[Breast cancer metastasis into a giant hormone-inactive pituitary adenoma adenoma. (Clinical case and literature review)]

Brain metastases of various types of cancer are diagnosed in 8-10% of all cancer patients. In the world literature, only 30 cases of cancer metastasis to the pituitary adenoma are described. This article presents yet another observation of a patient with breast cancer metastasis into the hormone-inactive pituitary adenoma at the Burdenko neurosurgical center, Russia The patient underwent endoscopic endonasal transsphenoid removal of the neoplasm. During microscopy and immunohistochemical studies of the biopsy, two types of tissue (pituitary adenoma and cancer metastasis) with different Ki-67 treated surgically (1% and over 40%) were found.

[Endoscopic transsphenoidal resection of pituitary adenomas invading the cavernous sinus]

INTRODUCTION

Pituitary adenomas are benign growths that invade the cavernous sinus (CS) in 10-15% of cases. There are different types of microsurgical and endoscopic approaches enabling resection of tumors from the CS cavity that is a relatively small and hard to reach anatomical structure comprising eloquent neurovascular structures.

MATERIAL AND METHODS

A study group included 97 patients with pituitary adenomas (PAs) invading the CS. PAs were resected using an endoscopic technique: adenomas were resected from the CS cavity through a standard endoscopic endonasal transsphenoidal approach in 62 cases; a lateral extended transsphenoidal endoscopic approach was used in 35 cases. A control group included patients with PAs spreading into the laterosellar region who were operated on using microsurgical extra-intradural (n=14) and transsphenoidal (n=149) approaches. In the study group, the degree of PA invasion into the CS cavity was determined using the Knosp scale.

RESULTS

In the study group, total tumor resection was achieved in 49 (50.5%) cases, subtotal resection in 39 (40.2%) cases, and partial resection in 9 (9.3%) patients. In the case of visual disorders (n=70), vision improvement was achieved in 41.4% of cases. Vision deterioration was detected in 11.4% of cases; no vision changes were in 47.1% of cases. Patients (27.8%) who had not had visual impairments before surgery had no negative changes in vision in the postoperative period. The development/augmentation of oculomotor disorders in the study group occurred in 14 (14.4%) cases. In the study group, hormonal remission of the disease in patients with hormone-active PAs was in 26.7% of cases (n=12). There were no cases of nasal liquorrhea, meningitis, and death in the study group.

CONCLUSION

Endoscopic endonasal transsphenoidal resection of PAs invading the CS is a more efficient and safer surgical technique compared to microsurgical techniques (transsphenoidal and extra-intradural approach). The lateral extended transsphenoidal endoscopic approach enables resection of PAs with massive invasion into the CS (Grade III and Grade IV, Knosp scale) and has less postoperative complications compared to the extra-intradural approach (p<0.05).

[The algorithm for surgical treatment of skull base tumors invading the craniovertebral junction]

Surgical treatment of skull base tumors invading the craniovertebral junction is a complex medical problem due to a high rate of adverse postoperative outcomes in these patients.

AIM

The study aim was to optimize surgical treatment in patients with skull base tumors invading the craniovertebral junction.

MATERIAL AND METHODS

A comparative analysis of 2 groups of patients was performed. The study group included 28 patients with skull base and craniovertebral junction chordomas who underwent single-stage surgery, including posterior occipitospondylodesis and tumour resection using the transoral and combined transoral and transnasal approaches, in the period between 2000 and 2015. The control group included 21 patients with the same pathology who underwent microsurgery using the transoral approach without occipitospondylodesis in the period between 1990 and 2009.

RESULTS

Most of the patients in both groups were operated on at late disease stages when they presented with gross clinical signs. The use of single-stage occipitospondylodesis and transoral skull base tumor removal significantly (compared to the control group) extends indications for surgical treatment of skull base tumors, which were previously considered unresectable, and provides better results.

CONCLUSION

New surgical techniques significantly increase the completeness of tumor resection, decrease the rate of postoperative complications, accelerate the rehabilitation process, and improve the patient's quality of life.

[Identification of highly specific electroencephalographic patterns in patients with neuroepithelial tumors of the III ventricle by algorithmic methods]

An algorithm was suggested for identifying highly specific electroencephalographic (EEG) patterns in neurooncologic patients. The algorithm provides selection of patients with their further classification into main and control groups based on the already existing database of EEG indicators; requests to it; generation of mono-indicator candidates for EEG-patterns on the basis of a 4-dipole table for selecting and verifying sensitive and specific EEG patterns and outlining the best ones. Our material included 368 patients with basal-diencephalic tumors. Algorithmic methods revealed new EEG patterns in patients with different anatomical and topographical variants of neuroepithelial tumors in the III ventricle. We think it reasonable to use the revealed syndromes to improve diagnosis and identify pathophysiological basis of clinical syndromes.

[The classification of functional disorders of brain activity in patients with brain tumors]

This paper is devoted to the automatic classification of functional disorders of brain activity in patients with brain tumors on the basis of the reference groups. The test of statistical hypotheses set made crisp classification. Functional activity of the brain abnormality is assessed indicators of the frequency spectrum of the EEG. We describe the scheme of the algorithm and an analysis of the results. The publication is intended for IT-professionals and clinicians who are actively applying them in their work.

[Algorithm identification of differential diagnostic clinical syndromes in patients with neuroepithelial tumors of the III ventricle]

An algorithm for identifying differential diagnostic clinical syndromes in neurooncologic patients was suggested. This technique involves: creating a database of cases - lists of symptoms, requests for selection of thematic cases with their subsequent division into the main and control groups; generation of single-symptom applicants; selection and verification of clinical differential diagnostic syndromes appropriate to sensitivity and specificity using a 4-dipole table and selection of the best of them. Based on the database of 368 patients with tumors of basal-diencephalic localization, we tried to perform the algorithm of identification of differential diagnostic clinical syndromes in patients with different anatomical and topographical variations of neuroepithelial tumors of the III ventricle. The identified syndromes are reasonable to use for selecting the optimal treatment strategy.

[Specific features of cerebral blood flow changes after surgical removal of chiasmatic-sellar region tumors using data of transcranial duplex sonography]

Aim of the study was to discover specific features of linear blood velocity in early postoperative period in patients with tumors of chiasmatic-sellar region. Measurement of linear blood velocity using transcranial duplex sonography was performed in 294 patients with tumors of hypothalamo-hypophyseal area (149 suprasellar pituitary adenomas, 145 endosuprasellar, hypophyseal and ventricular craniopharyngiomas). It was found that vasospasm of different severity was present in 62% cases after surgical removal of chiasmatic-sellar region tumors. This "primary vasospasm" was associated with intraoperative damage to a vessel. Delayed angiospasm was caused by subarachnoid hemorrhage into basal cisterns due to hyperactivation of neuroendocrine systems of adenohypophysis and aldosterone. Persistent vasospasm with linear blood velocity over 200 cm/s results in irreversible ischemic damage of subcortical and hypothalamic structures.

[Water electrolyte disorders in the postoperative clinical picture of basal-diencephalitic tumors]

The paper deals with the relationship of homeostatic and motivational disorders in the postoperative clinical picture in basal-diencephalic tumors. The material included 354 clinical observations of: hypophysial adenoma (n = 135); craniopharyngioma (n = 71); tumors of the third ventricle (n = 88); basal meningiomas (n = 60). A comparative analysis of the findings allowed the authors to support that there are typical variants of changes in the patients' status, which reflect the nature of ion-osmotic disorders. The most significant mental disorders were transient hyperosmolar-hypernatriemic disturbances. The poor predictors were persistent hypernatriemia concurrent with evolving coma, systemic hemodynamic and respiratory disorders. Hyponatriemia is a better predictor of ionosmotic disorders, which requires a careful postoperative monitoring and a comparison of its findings with the specific features of intensive care performed.

[The psychopathology of tumors of the 3rd cerebral ventricle]

36 patients with tumors of diencephalic region of different histologic nature involving cavity of the third ventricle of the brain were observed. 27.7% of the patients had disorders of mental and physical development from the very first years of life. In presurgical period there was a wide spectrum of paroxysmal and permanent mental disorders from asthenia to rude disturbances of memory and consciousness which regressed or disappeared after the operation. The correlation was observed between such disorders, histologic structure and location of the tumor; individual characteristics of the patient (age, dextrality, sinistrality); scope and character of the operation (approach to the tumor, surgical interventions on the structures of the third ventricle).

[Clinical picture of colloid cysts of the III ventricle]

Clinical analysis of 74 cases of colloid cysts of the III-d ventricle was performed. Dynamics of clinical symptom complex was studied both in preoperative and early postoperative period as well as in remote periods after surgery. Most of the patients were treated in N.N. Burdenko Institute of Neurosurgery during 1980-1995. Peculiarities of the disease development before clinical manifestation, variations of complicated postoperative period, prognostically significant symptoms, possible mechanisms of clinical syndromes development were considered.

[Central regulatory disorders in the clinical picture of the early postoperative period in patients with tumors of the midbrain]

Neurological, clinical, biochemical examinations, electroencephalography, computer and magnetic resonance tomography of the brain of 336 patients with brain stem and para-brain stem tumors resulted in conclusion that nonspecific autonomic-endocrine reaction caused by disorders in central regulation was the main component of early postoperative period. The first type of such disorders included cases with rather stable indices of both hemodynamics and ionic-osmotic homeostasis characterized by favourable course. Unstable hemodynamics and tendency to increase of osmolarity and serum levels of sodium and glucose as well as unfavourable course of this period were typical for the second type.

[The early postoperative period in patients with tumors of the posterior cranial fossa]

The studies carried out during an early postoperative period in patients with posterior fossa tumors were made to analyse the role of the degree and the level of brain stem damages in formation of cerebral reactions. The three groups of cases were selected in accordance with the course of the postoperative period: 1.1-with exitus letalis (irreversible damages); 1.2-rehabilitation in persistent focal damages; 2-restoration with functional safety of brain stem. Differences of the integral cerebral reactions (the state of consciousness, emotional-affective disorders, awakening state) as well as the brain stem syndromes (formation of pathological systems, reciprocal relations between intact and destroyed brain stem structures) and diencephalic-subcortical syndromes were considered.

[Analysis of causes of fatal outcome in children in the intensive care unit after removal of craniopharyngiomas]

Postoperative states of 55 children after removal of craniopharyngiomas are analyzed. Clinical and morphological analysis of cases with a complicated course of the postoperative period helped single out three groups of patients differing by the time of lethal outcome, time course of homeostatic reactions in the postoperative period, and autopsy findings. The data will help improve the diagnostic and therapeutic methods used in the postoperative period in such patients.

[The electroencephalographic correlates of a disorder in higher cortical functions in local lesions of the hypothalamic area]

In order to reveal correlations between disturbances in higher cortical functions and characteristics of electrical activity 70 patients with pathological foci in the hypothalamic regions were examined using computer data processing. Destruction of the normal intercentral relations between EEG rhythms develops under the influence of the hypothalamic focus. The process builds up with the aggravation of cortical disorders (mnestic, emotional-affective, consciousness oppression with sleep inversion). General decrease of EEG coherence is observed with the highest destruction of correlations in the frontal cortical areas. The structure of high-frequency alpha-rhythm becomes deranged even in slight cortical disorders, its coherence decreases predominantly in the frontal cortical areas. With intensification of the pathological process in the focus, the stage of delta-rhythm coherence increase is observed and at the background of general destruction of correlations new, pathological intercentral relations develop. Using a BRAINLOC computer technique "sources" of the delta- and theta-activity have been localized in the medio-basal brain regions. The area of localization is specific for hypothalamic lesions. The "source" is mostly expressed in the slightest pathology of higher cortical functions. With aggravation of the process in the hypothalamic pathological focus and further derangement in the cortical functions expression of the "sources" reduces up to their complete disintegration in coma.

[The "midbrain waves" (MBW) in the human electroencephalogram]

The dynamic EEG study was performed in 19 patients with mesencephalic damages (verified by the contrast methods and during the surgery). A new EEG phenomenon, mesencephalic waves (MW), was observed in the early postsurgery period during the development of acute excitation focus. MW were recorded predominantly in the frontal and temporal neocortical areas. They appeared as a potential complex consisting of a negative monophasic wave with a superimposed one- or two-phasic spike followed by a 2-3 second theta-delta-burst. MW were recorded in 11 patients of 19 with mesencephalic damages and were not observed in the EEG of the control patients.