[Blood-brain barrier permeability in healthy rats and rats with experimental C6 glioma after fractionated radiotherapy of the brain].

OBJECTIVE: To evaluate the effect of fractionated radiotherapy on permeability of the blood-brain barrier in healthy rats and rats with C6 glioma in vivo. MATERIAL AND METHODS: An increase in BBB permeability in C6 glioma was assessed by dynamic MRI monitoring (glioma size before and after radiation therapy in combination with immunotherapy, n=30) and confocal microscopy (fluorescence imaging of tumor invasion boundaries in a dose-dependent experiment for the amount of injected antibodies). In healthy rats, BBB permeability to macromolecular substances (MMS) was assessed by ELISA (n=23, 192 plasma samples) and confocal microscopy (n=7). RESULTS: It was shown that BBB permeability to biological macromolecules in blood-brain and brain-blood directions was increased after fractionated radiotherapy. CONCLUSION: Drug delivery to the brain can be improved using therapeutic doses of radiation treatment that affects the BBB and minimizes the risk of serious side effects that are often associated with the drug dose.

[The outcomes of stereotactic radiotherapy in patients with cerebral arteriovenous malformations].

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.

Effect of γ-irradiation on expression of tight and adherens junction protein mRNA on in vitro blood-brain barrier model.

We studied the effect of γ-irradiation on HUVEC endothelial cells co-cultured with allogeneic astrocytes. This 2D in vitro model of the blood-brain barrier has the same parameters as cerebral microvascular endothelial cells forming the blood-brain barrier and allows reproducing its functions in vivo. Dose-dependent changes in cell morphology and violation of monolayer integrity were observed. Real-time PCR and immunocytochemical analysis revealed changes in the expression of tight (ZO-1, claudin-5) and adherens junction protein (vascular endothelial cadherin, ß-catenin) mRNA. Expression of tight and adherens junction proteins mRNA decreased in 2, 24, and 48 h after irradiation in doses of 2, 4, and 6 Gy. Significant dose-dependent changes were found only for ß-catenin mRNA expression in 2 h after exposition. This model of blood-brain barrier in vitro can be used for studying the molecular mechanisms regulating permeability of cerebral endothelium under normal conditions and after pathological exposures, e.g. γ-irradiation.

Expression of VEGF, GFAP, and BDNF genes in the brain of rats after fractionated γ-irradiation according to different protocols.

The expression of VEGF, GFAP, and BDNF genes in the nervous tissue changed on weeks 4, 8, and 12 after fractionated irradiation of the brain according to different protocols in a fixed total dose of 36 Gy. The expression of VEGF gene decreased in the prefrontal cortex and hippocampus after 4 and 8 weeks. After week 12, the expression of VEGF normalized in the prefrontal cortex and remained low in the hippocampus. The expression of GFAP gene was maximum in the prefrontal cortex after week 4 and returned to normal in week 12. In the hippocampus, the expression of GFAP was low only after week 12. The expression of BDNF gene was reduced only during the week 8 and this decrease was directly proportional to the single dose. Hence, fractionated γ-irradiation with fixed total dose differently modified gene expression in the nervous tissue.

Treatment of poorly differentiated glioma using a combination of monoclonal antibodies to extracellular connexin-43 fragment, temozolomide, and radiotherapy.

Antitumor efficiencies of monoclonal antibodies to connexin-43 second extracellular loop (MAbE2Cx43), temozolomide, and fractionated γ-irradiation in the monotherapy mode and in several optimized combinations were studied in Wistar rats with induced C6 glioma. The survival of animals with glioma and the dynamics of intracerebral tumor development were evaluated by MRT. Temozolomide monotherapy (200 mg/m(2)) and isolated radiotherapy in a total dose of 36 Gy shifted the survival median from 28 days (no therapy) to 34 and 38 days, respectively; 100% animals died under conditions of temozolomide monotherapy and radiotherapy. Monotherapy with MAbE2Cx43 in a dose of 5 mg/kg led to significant regression of the tumor (according to MRT data), cure of 19.23% animals with glioma, and prolongation of the survival median to 39.5 days after tumor implantation. Combined therapy with MAbE2Cx43 and temozolomide completely abolished the antitumor effect (survival median 29 days). Treatment with MAbE2Cx43 in combination with radiotherapy was associated with mutual boosting of the therapeutic efficiencies, leading to a significant inhibition of tumor development and prolongation of the survival median to 60 days. The mechanism of tumorsuppressive activity of the antibodies could be due to connexon blockade in Cx43-positive glioma cells in the peritumor invasion zone. Higher efficiency of combined therapy was presumably due to the increase in blood-brain barrier permeability for antibodies after irradiation of the brain and to additional inhibitory effect of antibodies towards radioresistant migrating glioma cells. The results suggested that MAbE2Cx43 could be effective as the first-line drug in combined therapy for poorly differentiated gliomas.

[Radiosurgical irradiation of patients with cerebral AVM on the Gamma knife].

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.

[Application of robotized radiosurgical system CyberKnife for the treatment of neurosurgical patients].

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.

[First experience of stereotactic radiation therapy for vestibular schwannoma using CyberKnife].

Currently stereotactic radiosurgery has become the treatment of choice in small vestibular schwannomas. This paper discusses our first experience of application of CyberKnife system for stereotactic irradiation of these tumors. From April 2009 till June 2011 we treated 62 patients (35 female and 27 male) with vestibular schwannomas. Stereotactic radiosurgery using CyberKnife system was performed in 33 patients. Mean tumor volume was 2 +/- 1.4 cm3. Hypofractionated treatment was used in 30 cases (31 tumor). Mean tumor volume reached was 7 +/- 6.2 cm3 (range - 0.5-31.3 cm3). In a case of a patient with NF2 simultaneous irradiation of bilateral tumors was performed. Most frequently we applied 3 fractions 6 Gy each (17 observations of 31, or 55%) and 5 fractions with mean dose 5 Cy (10 cases, or 32%). Follow-up period varied from 1 to 26 months (mean 9 +/- 4.5 months). By the end of this study (June 30, 2011) surgical resection was required in the only case of 47-years old male patient with cystic schwannoma of left vestibular nerve 5 months after radiation treatment, due to progressive growth of the cyst and increased brainstem compression. Tumor growth control was established in 97.5% of cases. Stabilization of auditory function was achieved in 77.5% of series. Effective hearing was preserved in 75% of patients. Facial nerve palsy after stereotactic radiation treatment was observed in 2 cases (3%). Incidence of trigeminal nerve dysfunction was significantly higher: sensation disturbances occurred in 6 (10%) patients: 3% after radiosurgery and 16.7% after hypofractionation. We did not obtain significant correlations between risk of cranial nerve complications and dosimetric or demographic factors. However we observed stable tendency: larger initial volume of the tumor and presence of trigeminal nerve dysfunction before treatment were poor prognostic factors for trigeminal neuropathy. Stereotactic irradiation using CyberKnife system is effective and sufficiently safe technique for management of vestibular schwannoma. The paper demonstrates high rates of tumor stabilization, hearing preservation and minimal incidence of complications associated with trigeminal or facial nerve.

[Early results of irradiation of intracranial meningiomas using CyberKnife].

Meningiomas are frequently diagnosed intracranial lesions which cannot be resected radically in the majority of cases. Traditional radiotherapeutical techniques allow control of tumor growth in such situations. CyberKnife system may be used for radiosurgery and in sight hypofractionation. During 27 months 231 patient with intracranial meningiomas of different localization was treated in department for radiation therapy of Burdenko Neurosurgical Institute using CyberKnife system (Accuray Inc., USA). Mean age was 53 years. 55% of patients underwent previous surgical treatment, and diagnosis of meningioma was histologically verified. In 231 patient 374 targets were irradiated. Mean volume of irradiation reached 15.8 cm3 (range - 0.73-108.5 cm3). In 89% of cases hypofractionated therapy was used, in 10.1% we performed radiosurgery. Catamnestic data were available in 80 patients. Mean follow-up period was 11.6 months (6-27 months). Control of tumor growth was established in 100% of cases with WHO grade I tumors, in 66.7% of WHO grade II tumors and 60% in WHO grade III tumors. Deterioration after radiation treatment was observed in 16% of cases of 75 with control of tumor growth. In 8 cases worsening was due to radiation-induced reactions verified by MRI studies. Radiosurgical and hypofractionated treatment of meningiomas using CyberKnife is actual and highly-effective technique. Further investigations are needed to determine optimal standards of hypofractionated radiotherapy of meningiomas.

[Stereotactic radiotherapy for cerebral metastases using CyberKnife].

During recent decade development of frameless techniques of fixation enabled introduction of stereotactic radiation therapy in metastatic brain lesions and made possible irradiation of large foci involving or proximal to eloquent and critical brain areas. This paper focuses on comparative analysis of effectiveness of hypofractionation (HRST) and radiosurgery (SRS) using CyberKnife system in cerebral metastases. Since November 2009 till June 2011 54 patients with cerebral metastases were treated using CyberKnife system. Age of patients ranged between 25 and 77 years (mean 54 years). 16 patients received radiosurgical treatment (mean total dose was 22.5-35 Gy, number of fractions varied from 2 to 7, mean volume of irradiation was 22.69 cm3) and 8 patients were treated by HRST with RS of selected foci (mean total dose reached 23 and 30 Gy, mean volume of irradiation was 1.02 cm3 and 11.19 cm3, respectively). Indices of overall regression and stabilization of disease for HRST and SRS groups were 81% and 79%, respectively. With mean follow-up period of 12.3 (1-16.1) months median survival for SRS and HRST reached 6.38 (1-15.8) and 6.2 (0.2-16.1) months and median recurrence-free survival was 3.6 (1-13.6) and 5.5 (2-14.2) months, respectively. Obtained results confirmed biological advantages of fractionated stereotactic radiotherapy of large cerebral tumors in comparison with radiosurgery. Prospective studies with rigid criteria of inclusion are required to determine optimal dose/volume/fractionation interrelations in stereotactic radiation treatment of cerebral metastases.

[First experience of radiosurgical treatment of arteriovenous malformations using CyberKnife].

Radiation treatment techniques are essential in complex management of selected neurooncological, neurovascular and functional brain pathology. Stereotactic radiotherapy provides sufficient damage to the target (tumor, AVM, functional structures) with minimal impact on surrounding brain tissue. Development of stereotactic methods with X-ray guidance lead to expansion of indications for irradiation of intracranial and extracranial lesions. This paper represents the first experience of treating patients with AVMs using CyberKnife system in Russia. The technique of stereotactic radiotherapy (SRT) and radiosurgery (SRS) is described in details, as well as indications for SRT and SRS in different regiment of fractionation, possibilities of planning systems, with additional emphasis on specific complications, radiation-induced reactions and capabilities of neurovisualization methods in evaluation of radiation-induced damage of brain tissue.

[CyberKnife stereotactic radiotherapy for mass lesions of the spinal cord and spine].

Introduction of a novel technology of stereotactic radiation treatment using linear accelerators, refining of systems for visualization and guidance provided rapid development of extracranial radiosurgery. Nowadays there is a possibility of precise stereotactic irradiation of lesions with different size and localization. One of the most actual and promising indications for radiosurgery are different primary and metastatic lesions and arteriovenous malformations of spinal cord and spine. Radiosurgery and hypofractionated radiotherapy with precise dose delivery during one or several sessions allow effective and safe treatment of neoplasms with any degree of radioresistance. This paper contains analysis of the first Russian experience of stereotactic radiation treatment of lesions of spinal cord and spine using robotized system CyberKnife (Accuray Inc., USA).

[CyberKnife stereotactic radiosurgery in the treatment of patients with trigeminal neuralgia].

Trigeminal neuralgia (TN) is a disabling disease with severe impairment of quality of life and everyday activity of patients. Range of treatment modalities is wide and includes conservative therapy, surgical methods and stereotactic radiosurgery (SRS). SRS is a minimally invasive technique which provides good results and minimal rate of complications. High geometrical and clinical precision of frameless SRS using CyberKnife system allows its application in TN when high dose is delivered to a small volume. The given paper focuses on the first Russian experience of frameless SRS of TN using robotized system CyberKnife. Since April 2009 till June 2011 4 patients with TN were treated in department for radiation therapy of Burdenko Neurosurgical Institute using CyberKnife system. Mean age was 63 years. Mean and maximal target dose reached 70 and 90 Gy, respectively. Data of catamnestic clinical examination were available in all 4 patients. Follow-up period reached 8 months. Response to treatment was observed in all cases. In 2 (50%) patients full effect was reached while in the rest only partial effect was present. No complications were encountered. Effectiveness and safety of SRS using CyberKnife system is comparable with framed SRS.

[Stereotactic radiotherapy and radiosurgery in treatment of patients with deep-seated pilocytic astrocytomas].

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.

[Application of SPECT/CT in neurosurgical practice].

The paper presents the experience of application of single-photon emission computed tomography (SPECT) and CT in neurosurgery. Combination of these two techniques in the single system provides higher precision of both methods. The novel technique allows assessment of tumor spread in the brain, differential diagnosis of tumor regrowth and radiation-induced necrosis, evaluation of cerebral perfusion in epilepsy, traumatic brain injury (TBI), and diagnostics of secondary CNS lesions. Examples of primary diagnosis, dynamic follow-up and differential diagnosis of cerebral neoplasms, localization of epileptogenic foci in planning of surgery, prediction of outcome after TBI and evaluation of spread of metastatic skeletal involvement and further application of acquire data are presented.

[Linear accelerator-based stereotactic radiation treatment of patients with medial middle fossa meningiomas].

Medial middle fossa meningiomas are challenging for neurosurgical treatment. Invasion of cranial nerves and vessels leads to high risk of complications after removal of such meningiomas. Currently methods of conformal stereotactic radiation treatment are applied wider and wider for the discussed lesions. During a 3.5-year period 80 patients with medial middle fossa meningiomas were treated in Burdenko Moscow Neurosurgical Institute using linear accelerator "Novalis". In 31 case radiation treatment was preceded by surgical resection. In majority of patients symptoms included cranial nerve dysfunction: oculomotor disturbances in 62.5%, trigeminal impairment--in 37.5%, visual deficit--in 43.8%, facial nerve palsy--in 1.25%. 74 patients underwent radiotherapy with classical fractioning, 2--in hypofractionated mode and 4 received radiosurgery. In cases of classical fractioning mean marginal dose reached 46.3 Gy during 28-33 fractions, in hypofractioning (7 fractions)--31.5 Gy, in radiosurgery--16.25 Gy. Mean follow-up period was 18.4 months (6-42 months). Control of tumor growth was achieved in 97.5% of cases (78 patients): in 42 (52.5%) lesion shrinked, in 36 (45%) stabilization was observed. Clinical examination revealed improvement of visual function in 15 patients (18%) and deterioration in 2 (2.5%). No new neuropathies were found. Stereotactic radiation treatment is the method of choice for medial anterior and middle fossa meningiomas due to effective control of tumor progression and minimal rate of complications.

[Linear accelerator-based stereotactic radiotherapy and radiosurgery in treatment of neurosurgical patients].

Radiation methods are essential in management of certain types of neurooncological, neurovascular and functional brain pathology. Application of stereotactic technique of irradiation allows sufficient damaging impact on target (tumor, AVM, functional structures) and maximal protection of surrounding brain tissues. Indications to radiation treatment of intracranial lesions are expanding with evolution of stereotactic methods. The paper deals with the first experience of linear accelerator-based treatment of patients with intracranial neurosurgical pathology in this country. Techniques of stereotactic radiotherapy (SRT) and radiosurgery (SRS), indications to SRS and SRT in different modes of fractioning are described in details. Additionally specific complications, radiation reactions and feasibility of neurovisualization in diagnosis of radiation-induced brain damage are discussed.

[Stereotactic radiotherapy and radiosurgery in treatment of patients with intracranial schwannomas].

Aim of this study is to assess the role of stereotactic radiosurgery (SRS) and radiotherapy (SRT) in management of cranial nerves schwannomas by analysis of tumor control, clinical response and variables affecting treatment outcomes. Between April 2005 and January 2009 patients with schwannomas of VIII (63), V (14) and caudal nerves (2) were treated in Burdenko Moscow Neurosurgical Institute using linear accelerator. Mean age was 49 years (13-82). In 42 cases radiation treatment was preceded by surgical resection. 13 patients had type I or II neurofibromatosis. Mean volume of the tumor was 3.9 cm3 (0.5-14.4 cm3) and 13.4 cm3 (2.8-41.3 cm3) for SRS and SRT, respectively. Mean SRS dose was 12 Gy (10.8-14.4 Gy) for vestibular schwannomas and 15 Gy (13.2-18 Gy) for schwannomas of other nerves. In hypofractionated SRT the dose of 35 Gy was delivered in 7 fractions or 30 Gy in 6 fractions. In cases of classical fractioning total dose of 50-60 Gy was divided into daily fractions of 1.8-2.0 Gy. Radiographic tumor control rate reached 97.5% at the last follow-up. 5 patients experienced trigeminal dysfunction, it was transient in 3 cases and persistent in 2. Permanent decline in House-Brackmann facial nerve scale developed in 2 of 79 patients. After treatment effective hearing (class I-II) was preserved in 7 of 9 patients (67%) who had same level of hearing before SRS. Linear accelerator-based stereotactic radiation treatment provides long-term tumor control associated with high rates of preservation of neurological functions. No further tumor surgery was necessary in 100% of cases with solitary tumors with a minimal follow-up of 5 years.

[Stereotactic radiosurgery in treatment of patients with hypothalamic hamartomas].

Hypothalamic hamartoma (HH) is malformation of the brain manifesting by paroxysmal disorders (gelastic seizures) and endocrine disorders (mostly precocious sexual development). Surgical resection of HH is associated with the risk of severe neurological and neuroendocrine complications. Alternative ways of treatment are being investigasted. Stereotactic radiosurgery is one of the leading techniques in treatment of pharmacoresistant seizures due to high effectiveness and low complication rate. Since 2005 till 2009 7 patients with HH were treated in Burdenko Moscow Neurosurgical Institute. Age of patients varied between 9 months and 20 years 9 mean - 8.5 years). In all cases the disease manifested by gelastic seizures with frequency differing between 2-3 per months and 17 per day. All patients received long-term combined anticonvulsant treatment (using valproates, carbamazepine, lamotrigine, oxcarbazepine, topiramate) with temporary and insufficient effect or without any effect. In 4 patients frequency of seizures increased during anticonvulsant therapy. I patient had been operated (partial resection of HH) with temporary effect which consisted of decrease in frequency of seizures for 8 months; later frequency of paroxysms increased. Main indications to radiosurgical treatment included progressive course of disease, low effectiveness of anticonvulsant therapy and high risk of direct surgical treatment. 6 patients were treated using linear accelerator "Novalis" and 1 using "Cyber-knife". Treatment was performed under pharmacological sedation (midazolam, ketamine). Marginal dose was 11-18 Gy (mean 15.7 Gy). Volume of hamartomas was 0.3-3 cm3. Follow-up period varied between 3 and 50 months. Decreased frequency of seizures was observed in 100% of cases. Stereotactic radiosurgery is an effective and safe method of treatment for HH and may be considered as treatment of choice for pharmacoresistant seizures caused by HH.

[Linear accelerator-based stereotactic radiotherapy in combined treatment of skull base chordomas].

Short-term results of postoperative stereotactic linear accelerator-based radiation treatment of 18 patients with cranial base chordomas are analyzed. Total dose was 70 Gy or more. Control of tumor growth confirmed by CT and/or MRI was achieved in 15 cases (83%). Only 1 patient had complication--visual deficit which resolved after 3 months. Control group consisted of 73 patients treated only surgically. 38% of cases in this group were recurrence-free. The study has demonstrated effectiveness of radiotherapy of skull base chordomas.