[Modern aspects of reconstructive surgery of skull defects]. / Sovremennye aspekty rekonstruktivnoi khirurgii defektov cherepa.

The aim of this study is to systematize the modern methods used for reconstruction of extensive and complex skull defects. Special attention is paid to computer technologies, including 3D imaging and CAD/CAM. Laser-based stereolithography is thoroughly reviewed among other additive technologies. We present our view of the problem associated with proper timing of cranioplasty and choice of materials for it. Complications of skull defect reconstruction are also discussed.

[Intraoperative vascular fluorescence in cerebral glioblastomas and vascular histological features]. / Intraoperatsionnaia fluorestsentsiia sosudov v strukture glioblastom golovnogo mozga i ikh gistologicheskaia kharakteristika.

5-ALA intraoperative fluorescence is widely used in surgery of brain tumors for intraoperative demarcation of boundaries and more total resection because 5-ALA metabolites are not accumulated in the intact brain and vascular tissues. Given this fact, it was hypothesized that fluorescence of vessels in the immediate vicinity of a brain tumor may indicate their infiltration by tumor cells as a potential pathway for their dissemination and as a factor for continued tumor growth after surgery and adjuvant therapy. PURPOSE: Identification of fluorescent vessels located near cerebral gliomas, with a histological description of their structure, relationships with the tumor, and potential invasion of the walls by tumor cells. MATERIAL AND METHODS: A prospective cohort study included 14 patients with malignant supratentorial gliomas, aged 20 to 78 years. Five patients were operated on due to continued tumor growth. Two hours before surgery, all patients received 5-ALA orally. During surgery, a microscope (Carl Zeiss OPMI Pentero, Germany) with a fluorescent module (BLUE-400) was used. In all cases, molecular-genetic and immunohistochemical examinations of the tumor material were performed. During surgery, fluorescent vessels, after evaluating their functional significance, were also resected for histological examination. RESULTS: Glioblastoma and anaplastic astrocytoma were verified in 10 and 4 patients, respectively. In 4 out of 10 glioblastoma cases, vessels with homogeneous or fragmentary fluorescent walls were detected in the tumor bed after resection of most of the tumor; in patients with anaplastic astrocytomas, vascular fluorescence was not observed. In the four vascular samples with intraoperatively detected wall fluorescence, tumor invasion into the vascular layers was revealed in all cases. These patients underwent an immunohistochemical examination with monoclonal antibodies to the glial GFAP marker, which clearly identified areas of ingrowth of tumor cells into the vascular wall. CONCLUSION: 5-ALA intraoperative fluorescence is a fundamentally new approach in the rapid diagnosis of tumor-infiltrated blood vessels. Invasion of tumor cells to intact vessels may be a mechanism of tumor progression and dissemination. Additional resection of fluorescent vessels may affect the radicalness of surgical treatment, but requires a mandatory assessment of their functional significance.

[Additive technologies in neurosurgery]. / Additivnye tekhnologii v neirokhirurgii.

Modern achievements of technical progress, in particular additive technologies (ATs) and three-dimensional printing, have been increasingly introduced in neurosurgical practice. The increasing complexity of surgical interventions requires thorough planning of surgery and a high level of training of young neurosurgeons. Creation of full-scale three-dimensional models for planning of surgery enables visualization of the anatomical region of interest. Additive technologies are especially extensively used in reconstructive surgery of skull defects. ATs enable fast and efficient solving of the following tasks: - generation of accurate models of the skull and an implant; - development and fabrication of individual molds for intraoperative formation of implants from polymeric two-component materials (e.g., PMMA); - fabrication of individual implants from titanium alloys or polyetheretherketone (PEEK) for further use in surgery.