[Radiodiagnostics of brain tumors before and after operation].

The radiation diagnosis made before and after operation was analyzed in 231 case histories of patients with brain tumors treated in hospitals of St.Petersburg in 2009. Most typical errors of administration and interpretation of radiation diagnostic methods were established. MRI was not performed in 54% of cases, in 32% operative intervention was performed without SCT findings. Contrast enhancement was used but in 68% of observations, angiographic methods--in 8%. Not a single radiation examination was performed in 61% of patients, in 33% SCT was made, in 6%--MRI, only in a third of patients contrast enhancement was used. In 52% of cases control radiation examination was not prescribed in dynamics. The estimation of the data obtained helped to obtain more exact criteria of using radiation methods in patients with tumors of the brain before and after operation.

[Questions of quality and its assessment in rendering medical aid to patients with cerebral tumors].

A retrospective analysis of 231 case histories of patients with cerebral tumors treated at different hospitals of St. Petersburg in 2009 and expert assessment of the quality of medical care were made. Most frequent defects of medical care were established which were systematized in 3 main groups depending on their influence on the state and results of treatment of the patient: significant, minimally significant and not significant. They were: different errors in pre- and postoperative examinations, medical and surgical strategy as well as making up medical documentation. Significant defects were revealed in 75%, minimally significant--in 47% and not significant--in 83% of observations. In most cases there was a combination of defects of different groups (79-90%). Assessment of the quality of medical care on the basis of the groups established allows the aimed clinical-organizational liquidation of them.

[Significant regression of glioblastoma with low level of Mgmt gene expression following radiotherapy].

Radiochemotherapy is leading the universal research effort in fighting lethality: it is improving relapse-free survival of patients with inoperable glioblastoma, the most pernicious brain tumor in adults. Its effectiveness was found to depend on expression of Mgmt gene of tumor DNA reparation following radiochemotherapy and adequate medication based on the molecular phenotype of tumor. Our study involved a 40-year old male with a low level of Mgmt gene expression as established by stereotactic biopsy. The patient received hypofractionated three-dimensional conformational proton therapy with the benefit of temozolomide (140 mg/24 hr). Subsequently, the dose was raised to 360 mg/24 hr, on days 1-5 of the cycle. Contrast-enhanced MRI examination established significant diminishing of the size of tumors on completion of cycles 7 and 8; patients felt better, memory and blood indices improved. As of the time this paper was written, relapse-free survival was 17.5 months, as compared with the literature data on inoperable glioblastoma--5.5 months.

[Application of damper craniofixators from nitinol in plasty of skull defects].

An overview of the methods of fixation of the skull bones is presented,as well as discussion and characterization of different methods of fixation. A new system of fixation of the skull bones was used in osseous-plastic trepanation and reconstructive operations using nitinol craniofixators. Results of cranioplasty using craniofixators were analyzed in 62 patients with craniocerebral injuries and its consequences, vascular and oncological diseases of the brain. There were no complications in the postoperative period. Articles made of nitinol are very strong, elastic and have the effect of thermo-mechanical memory of the form.

[Metastatic glioblastoma in a submandibular lymph node (a rare case)].

Extraneural metastases from glioblastoma are rare. A case of metastatic right parietal lobe glioblastoma in cervical node after repeat craniotomy is presented.

[Long-term results of treatment in patients with oligodendrogliomas and oligoastrocytomas of the cerebral hemispheres].

BACKGROUND: the current approach to treating patients with cerebral oligodendrogliomas and oligoastrocytomas involves surgical treatment with the maximum tumor resection in reasonable ranges, by taking into account the anatomic and physiological availability, followed by chemo- and radiotherapy. Nevertheless, it should be recognized that criteria for choosing the optimum regiment for the treatment of these tumors have not conclusively established. MATERIALS: the long-term results of treatment were analyzed in 80 patients with oligoglial tumors (oligodendrogliomas and oligoastrocytomas in 31 and 49 patients, respectively) treated at the A.L. Polenov Russian Institute of Neurosurgery in 1990 to 2004. The patients' mean age was 18.9 years. 38.5% of tumors were located in the frontal lobe. In 67 (83.75%) patients, Karnoffsky score was 70-90. Radiotherapy was used in the treatment of 71 patients and postoperative chemotherapy in 52 (87,5%) patients. RESULTS: After complex therapy, the mean survival was 80.6 months in patients with oligodendrogliomas, 63.3 months in those with anaplastic oligoastrocytomas, and 42 months in those with anaplastic oligodendrogliomas.

[Modern classification approach to central nervous system tumors].

Central nervous system (CNS) tumors cannot be, for a number of reasons, organically included into the existing tumor classification system - TNM. This hampers the registration and systematization of CNS tumors, the acquisition of valid data on their prevalence, and the organization of treatment in patients with CNS tumors. A variant of a classification of CNS tumors is proposed, which takes into account the specific features of this group of neoplasms.

[Ophthalmological symptoms in patients with giant pituitary adenomas].

In patients with giant pituitary adenomas, visual dysfunction is a common complaint and the chiasmatic syndrome is the major clinical sign of the disease. Reduced vision should be also considered to be a major factor that influences the quality of life. Early and timely diagnosis of a tumor in the absence of its extracellular growth makes it possible to improve visual function in the postoperative period and the quality of life.

[Invasive giant pituitary adenomas].

7 cases of pituitary adenomas with the pronounced signs of invasive growth, confirmed by MRI, clinical and intraoperative observations. Invasive growth of adenomas was related to neither the structure of the tumor, the degree of anaplasia, or the nature of a generated hormone.

[Pituitary apoplexy in giant cell adenoma].

Hemorrhage in giant cell adenomas of the pituitary gland was detected in 20.8%. It occurred mostly in supracellular mixed multi-nodular tumors. The course of the disease was symptom-free, acute, subacute or mild. There was a relationship between pituitary apoplexy course, on the one hand, and age and tumor growth, on the other. Since postoperative complication and lethality rates were relatively higher in younger patients, it is suggested that differentiated approach be taken to the diagnosis and management of the disease.

[Treatment of cancer metastasis in the brain].

Surgery for brain metastases is an effective treatment for most cancer patients. It involves low post-operative lethality (2.9%) and causes neurological symptoms to regress in most patients. 12-month survival occured in 48.5%, 5 years--10.8%; mean survival duration with good quality of life--11.8 months. Survival basically depended on tumor pattern, metastases to other organs, multiple foci in the brain and habitus.