[The collateral venous blood flow and the surgical procedure in parasagittal meningiomas]. / Kollateral'nyi venoznyi krovotok i khirurgicheskaia taktika pri parasagittal'nykh meningiomakh.

Peculiarities of the collateral venous bloodflow were analysed in 242 cases of parasagittal meningiomas (PM). The cerebral veins participated in collateral bloodflow in 52.1% of cases with tumours of the anterior third of the superior sagittal sinus (SSS), whereas in 39% of such cases the retrograde flow through proximal SSS have been found. Neoplasms of the middle/posterior third of SSS led to the collateral venous bloodflow through the anastomoses of the cerebral veins in 67% of cases. In 56% of patients the collateral flow was through extracerebral veins. The absence of strict conformities in the development of the collateral venous bloodflow leads to necessity of its intraoperative control by EEG monitoring. Severe changes of bioelectrical activity (14.9% of cases) are an indication for division of the surgical procedure into several stages.

[Results of the surgical treatment of patients with basal extracerebral parastem tumors of large and giant dimensions]. / Rezul'taty khirurgicheskogo lecheniia bol'nykh s bazal'nymi vnemozgovymi parastvolovymi opukholiami bol'shikh i gigantskikh razmerov.

A retrospective analysis of the results of treatment of 123 patients with large and giant basal extracerebral parastem tumors was made. The majority of the neoplasms (81%) were acoustic neuromas and meningiomas. The nearest results of the treatment were good in 103 patients and unfavorable results were noted in 20 patients. Postoperative mortality was 8.9%. Four factors negatively influencing the outcome were revealed during the statistical analysis (p < 0.05): low Karnofsky score at admission, regrowth (recurrence) of the tumor, previously performed radiation therapy and shunt surgery as the first stage of treatment. These prognostic factors must be taken into account when choosing the best treatment of patients with parastem tumors.

[The characteristics of the surgical treatment of basal meningiomas with supra-subtentorial spread]. / Osobennosti khirurgicheskogo lecheniia bazal'nykh meningiom s supra-subtentorial'nym rasprostraneniem.

The results of surgical treatment of 63 patients with basal meningiomas with supra-subtentorial spread were analyzed. The study has shown the effectiveness of one-stage tumor removal via supra-transtentorial approach with skull base bones resection. It is recommended to estimate an extent of operation on the basis of intraoperative assessment of biological behavior of the tumor, including interrelationship of tumor capsule and brainstem pia mater. Mortality rate was decreased from 23.8% to 11.1% following introduction of these principles.

[The surgical treatment of meningiomas of the superior sagittal sinus (the surgical approach and technic)]. / Khirurgicheskoe lechenie meningiom verkhnego sagittal'nogo sinusa (taktika i tekhnika operatsii).

The authors analyze the results of surgical management of 242 patients with upper sagittal sinus meningiomas who have been treated in the past 20 years. All the patients were divided into 3 groups in accordance with the surgical policy and techniques of interventions and anesthesiological support. The type of sinus wall tumor lesion and its associated cerebral blood outflow disorders detected by electrophysiological studies in pre- and intraoperative periods determined surgical policy which along with microsurgical technique of recovery of the intact sinus and superficial veins of the brain enhanced the efficiency of operations up to 92.2% and reduced fatal outcomes to zero.

[Microsurgical revascularization of the brain with an autograft of the greater omentum (experimental research)]. / Mikrokhirurgicheskaia revaskuliarizatsiia golovnogo mozga autotransplantatom bol'shogo sal'nika (éksperimental'noe issledovanie).

The paper deals with improvement of procedures for autografting a greater omental fragment to the vascular layer of the brain in its experimental ischemic lesions. The findings suggest that a functional vasculature has formed between the omentum and the meninx vasculosa just at hour 24 postautografting. This provides evidence to recommend the method for clinical application to compensate cerebral circulatory disorders in tumor-induced and vascular abnormalities in the brain.

[A nontraditional approach to anesthesiological support and intensive therapy in neurosurgery]. / Netraditsionnyi podkhod k anesteziologicheskomu obespecheniiu i intensivnoi terapii v neirokhirurgii.

Using mediator agents in definite combinations allows one to simulate the functions of the genetically determined levels of adaptive reaction integration. The action of combinations of narcotic analgetics with varying receptor affinity and alpha 2-adrenomimetics impoverishes and modulates a flow of sensory information to the higher centers of autonomic integration and largely relieves efferent impulsation. This ensures harmonicity of the reactions and makes for the operation of local sanogenetic mechanisms of the brain at functional rest. Anesthesia performed in the early postoperative period by using a combination of the narcotic analgetic phentanyl and the centrally acting alpha 2-adrenoagonist clofelin enables the authors to significantly improve the outcomes of treatment.

[Monitoring control of the visual evoked potentials during the surgical treatment of tumors of the chiasmal-sellar area]. / Monitornyi kontrol' zritel'nykh vyzvannykh potentsialov pri khirurgicheskom lechenii opukholei khiazmal'no-selliarnoi oblasti.

Visual evoked potentials were recorded in different stages of the operation in 12 patients with tumors of the chiasmal-sellar region. A correlation was noted between the dynamics of the P100 latent period and the changes of visual functions after the operation. Intraoperative monitoring of visual evoked potentials makes it possible to appraise the functional condition of the optic nerves objectively and correct the techniques and tactics of the operative intervention.

[The evaluation and choice of treatment methods (surgical removal, proton-beam irradiation) in endosellar hypophyseal adenomas]. / Otsenka i vybor metodov lecheniia (khirurgicheskoe udalenie, obluchenie puchkom protonov) éndoselliarnykh adenom gipofiza.

The article analyses the immediate and late-term results of treatment of endosellar pituitary adenomas: removal through a transsphenoidal approach--16 patients, transnasal stereotaxic administration of 90Y--14 patients, irradiation by proton beam--263 patients. Surgery as well as radiotherapy produced quite satisfactory results. Proton therapy on a Leningrad synchrocyclotron is not inferior to the modern surgical methods in efficacy and safety. It is indicated in endosellar pituitary adenomas when the sella turcica measures no more than 20 x 16 mm.

[The results of the microsurgical treatment of supratentorial meningiomas]. / Rezul'taty mikrokhirurgicheskogo lecheniia supratentorial'nykh meningiom.

Analysis of the results of treatment of patients who underwent operation for supratentorial meningiomas showed the advantages of operations using wide modified approaches, microsurgical methods, improved anesthesiological service and timely treatment in the early postoperative period. These advantages were manifested in diminished degree of neurological disorders after the operation, significant decrease of the number of postoperative cerebral complications, and reduction of postoperative lethality, altered structure of the causes of death, and shortening of the postoperative inpatient treatment period.

[Prophylaxis of brain edema in neurosurgical operations]. / Profilaktika oteka golovnogo mozga pri neirokhirurgicheskikh operatsiiakh.

Rational surgical approaches providing for preservation of the arteries and veins of the brain and minimal mechanical damage to it during the removal of tumors, the use of adequate anesthesia which prevents the development of vegetative reactions of central origin, and postoperative correction of the patients' condition under clinical and physiological control allow the development of cerebral edema to be prevented. Experience in the management of 1,447 patients with intracranial, mainly extracerebral, tumors showed that postoperative lethality can be reduced from 27.0 to 4.3%.

[Approach to tumors of the chiasm-sellar region with preservation of the olfactory tracts]. / Dostup k opukholiam khiazmal'no-selliarnoi oblasti s sokhraneniem oboniatel'nykh traktov.

Mobilization of the olfactory tract in mono- and bifrontal approach to the chiasmal-sellar region with preservation of its own vascular network down to the olfactory trigone on the side of the approach and for a distance of 20 mm from the other side creates adequate conditions for the operation. According to the EEG values, the degree of the operative trauma does not increase essentially and the prognosis of vision restoration is no worse. The olfactory function is restored immediately after surgery in most cases.

[Features in the diagnosis of meningiomas of the Sylvian fissure]. / Osobennosti diagnostiki meningiom sil'vievoi shcheli.

Examination of 12 patients with meningiomas of deep portions of the Sylvian fissure showed that at the early stages of the development of tumours the disease manifested clinically in intracranial pressure elevation and intellectual-mnemonic disturbances. Focal neurotic symptomatology is expressed at a later stage of the disease. The use of supplemental methods of examination, in particular of Echo EG, allowed localization of the tumor process in the area of the lateral sulcus in all cases. Preoperative identification of the histological structure of the neoplasm became possible only after angiography had been performed.

[Surgical echographic diagnosis of brain tumors]. / Operatsionnaia ékhograficheskaia diagnostika opukholei golovnogo mozga.

Echographic examination of 43 patients was conducted during removal of tumors or during diagnostic operations. Brain tumors of supra- and subtontorial localization were detected. The use of an improved ultrasonic transducer and the transmission sonication method helps in identifying more exactly the character, size, and depth of the tumor as well as determining the condition of the ventricles and main arteries of the brain. The application of the improved method ensures the choice of an adequate surgical approach and reduces the traumatic character of the operation.