[Primary and metastatic Ewing sarcoma of the skull base - case reports and comparative analysis].

UNLABELLED: The aim of the present study was to evaluate and compare diagnostic/and treatment modalities of primary and metastatic Ewing sarcoma (ES) of the skull base. MATERIAL AND METHODS: We analyzed nine cases of the skull base ES patients operated in Burdenko Neurosurgical Institute from 2003 to 2011. Among them there were five cases of primary ES, the other four were of metastatic origin. Clinical history, neuroimaging and pathology data together with IHC are presented. Treatment options and results are discussed. Seven patients were operated transcranially, in the other two cases endoscopic endonsnasal operations/were performed. Mean follow up was 11-92 months. RESULTS: We did not reveal arW pathological or IHC differences between primary and metastatic tumors. The labeling index Ki-67 was insignificantly higher in the metastatic tumors gro'Vip. In one case the patient developed relapse of the metastatic tumour in the temporal bone; he underwent second surgery and died 7 months after the operation. CONCLUSION: Despite both metastatic and primary ES of the skull base are of maMignant behavior, the long-term relatively good prognosis can be achieved when combined treatment, including surgery, chemotherapy and radiation is applied.

[Orbitosphenopetroclival meningeomas: clinical and topographic features and results of combined treatment]. / Orbitosfenopetroklival'nye meningiomy: kliniko-topo-grafi-cheskie osobennosti i rezul'taty kombinirovannogo lecheniia.

UNLABELLED: The aim of the study was to access clinical and topographic features of orbitosphenopetroclival meningeomas and the results of surgical and combined treatment in patients with meningeaomas of that location. Orbitosphenopetroclival meningeomas comprise a peculiar group of tumors and are the result of infiltrative sphenopetroclival meningeomas progression, when the latter extend into the orbit and temporal fossa. Development of neurosurgery, use modern approaches and adjuvant therapies such as stereotaxic radiosurgery and radiotherapy in the past years markedly improve treatment results in these patients. However, difficulties in treatment strategy choice remain. One attempting to excise a tumor radically encounters with the risk of damage to critically important neurovascular structures. When a tumor is excised partially the risk of complication dwindles, however risk of relapse increases. Palliative surgery improve patients' quality of life. Radiosurgery and irradiation of residual tumors allow to establish control on a tumor growth. MATERIAL AND METHODS: Twenty three patients were studied, of them 20 received surcery, 9 - stereotaxic irradiation, 5 - conventional irradiation. The follow-up interval comprised 8-84 months (median 37 months). RESULTS: Manifestations of orbitosphenopetroclival meningeomas are combined from signs and symptoms of cranioorbital and petroclival meningeomas, and in many patients include signs of skull base external surface involvemevt, marked cosmetic deficits and psychological distress. Orbitosphenopetroclival meningeomas originate from cavernous sinus and medial parts of sphenoid bone wings. During its progression a tumor extends onto orbit and onto clivus, and then onto infratemporal and sphenopalatine fossae, nasopharynx and posterior cranial fossa. CONCLUSION: If a residual tumor is present patients with orbitosphenopetroclival meningeomas should undergo adjuvant irradiation after the first surgery.

[A combination of a meningioma of the base of the skull and an arteriovenous micromalformation of the brain stem]. / Sochetanie meningiomy osnovaniia cherepa i arteriovenoznoi mikromal'formatsii stvola mozga.

The paper describes a rare combination of atypical meningioma of the base of the skull, which was greatly extended, with a life-time unrecognized small vascular malformation of the brain stem at the level of the pons. Intraoperative hemorrhage into the stem from the micromalformation was a cause of the female patient's death. A detailed account of the operation and the postoperative period and a review of literature on the main aspects of the problem in the diagnosis of cerebral micromalformations are given.

[The 2-stage surgical treatment of a giant chordoma of the clivus growing into the oropharynx and posterior cranial fossa]. / Dvukhétapnoe khirurgicheskoe lechenie giganskoi khordomy skata s rostom v rotoglotku i zadniuiu cherepnuiu iamku.

Chordomas are relatively rare dysontogenetic tumors developing from the remnants of the spinal chord. Intracranial chordomas consist of 85% of all chordomas. Slowly progressive growth with destructive osteolysis in adjacent bones and low metastatic potential are specific for chordomas. Ninety six surgeries were performed in 71 patients with chordomas at the Burdenko Institute of Neurosurgery from 1987 to 1996. This article presents a clinical case of large clival chordoma with extra-intracranial growth in a 58 year-old female patient. The clinical picture is characterized by lesions in the caudal cranial nerves, predominantly on the right side, as well as cerebellar and brainstem signs and symptoms. Two-stage partial removal of malignant clival chordoma was performed via transoral and retrosigmoid approaches. The interval between the stages was 6 months. In the authors' opinion, multistage surgery is preferred in the treatment of giant clival chordomas. Partial removal should be started from the portions of a tumor producing the most prominent neurological signs. This method allows the patient's status to be temporarily improved.

[Surgery of the base of the skull]. / Khirurgiia osnovaniia cherepa.

To treat pathological processes, primarily tumors, in the base of the skull is one of the most intricate neurosurgical problems. In the past decade, interest in this problem has greatly increased due to the advent of new methods of diagnosis, up-to-date neurosurgical equipment and to a greater cooperation of physicians of related disciplines: ophthalmologists, otosurgeons, plastic surgeons. The authors present and summarize the experience accumulated by the researchers of the N. N. Burdenko Institute of Neurosurgery in the past 10 years in treating basal tumors. Based on a great deal of clinical findings, approaches are proposed in treating some groups of basal tumors, such and pituitary adenomas, craniopharyngiomas, meningiomas at various sites, trigeminal and acoustic neurinomas, and malignant neoplasms of the base of the skull. The conditions required for successful surgical treatment of the processes in the base of the skull are described in detail. One of them is a correct determination of a surgical approach.

[Disorders of cerebrospinal fluid dynamics and intracranial hypertension in patients with several cranio-cerebral trauma]. / Narusheniia likvorodinamiki i vnutricherepnaia gipertenziia u bol'nykh s tiazheloi cherepno-mozgovoi travmoi.

The authors studied the incidence of hydrocephalus and intracranial hypertension in 60 patients with severe craniocerebral trauma from comparison of the findings of computed tomography and the results of prolonged monitoring of intracranial pressure. The mechanisms of the development of hydrocephalus and intracranial hypertension are described. Hydrocephalus is among the causes of intracranial hypertension. In view of this, external fractional drainage of the ventricular CSF should be applied together with the removal of intracranial hematomas and measures of intensive therapy in patients with severe craniocerebral trauma.