov AV, Konovalov AN, Iakovlev SB, Il'ialov SR, Èliava SS, Pronin IN, Kostiuchenko VV, Iakhina MV, Gorlachev GE. Radiosurgical irradiation of patients with cerebral AVM on the Gamma knife. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2013; 77:16-29. [PMID: 24564082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED Arterio-venous malformation (AVM) of the brain are congenital malformations of cerebral vessels in the embryonic period. Standards in AVM treatment is currently applying the endovascular technique, microneurosurgical removal and stereotactic radiation. MATERIALS AND METHODS In the period from 2005 to 2011, in 139 patients with arteriovenous malformations of the brain were treated using "Gamma Knife". 89 (64%) of 139 patients suffered bleeding in anamnesis. Paroxysmal symptoms of varying severity dominated in the clinical picture of 35 (27%) patients. Previous microsurgical resection was performed in 10 patients. 28 patients experienced a partial embolization of vascular malformations before radiosurgery. A boundary value radiation dose ranged from 18 to 28 Gy (mean dose 20 Gy), day dose was in the range of 40-80% (average 50% isodose). Maximum dose ranged between 18-60 Gy (mean dose of 38 Gy.). RESULTS Control angiography or spiral CT screening angiography was performed in all 85 patients who were treated with follow-up data for more than two years, showed that total obliteration occurred in 75% of cases. Frequency of symptomatic radiation reactions was less than 5%. After two years or more after treatment, complete obliteration was observed in 74% of patients. CONCLUSIONS Higher frequency of AVM obliteration was seen with up to 2 cc. and the irradiation dose of at least 24 Gy.
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Konovalov AN, Kadyrov SU. Temporal transchoroidal approach for tumors of the midbrain and thalamus. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2013; 77:16-25. [PMID: 24364242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Surgical approach to the tumors of deep localization depends on the predominant direction of tumor growth. The main task of the surgeon in such cases is to choose less traumatic approach with a sufficient angle of operational action to achieve greater surgical radicality. The article describes temporal transchoroidal approach to the tumors of the midbrain, thalamus, and optic tract. This approach in selected cases allows to remove deep-seated tumors with less damage compared with pterional and subtemporal approach.
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Konovalov AN, Kozlov AV, Cherekaev VA, Shimansiĭ VN, Taniashin SV, Kornienko VN, Pronin IN, Golanov AV, Kobiakov GL, Shishkina LV, Ryzhova MV, Gol'bin DA, Galkin MV, Bocharov AA, Lasunin NV. Meningioma challenge: analysis of 80-year experience of Burdenko Neurosurgical institute and future perspectives. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2013; 77:12-23. [PMID: 23659116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The paper describes the history of meningioma surgery at Burdenko Neurosurgical Institute, analyses of accumulated series of patients and assesses effectiveness of different techniques for meningioma diagnosis and treatment of. We analyzed 15413 patients with meningiomas operated in Burdenko Neurosurgical Institute from 1932 to 2011. Mathematical analysis was performed using Statistica 6.0 program. Mortality rate during World War II reached a disastrous level of 45,8%, in 21st century it is below 1%. Temporary and permanent morbidity has also decreased. While in 1961 Karnofsky performance score was 71, in 2011 it became 83. The probability of postoperative tumour recurrence also diminished, from 40% in 1960-s to 29% in 1996 and presumably to 25% nowadays. Independent factors that influence the risk of recurrence are primary gross total resection, grade of anaplasia and radiation therapy. However, unreasonably aggressive surgery leads to significant increase of morbidity. Further improvement of surgical results in patients with meningiomas depends on implementation of new technologies for neurovisualization, abandoning extensive surgical approaches whenever possible, finding the "balance" between radical removal and expected functional outcome, wider application of radiosurgery and three-dimensional conformal radiation therapy.
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Konovalov AN, Pitskhelauri DI, Shishkina LV, Kopachev DN, Sanikidze AZ, Gavriushin AV, Puchkov VL. Intraparenchymal brainstem schwannomas: report of three cases and literature review. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2013; 77:35-43. [PMID: 25042369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report three patients with intraparenchymal brainstem schwannomas that were confirmed by surgery and pathological examination: tumors originated from the midbrain parenchyma, the dorsal aspect of the pontomedullary junction and the medulla oblongata respectively. Two of the presented patients differed in age of disease presentation which may reflect different mechanisms of tumor development according to the current views on origin of intraparenchymal schwannomas. One of the cases illustrates treatment of non-communicating hydrocephalus associated with ventricular tumors by preventive stenting of the cerebrospinal fluid pathways.
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Kadyrov SU, Konovalov AN, Khukhlaeva EA, Gorelysh SK, Kbiakov GL, Trunin II, Kholodov BV, Ozerov VI, Shishkina LV, Ryzhova MV. [Diffuse bithalamic astrocytomas in children and adults]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2012; 76:14-19. [PMID: 23379178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Diffuse bithalamic glioma is rare entity. A few cases have been described so far. We present the data of 13 patients (both children and adults) with diffuse bithalamic gliomas observed and treated at Burdenko Neurosurgery Institute within the period of 2004-2011. Age of patients varied from 3 to 29 y.o. Bithalamic gliomas appear as symmetric enlargement of both thalami on MRI with frequent spreading to adjacent structures (brainstem, temporal lobes). Histologically they appear as astrocytomas (Grade II-IV). Bithalamic gliomas posess different clinical course. There is no indication for surgical treatment because of diffuse growth of these tumors. Stereotactic biopsy is indicated to verify histological origin. Treatment of bithalamic gliomas confined with radio- and chemotherapy. In cases with obstructive hydrocephalus CSF diverting operations are indicated. Attempts of surgical excision lead to worsening of patient's neurological condition. Most patients with bithalamic gliomas have unfavorable prognosis. Tumors remain stable with adjuvant therapy for a very short period of time in most cases. Benign course of this pathology with long-term follow-up is observed only in a few cases.
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70
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Zhukov VI, Konovalov AN, Pitsehelauri DI, Gorelyshev SK, Kadyrov SU, Krasnova TS, Mazerkina NA. [Implantation metastasizing of craniopharyngioma]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2012; 76:51-56. [PMID: 23379184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The paper describes two cases of implantation metastasizing of craniopharyngioma after its resection using combined (transcallosal and subfrontal) and pterional approach. The mechanisms of metastasizing and possible ways of prevention are discussed.
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Konovalov AN, Likhterman LB. [80-th anniversary of Moscow Neurosurgical Institute: history and achievements]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2012; 76:3-25. [PMID: 22856120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Konovalov AN, Golanov AV, Gorlachev GE, Kornienko VN, Trunin II, Kotel'nikova TM, Zolotova SV, Vetlova ER, Galkin MV, Antipina NA, Mariashev SA, Pronin IN, Arutiunov NV, Lubnin AI, Iakovlev SB. [Application of robotized radiosurgical system CyberKnife for the treatment of neurosurgical patients]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2012; 76:3-12. [PMID: 22629842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Robotized system for radiosurgery CyberKnife (Accuray Inc., USA) is the first device dedicated and optimized for advanced irradiation during 1-7 fractions (i.e. radiosurgery and hypofractionation). CyberKnife is characterized by elaborate guidance system, high precision of dose delivery, possibility of conformal dose distributions with high gradient of target borderline dose which is most important in proximity of critical structures. The first CyberKnife system in Russia was installed in Burdenko Neurosurgery Institute. The paper presents 2-year experience of treating patients using CyberKnife. From April 2009 till October 2011 896 patients were treated using CyberKnife. Mean age was 48 years. Overall number of sessions was 2626. Radiosurgical procedures were performed in 21.8% of patients. 91% of cases were treated for intracranial lesions. Limited follow-up period in all kinds of pathology demonstrated results consistent with standard fractionation or radiosurgery. The rates of observed complications were also comparable with accepted techniques. CyberKnife system plays significant role in everyday activity of department of radiation therapy. In careful and thorough selection of patients it allows efficient and high-quality treatment of patients with neurosurgical diseases.
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Trunin II, Golanov AV, Konovalov AN, Shishkina LV, Gorlachev GE, Gorelyshev SK, Pronin IN, Khukhlaeva EA, Serova NK, Korshunov AG, Melikian AG, Ryzhova MV, Kadyrov SU, Sorokin VS, Mazerkina NA, Mariashev SA, Il'ialov SR, Kostiuchenko VV. [Stereotactic radiotherapy and radiosurgery in treatment of patients with deep-seated pilocytic astrocytomas]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2012; 76:64-78. [PMID: 22629849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pilocytic astrocytoma (PA) is a low-grade glial tumor (WHO grade I) with predominant occurrence in pediatric patients. According to many authors, stereotactic radiosurgery (SRS) and radiotherapy (SRT) promote long-term remission or retardation of tumor progression in patients with in inoperable lesions after incomplete resection or recurrence. Therefore it is essential to determine the role of SRS and SRT in complex management of patients with deep-seated PA. Since April 2005 till May 2010 101 patient with intracranial PA was treated in department for radiation therapy of Burdenko Neurosurgical Institute. The series consisted of 70 pediatric patients (below 17 years inclusively) and 31 adults, of them--51 male and 50 female patients. Mean age was 15.1 years (9.8 years in children and 28.7 in adults). In 90 patients (89.2%) tumors were previously histologically verified (tumor resection in 83 cases and biopsy in 7). In 11 (10.8%) patients diagnosis of PA was based on clinical and neurovisualization data. In most cases SRT (66 (66.3%) patients) was preformed, the rest 35 (34.7%) patients were treated by SRS. Median follow-up from the onset of disease reached 52 months (2-228 months). Catamnestic data were available in 88 (87%) patients. By the end of catamnestic follow-up (December 2010) 87 (98.8%) patients treated by SRS and SRT were alive. Median follow-up from the start of radiation treatment was 22.7 months (6-60 months). Progression of tumor was observed in 20 patients (22.7%), in 18 of them due to cyst growth. 18 patients were reoperated. In 12 operated patients histological examination and its comparative analysis were performed. We found that alterations in the tumor tissue, accompanied by regression of solid component and progression of cystic portion, represent reactive-degenerative changes in the tumor as a consequence of radiation-induced pathomorphism. SRS and STR are effective techniques for treatment of patients with primary and recurrent PA despite regardless of localization of the tumor. There procedures should be performed shortly after non-radical resection. Control of tumor growth by the present time (median follow-up is 22.7 months) reaches 98%. "Progression" of the tumor due to enlargement of cystic portion shortly after SRT and SRS represents reactive-degenerative alterations in the tumor tissue and should not be evaluated as true recurrence; without neurological deterioration these cases do not require special treatment.
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Spallone A, Rizzo A, Konovalov AN, Giuffre R. Fronto-orbito zygomatic approach: a technical modification. Skull Base Surg 2011; 6:125-8. [PMID: 17170987 PMCID: PMC1656571 DOI: 10.1055/s-2008-1058904] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The fronto-orbito zygomatic approach is part of the surgical armamentarium of modern skull base surgery. As described in the literature, it requires costly technological tools such as powerful drills and saws, to be performed. In the present communication we describe a technical modification that allows the zygoma to be elevated "en bloc" together with the fronto-orbital bone flap by means of appropriate use of the Gigli's saw. Using this technique, adequate replacement of the craniotomy flap requires only two silk sutures. This technical modification, which was already successfully used in over 20 cases, would also allow this useful approach to be performed in those neurosurgical environments where modern costly technology for cranial base surgery is not available.
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Konovalov AN, Nazarenko GI, Shevelev IN, Vetrilé ST, Mikheev AE, Konovalov NA, Nazarenko AG. [Necessity of development of Russian vertebrologic registry]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2011; 75:85-91. [PMID: 21793302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Development of national and international registers for the most socially significant diseases is an important problem of contemporary medicine. Importance and priority of vertebrological register is explained by relatively young age of spinal neurosurgery as specialty, in which many questions concerning indications and optimal methods of treatment remain unsolved, and accumulated experience is quite limited. Nevertheless, vertebrology is on the way from opinions of certain experts to evidence-based scientific proofs. This transition needs generally accepted and convenient instruments for assessment of outcomes of treatment and procedures which should be presented by national vertebrological register. Aims of its development include accumulation of clinically valuable resources and knowledge in vertebrology by means of organization of society of interested professionals and patients. The paper discusses architecture, contents and importance of development of Russian vertebrological register targeted on neurosurgeons, orthopaedic surgeons, vertebrologists and other specialists dealing with this problem. Foreign vertebrological registers are analyzed, their advantages and disadvantages are summarized, requirements for inclusion of criteria in the register are investigated.
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