[Craniosinusonasal tumors]. / Kraniosinusonazal'nye opukholi.

Tumors extending into the nasal cavity, cranium, and paranasal sinuses have a number of distinctive features to take into consideration. Among them are the communication with an open air, high incidence of associated intracranial infections, specific complications (i.e. suppurative sinusitis, polyps, mucocele, pneumocephalus, nasal CSF leak). The features mentioned make these lesions unique. 50 consecutive patients underwent treatment in Burdenko Neurosurgical Institute. The diagnosis was confirmed either by CT, MRI, or at operation. Rhinological and otoneurological signs were also subjected to analysis. Most frequently these tumors (the majority of which were meningiomas (n = 34) extended into the nasal cavity (40 patients) and paranasal sinuses (n = 50). It was noted that the clinical signs vary depending on the histological type of tumor, its location and direction of growth (i.e. medial or lateral). Medially growing tumors usually involved 2-4 sinuses, while laterally growing tumors involved only one sinus. Among the symptoms, disturbances of smell, conductive hearing impairment, deformation of both the soft and hard palate, slowing of the experimental nystagmus due to disturbed extraocular movements. Some light is shed on the differential diagnosis, indications for various surgical approaches (transcranial, transnasal, and facial). The results of surgical treatment and postoperative complications are presented in the paper. The diagnosis and treatment of such patients require an interdisciplinary approach while would involve a team of a neurosurgeon, neuroradiologist, otoneurologist, and a neuro-ophthalmologist.

[The comparative characteristics of the otoneurological disorders and of the computed and magnetic resonance tomographic data in tumors of the pineal area]. / Sravnitel'naia kharakteristika otonevrologicheskikh narushenii i dannykh komp'iuternoi i magnitno-rezonansnoi tomografii pri opukholiakh pineal'noi oblasti.

A hundred and twenty patients with pineal tumors were examined and analyzed. All the patients underwent detailed otoneurological examination supplemented by vocal and tone audiometry, electronystagmography. Computerized tomography (CT) with contrast reinforcement was made in all the patients. Magnetic resonance imaging (MRI) was conducted in 43 patients. Based on the findings, otoneurological symptomatology and CT and MRI data were compared. All the patients were divided into 4 groups by the size of a tumor and by the magnitude of its impact, as evidenced by CT and MRI. Comparing the findings, it can be concluded that with larger pineal tumors and the increased decompensation of a process there is a steady rise in the incidence of some otoneurological symptoms. Nevertheless, there is a clear relationship of otoneurological manifestations to the predominant growth of pineal tumors into the diencephalic area or into the posterior cranial fossa, by affecting truncal cochleovestibular formations and tumor sizes.

[Otoneurological symptoms and their changes after removal of pineal tumors]. / Otonevrologicheskaia simptomatika i ee dinamika posle udaleniia opukholei pineal'noi oblasti.

The authors analyze otoneurological symptoms in 120 patients with pineal tumors. A marked cochleovestibular syndrome was found characterized by bilateral neurosensory hypoacusis with vocal-tonal dissociation, head noises, vertigo, multiple spontaneous nystagmus including a converging one, impaired optokinetic nystagmus, enhanced vestibulovegetative reactions. 39 cases are reported with pineal tumors removed microsurgically. Otoneurological symptoms were followed up in 32 patients early after surgery (within 20 postoperative days) and in 6 patients 1 to 5 years after radiotherapy. As evident from otoneurological examination, electronystagmography, tonal and speech audiometry, positive postoperative changes in auditory and vestibular functions occurred in most of the patients. The response persisted long in 5 patients.

[The dynamics of the vestibulocochlear syndrome after the removal of tumors in the pineal area]. / Dinamika preddverno-ulitkovogo sindroma posle udaleniia opukholei pineal'noi oblasti.

The paper presents the follow-up data on 39 patients who underwent microsurgical removal of pineal tumors. Computerized and magnetic resonance tomographies were performed prior to and following the removal of pineal tumor. Otoneurological symptoms were analyzed in their dynamics in 32 patients in the early postoperative period (up to 20 days) and in 6 patients in the late period (1 to 5 years) after radiation therapy. Seven patients died from intracranial complications in the early postoperative period. Acoustic and vestibular functions were evaluated from otoneurological, electronystagmographic, pure-tone and verbal audiometric findings. The postoperative positive dynamics of acoustic and vestibular functions was observed in most patients. A steady-state positive effect also remained in 5 patients in the long-term period. The paper gives 2 cases with clear-cut positive cochlear dynamics after removing pineal tumors.

[Features of rhinologic and otoneurologic symptoms and complications in intracranial tumors growing into the nose and paranasal sinuses]. / Osobennosti rinologicheskoi, otonevrologicheskoi simptomatiki i oslozhnenii pri vnutricherepnykh opukholiakh, vrastaiushchikh v nos i ego pazukhi.

The authors analyse rhinological and otoneurological symptoms in 50 patients with benign craniofacial tumors verified at surgical interventions, computed tomography, NMR-tomography. The tumors involved anterior parts of the brain stem, nasal cavity and paranasal sinuses, 34 tumors were diagnosed as meningiomas. Clinical correlations with tumor histology and topography were noted. Specific ENT preoperative, postoperative and long-term complications are described. The diagnosis and treatment of the above patients need cooperation with specialists of the allied fields: neurosurgeons, neuroroentgenologists, otoneurologists, neuro-ophthalmologists.

[Rhinological data in the diagnosis and choice of the type of surgical intervention in cerebrospinal rhinorrhea]. / Rinologicheskie dannye v diagnostike i vybore vida operativnogo vmeshatel'stva pri nosovoi likvoree.

The study covers 70 cases of liquorrhea nasalis of various etiology. ENT specialists frequently regard liquorrhea nasalis as vasomotor allergic rhinitis. Liquorrhea nasalis may be divided into craniosinusonasal and cranionasal ones. The latter is more commonly followed by intracranial complications. An otorhinolaryngological otoneurological examination as part of a comprehensive study of patients with liquorrhea nasalis aids in diagnosing the disease and reveals the results of surgical treatment from the nasal endoscopic data, detects intranasal cerebral hernias, liquor cysts and tumors in the nasal cavity, residual otoneurological symptoms after prior meningitides, brain injuries and other diseases. A patient's positions and conditions allowing one to successfully detect even minimum liquorrhea nasalis have been worked out. Liquorrhea nasalis is subdivided into liquorrhea: a) that has no concurrent changes in the nasal cavity; b) that is accompanied by intranasal hernias and liquor cysts; c) that is concomitant with purulent sinusitis. The indications for any surgical intervention are different in each group, the rhinoscopic findings may be decisive in its choice. Among residual symptoms in patients with liquorrhea nasalis there are the most common olfactory disorders (35%) and mainly neurosensory hearing decrease (30%), beginning from mild hearing impairments resulting in complete deafness without vestibular excitability.

[Rhinologic and otoneurologic tests in the diagnosis of nasal liquorrhea and their significance in the choice of surgical treatment]. / Rinogolicheskie i otonevrologicheskie dannye v diagnostike nosovoi likvorei i znachenie ikh dlia vybora vida operativnogo vmeshatelstva.

Liquorrhea nasalis (LN) is considered by ENT specialists as vasomotor--allergic rhinitis. It is divided into craniosinusonasal and cranionasal. The latter form is more dangerous as to intracranial complications. Otorhinolaryngological and otoneurological examinations of LN patients are essential in the disease diagnosis, evaluation of surgical results (by nasal endoscopy), detection of intranasal medullary hernia, liquor cysts and tumors as well as residual otoneurological symptoms consequent to meningitis, brain trauma, etc. In choice of surgical treatment the attention of the physician should be directed to concomitant intranasal hernias and liquor cysts, tumors, purulent sinusitis. Out of 70 LN cases residual symptoms of olfactory disorders were recorded in 35%, neurosensory hypoacusis in 30% of the cases. The best position of the patient and relevant facilities for identification of even minimal LN are described.

[Otoneurologic symptoms of temporal pyramidal neoplasms]. / Otonevrologicheskaia simptomatika opukholei piramidy visochnoi kosti.

The paper reports 3 cases of primary tumors in the temporal bone. The diagnosis was confirmed clinically, by CT and NMR-tomography findings. The pyramid tumors are characterized by involvement of the VII and VIII nerves and tactile disorders on the anterior and middle tongue. The images obtained visualized destruction foci. When the tumor spreads to the top of the pyramid, it destroys the function of the acoustic tube, the tympanic membrane acquires remarkable sucked-in appearance. Symptoms of focal neurological affection are usually absent, intracranial pressure is not elevated. The symptom complex may be incomplete depending the tumor location on the pyramid. Tumor lesion occurs in the pyramid or may invade the posterior cranial fossa.

[Vestibulocochlear syndrome in lesions of the midbrain]. / Preddverno-ulitkovyi sindrom pri porazhenii srednego mozga.

Midbrain affection can be evidenced by pronounced central cochleovestibular syndrome which presents with converging spontaneous nystagmus, elements of monocular nystagmus, early impairment of optokinetic nystagmus in all the directions, bilateral neurosensory hypoacusis, a dramatic decrease of speech intelligibility in several sound sources, disturbed binaural hearing in normal or symmetrically reduced hearing, the absence of sound lateralization in Weber test under acute hearing asymmetry or unilateral deafness. Midbrain tumors are characterized by early hypertensive otoneurological syndrome indicated by caloric nystagmus of longer duration and greater tonicity. One case of midbrain lesion is detailed.

[The otoneurological symptoms in neurinomas of the gasserian ganglion and the root of the 5th nerve]. / Otonevrologicheskaia simptomatika pri nevrinomakh gassera uzla i koreshka V nerva.

The papers covers the specific features of manifestations of the Gasserian ganglion and its root with emphasis on the otoneurological findings of 70 patients with the diagnosis verified during surgery. According to the predominant extent of tumor growth, three groups of patients are identified: 1) those with a tumor located only in the middle cranial fossa (n = 23); 2) those with that in the cerebellopontine angle (n = 22); 3) those with its bulk in the middle cranial fossa, which extended to the posterior cranial fossa medially along the cranial clivus (n = 25). In addition to the local symptoms common to all three groups, otoneurological data typical of each group identified are analyzed thoroughly. The differential diagnostic criteria of neurinomas of the trigeminal nerve are presented.

[The surgical treatment of dysembryogenetic tumors in the sella-sphenoid location by a transnasal-trans-sphenoid approach]. / Khirurgicheskoe lechenie dizémbriogeneticheskikh opukholei selliarno-sfenoidal'noi lokalizatsii transnazal'no-transsfenoidal'nym dostupom.

In 1979-1993, a total of 1,320 patients with tumors of various histological patterns were operated on by transnasal and transsphenoidal access. Among them, 57 patients had dysembryogenetic tumors: craniopharyngiomas (n = 37), chordomas (n = 10), angiofibromas (n = 6), Rathke's pouch cysts (n = 2), epidermoid cysts (n = 2). Eleven patients were operated on by a combined access (transcranial, then transnasal). The paper gives in detail the clinical aspects, X-ray diagnostic features of dysembryogenetic tumors of sellar-sphenoidal site, identifies their basic growth variants. It also describes the specific features of the access and operation techniques. Indications and contraindications for surgery have been developed. Tumors were totally and subtotally removed in 82.5% of patients. Visual improvements were observed in 74.4%. It is concluded that the transnasal and transsphenoidal access maybe used as the major method of surgical treatment and combined surgical treatment of dysembryogenetic tumors of sellar-sphenoidal site.

[The treatment of severe peripheral vertigo by the intracranial ligation of the vestibular portion of the 8th nerve]. / Lechenie tiazhelykh perifericheskikh golovokruzhenii s vnutricherepnoi pererezkoi vestibuliarnoi portsii VIII nerva.

Eight patients with severe peripheral vestibular vertigo refractory to other drug and surgical treatments underwent intracranial ligation of the vestibular nerve VIII portion. All the patients had been operated on the middle and internal ears many times (from 12 to 15 operations) for chronic purulent otitis (5 patients), cholesteatomas, 2-3 attempts had been made to destruct the labyrinth; shunting of the endolymphatic sac was made 2-3 times in patients with Meniere's disease. In all the patients, severe peripheral vestibular syndrome was associated with central nervous disease, mainly formations of the cerebellopontile angle due to secondary arachnoiditis. After ligation of the vestibular nerve VIII portion, good results were achieved in 7 out of the 8 patients, but one had a satisfactory effect. The paper shows indications and contraindications for intracranial ligation of the vestibular nerve VIII portion. It also emphasizes that the operation is effective, but it should be effected by very strict and limited indications when all other treatments are ineffective and vertigo is critical.

[The clinical picture and differential diagnosis of rhinosinogenic brain abscesses]. / Klinika i differentsial'naia diagnostika rinosinusogennykh abstsessov golovnogo mozga.

Some specific features of the course of rhinosinogenic brain abscesses (RBA) in adults and children were distinguished on the basis of analysis of the clinical data in 49 patients. RBA is encountered more frequently among adults and rarely among children, especially those of young age. In adults RBA are mostly consequent upon chronic frontitis or polysinusitis, while in children they occur after maxillary sinusitis, and in young children also after acute purulent processes in the nasal cavity. The contact route of infection of the cranial cavity and solitary abscesses are usually encountered in adults, and the hematogenous-metastatic route in children with the formation of solitary RBA and, in many cases, of multiple and multichamber abscesses. In children the abscesses grow to a large size. The hypertension syndrome is clearly defined in adults, while the hydrocephalus-hypertension syndrome comes to the forefront in children. The infectious-toxic symptoms are more marked in children. Focal neurologic symptomatology is manifested more markedly in adults and is less marked and labile in children.

[A reliable symptom in differential diagnosis of cochlear and retrocochlear neurosensory hypoacusis (study of sound lateralization in Weber's test and ultrasound)]. / Nadezhnyi simptom dlia differentsial'noi diagnostiki kokhlearnoi i retrokokhlearnoi neirosensornoi tugoukhosti (issledovanie lateralizatsii zvuka v opyte Vebera i ul'trazvuka).

Sound laterality in Weber test occurs mainly in peripheral defects of the acoustic analyzer (lateral conduction or reception acoustic defects of the cochlea). In retrocochlear unilateral hypoacusis or loss of hearing, laterality in this test is absent in 80-90% of the cases (affection of the VIII nerve root, acoustic nuclei, stem and midbrain conductors). This symptom is most reliable in differentiation of cochlear with retrocochlear unilateral hypoacusis and deafness. In combination of retrocochlear hypoacusis of deafness with impaired sound conduction in the same ear, the sound in Weber test can show a paradoxical laterality in an absolutely deaf ear. This indicates that Weber test sound laterality definitely reflects changes in sound conduction. Ultrasound laterality occurs in the better hearing ear in any unilateral cochlear or retrocochlear lesions, thus complicating recognition of cochlear from retrocochlear affections. Laterality of ultrasound is a sensitive indicator of neurosensory abnormalities. Major trepanation bone defects of the parietotemporal skull did not influence sound laterality in Weber test.