[Comparative characteristics of genetic aberrations in glioblastomas in children and adults].

Glioblastomas in children and adults are a heterogeneous group of tumors that can be divided into at least three different subgroups: pediatric glioblastomas, IDH1-mutant glioblastomas in adults (the most favorable prognostic subtype), and IDH1-wild type glioblastomas in adults. According to the frequency of detected cytogenetic aberrations (amplification of the MYC/MYCN, EGFR and PDGRFA oncogenes, homozygous deletion of the CDKN2A gene, and deletion of the PTEN gene), pediatric glioblastomas bear analogy to the subgroup of IDH1-mutant glioblastomas in adults.

[Intraoperative fluorescence diagnostics upon recurrent operations for brain gliomas].

UNLABELLED: The method of fluorescent diagnosis (FD) using 5-ALA has been widely employed in surgery of primary intracerebral tumors over the last years. The issue of FD application in surgery of gliomas with continued growth has remained less studied. OBJECTIVE: To investigate the efficacy of using FD with 5-ALA and laser spectral analysis in surgery of brain gliomas with continued growth. MATERIAL AND METHODS: 19 patients with Grade II-IV (WHO) gliomas with continued growth of different localization were studied. All tumors localized supratentorially. 5-Aminolevulinic acid hydrochloride "Alasens" (SSC "NIOPIK", Moscow, Russia) was used in the study. The equipment used during surgery included an operating microscope with an attachment for fluorescent navigation. Apart from expert qualitative assessment of a fluorescence extent, computer analysis of the fluorescence and light scattering (diffuse reflection) spectra was performed on a LESA-01-BIOSPEK spectrum analyzer (Russia). RESULTS: Detectable fluorescence was obtained in all the cases. PP IX fluorescence indices from 9.05 to 53.97 (the study was conducted in 12 cases) were determined by quantitative analysis of the spectrograms. The analysis of light scattering revealed its inverse relationship with respect to the fluorescence index. High sensitivity of the method in surgery of gliomas with continued growth requires clarification of method specificity because non-specific accumulation of PP IX in the area of post-radiation necrosis may occur in these patients. CONCLUSIONS: The FD method can be used for intraoperative demarcation of tumor resection boundaries in surgery of cerebral gliomas with continued growth. However, it is necessary to be critical of the high sensitivity of the method in patients with postradiation pathomorphism due to possible non-specific accumulation of PP IX in tissues. A light scattering study may provide additional information about the structure of tissues in the surgical wound.

[Meningioma challenge: analysis of 80-year experience of Burdenko Neurosurgical institute and future perspectives].

The paper describes the history of meningioma surgery at Burdenko Neurosurgical Institute, analyses of accumulated series of patients and assesses effectiveness of different techniques for meningioma diagnosis and treatment of. We analyzed 15413 patients with meningiomas operated in Burdenko Neurosurgical Institute from 1932 to 2011. Mathematical analysis was performed using Statistica 6.0 program. Mortality rate during World War II reached a disastrous level of 45,8%, in 21st century it is below 1%. Temporary and permanent morbidity has also decreased. While in 1961 Karnofsky performance score was 71, in 2011 it became 83. The probability of postoperative tumour recurrence also diminished, from 40% in 1960-s to 29% in 1996 and presumably to 25% nowadays. Independent factors that influence the risk of recurrence are primary gross total resection, grade of anaplasia and radiation therapy. However, unreasonably aggressive surgery leads to significant increase of morbidity. Further improvement of surgical results in patients with meningiomas depends on implementation of new technologies for neurovisualization, abandoning extensive surgical approaches whenever possible, finding the "balance" between radical removal and expected functional outcome, wider application of radiosurgery and three-dimensional conformal radiation therapy.

[Lung cancer metastases to the brain: clinical and morphological prognostic factors].

Brain metastases (BM) are the most frequent intracranial SOL and extremely heterogeneous group of tumours from morphological point of view. Nevertheless, studies devoted to BM up to now paid little attention to the histogenesis of the primary tumour. Lung carcinoma is the most common source of BM; morpologically this is a very heterogeneous group of tumors, and they demostrate different clinical pathway and outcome. The aim of present study was to evaluate clinical and morphological prognostic factors in 126 patients with lung carcinoma metastases to the brain, operated in 2004-2010 at Burdenko Neurosurgical Institute. Statistical analysis demonstrated that age, gender, amount and location of BM, primary operation and even histological tumour type were not significant prognostic factors, meanwhile absence of extracranial metastases and Karnofsky index above 70 were significant factors of the favorable prognosis.

[Intraoperative fluorescent visualization and laser spectrosopy in intrinsic brain tumor surgery].

Absence of well-defined borders of the glial tumor due to their infiltrative growth is one of the main issues in neurosurgery. A number of methods for intraoperative visualization are available today. The fluorescent metabolic navigation with 5-aminolevulinic acid (5-ALA) combined with quantitative laser spectroscopy is one of the latest technique. In our series of 99 consecutive patients with brain gliomas (WHO Grade I-IV) we found that visible fluorescence was observed in 68% of cases. Additional use of the laser spectroscopy could increase method sensitivity up to 74% due to accumulation of the protoporphyrine IX in nonfluorescense tumors. It was shown that there are some differences in quantitative fluorescence not only within same tumor (glioblastoma) but also in-between low- and high-grade gliomas. Intraoperative fluorescence and laser spectroscopy are effective and very helpful methods of intraoperative imaging in of intrinsic brain tumor surgery.

[Initial experience of treatment of primary intraocular lymphomas associated with primary CNS lymphomas].

Methods of diagnostics of primary intraocular lymphomas associated with primary CNS lymphomas are described. This article demonstrates the value of neurophtalmological assessment before surgery in patients with intracranial space occupying lesions. Three cases with bilateral primary intraocular lymphomas are presented. Authors analyzed initial results of intraocular lymphomas treatment with intravitreal methotrexate injections.

[Photodynamic diagnosis and laser biospectroscopy as an intraoperative guidance in neurosurgery].

Different techniques are used today in neurosurgery for intraoperative navigation, including metabolic guidance using 5-aminolevulinic acid (5-ALA). The article focuses on history of intraoperative photodynamic diagnosis (PDD), mechanisms of 5-ALA action, possibilities of its application in different areas of neurosurgery. In addition to visual assessment of fluorescence, laser biospectroscopy significantly increases the diagnostic value of PDD. Laser biospectroanalysis is described in details, wide perspectives of its application in neurosurgery are demonstrated.

[Meningioma with extracranial metastases].

The paper discusses a case of recurrent posterior skull base meningioma with extracranial metastases. Metastases of meningioma may spread through venous system, lymphatic vessels and cerebrospinal fluid, and also via contact route (implantation). Penetration of dura mater of venous sinuses leads to invasion of tumor cells and their spread into pulmonary circulation, system of vena azygos and hemiazygos, vertebral venous plexuses which may facilitate further dissemination of the tumor. Histological examination of recurrent meningiomas requires additional immunohistochemical investigation with estimation of proliferative activity.

[Application of "Gamma-knife" radiosurgery in treatment of intracranial metastases of extracranial malignant tumors].

Treatment of intracerebral metastases is one of the key problems in neurooncology. Modern methods of combined treatment do not significantly affect terms of survival. Quality of life during the whole period of treatment depends on selected tactics. We summarized our experience of treatment of 119 patients with cerebral metastases of extracranial tumors with "Gamma-knife" stereotactic radiosurgery (GKSRS) during 2005 and 2006 years. "Leksell Gamma-knife C" was used for treatment procedures. Primary tumor was located in lung in 35 cases, in breast in 32 cases. Renal cancer metastases were less common (15 cases) as well as skin melanoma (14), colon cancer (8) and other localizations (6 cases). Total amount of treated metastases was 628. Marginal doses ranged between 15 and 24 Gy. During followup 77 patients were examined 153 times by contrast-enhanced MRI every 3 months. Mean follow-up period was 194.6 days (6.5 months). In 68 cases (88.3%) GKSRS provided total tumor control of 446 irradiated lesions (92%). Median survival after GKSRS was 8.2 months. All patients were assessed using RPA prognostic criteria. The best prognosis for life ( > 1 year) was observed in RPA I class patients. Median survival in patients with initial Karnofsky performance level < 70% (RPA III class) did not exceed 3.5 months. Presence of circumscribed brain involvement (less than 10 foci) is associated with more favorable prognosis (median survival is increased to 9.4 months). In patients with disseminated brain involvement (more that 10 metastases) survival median was 3.8 months (p < 0.05). GKSRS is minimally invasive, safe and effective method for treatment of intracerebral metastases of all main histological types of extracranial tumors. Local tumor control is observed in 88% of patients. Life expectancy prognosis depends on activity of extracranial process, initial condition of patient by the moment of treatment and initial spread of metastatic brain involvement.

[Influence of molecular-genetic factors on prognosis in patients with oligodendroglial tumors].

Previous studies demonstrated that patients with oligodendroglial tumors (OT) have longer overall and recurrence free survival than patients with other glial tumors of the same grade. Recent investigations showed high influence of genetic alterations on patients' outcome: overall and recurrence free survival increased in the case of presence 1p19q deletion and decreased in the presence of 9p or 10q deletion and/or EGFR amplification. In the series of 241 cases (107 male, 134 female patients, median age -- 38 years, (16-73)) we analyzed the impact of histology, tumor grade and genetic alterations on time to tumor progression (TTP). All patients underwent surgical resection of tumor or biopsy from 2000 to 2005. 70 patterns (oligodendroglioma (O) -- 13 cases, oligoastrocytoma (OA) -- 13, anaplastic oligodendroglioma (AO) -- 30, anaplastic oligoastrocytoma (AOA) -- 14) were assessed by fluorescent in situ hybridization. Median follow up was 24 months. The type of tumor (pure or mixed) didn't influence survival. TTP of patients with grade II and grade III tumors was 37.7 and 48.2 months, respectively (p = 0.035). Deletion 1p19q was noted in 34 (49%) cases. In pure O codeletion 1p19q was detected more frequently (in O -- 75%, in AO -- 56%) than in mixed tumors (in OA -- 31%, in AOA -- 35%). Deletions 9p, 10q and EGFR amplification were noted in 5, 6 and 4 cases, respectively. None of the tumors with 1pl9q deletion had other genetic alterations. Thus, we generated three prognostic groups: A -- deletion 1p19q; B -- balanced chromosomal profile; C -- deletion 9p. Median TTP in groups A, B and C was 46.6, 25.3 and 6.4 months, respectively (p < 0.001). The percentage of OT with 1p19q codeletion was lower than in previous studies. Pure O more frequently had 1p19q deletion than mixed tumors. Genetic alterations predict outcome stronger than histological criteria.

[Malignant lymphoma of the central nervous system and eye].

Intraocular lymphoma was encountered in 11.4% of the 79 examined patients with malignant lymphoma of the central nervous system. In most cases it had occurred long on an average of 26 months before the development of neurological manifestations and the diagnosis of cerebral lymphoma. Biomicroscopy showed intraocular lymphoma to manifest itself as corneal endothelial precipitation of translucent corpuscles, opacity of the vitreous body, and its posterior detachment. Isolated intraocular lymphoma has been misinterpreted as uveitis of unclear etiology. In this connection, resistance to steroidal and antibacterial therapy should be an indication for diagnostic vitrectomy, followed by an immunohistochemical study of a biopsy specimen. The intraarterial administration of methotrexate, by breaking the blood-brain barrier, caused regression of cerebral lymphoma, but did not result in that of intraocular lymphoma, on this basis the authors consider the intravitreal injection of the agent to be indicated.