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

UNLABELLED: 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.

[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.

[Surgical treatment of skull base chordomas].

The paper analyses the series of 220 observations of patients with cranial chordomas operated in Burdenko Neusurgical Institute (Moscow, Russia) since 1984 till 2007. Tumors were localized in sellar region (34.1%), clival region (32.3%), craniovertebral junction (27.3%); craniofacial chordomas were observed in 5.9% of cases, ectopias (without any connection with clivus and sphenoocipital junction)--in 0.5%. In most cases transnasal, retrosigmoid and pterional approaches were used for excision of the tumor. The paper emphasizes the problem of selection of surgical tactics, early and delayed postoperative results. 5-year survival rate was 62%, 10-year survival--47%.

[Topographic variants of cranial chordomas].

The objective of this study was to investigate variants of localization of cranial chordomas. We examined 220 patients treated in Burdenko Neurosurgical Institute (Moscow, Russia) since 1985 till 2007. In the vast majority of cases (93%) tumors were localized in sellar region (34%), clivus (32%) and craniovertebral junction (27%). As addition to previously suggested classifications we distinguish special group of craniofacial chordomas (5%). Although chordomas are theoretically midline tumors, according to our data in many cases (40%) they may be lateralized.

[Neurinomas and neurofibromas of the jugular foramen: diagnosis and surgical treatment]. / Diagnostika i khirurgicheskoe lechenie nevrinom i neirofibrom iaremnogo otverstiia.

The paper analyzes the authors' experience in treating 16 patients with neurinomas and neurofibromas of the jugular foramen. A tumor was located intracranially (Type A) in 1 case, at the level of the base of the skull (Type B) in 7 cases, extracranially (type C) in 3 cases, and extra- and intracranially (Type D) in 5. All the patients were operated on. One-stage removal was performed in 15 patients, in 1 case a tumor was removed in 2 steps. By taking into account differences in the site of the tumors, the authors used the following accesses: retrosigmoid, supracondyllar, extreme lateral transcondylar, retroauricular transtemporal, extended retroauricular transtemporal, lateral cervical. While planning accesses, it is necessary to bear in mind not only the direction of growth of these tumors, but also the pathways of collateral venous blood flow.

[Surgical treatment of meningiomas of the craniovertebral junction]. / Khirurgicheskoe lechenie meningiom kraniovertebral'nogo perekhoda.

The results of surgical treatment in 21 patients with meningiomas of the craniovertebral junction are presented. Main clinical diagnostic criteria in relation to the site of a tumor relative to the brain stem are considered. The basic surgical approaches used in the surgical treatment of meningiomas of the craniovertebral junction are described. These include posterior, median, posterolateral, transcondylar approaches. Surgical techniques to remove meningiomas having a matrix of varying areas were concretized, this is also done in relation to the consistency of a tumor. The outcomes of surgical treatment are analyzed. Possible postoperative complications and measures of their prevention and treatment are considered.

[Compression of the inferior cerebellar artery-induced compression of the medulla oblongata in Arnold-Chiari malformation as a cause of essential hypertension]. / Kompressiia prodolgovatogo mozga zadnei nizhnei mozzhechkovoi arteriei pri mal'formatsii Arnol'da-Kiari kak prichina arterial'noi gipertenzii.

Cerebrovascular abnormalities (primarily looping of cerebellar arteries) are almost without exception concurrent with the Arnold-Chiari syndrome and hydrocephalus. Persistent essential hypertension may be a manifestation of pathological vessel-brain contact. Customary microvascular decompression may lead to blood pressure stabilization in the postoperative period for a long time. The paper presents a clinical case of a 52-year female patient with the Arnold-Chiari syndrome who underwent microvascular decompression of the left posterior inferior cerebellar artery at the level of the medulla oblongata. Surgical treatment regressed preoperative cerebellar, bulbar, and truncal symptoms, lowered blood pressure from 190/100 to 120/80 mm Hg, and stabilized it at this level.