[Connexin-43 antibodies in intraoperative diagnosis of experimental poorly differentiated gliomas].

Fluorescent diagnosis was first proposed in the early XX century and has been used in neurosurgery for about 15 years. The method relies on selective accumulation of strongly fluorescent protoporphyrin IX in tumor cells. Over the past years, the method of intraoperative fluorescence diagnosis has occupied its niche in many neurosurgical clinics around the world and is now used for fast intraoperative diagnosis in brain tumor surgery. However, the efficiency of fluorescent intraoperative diagnosis using 5-aminolevulinic acid is 80-90% and 58.8% for surgery of Grade III-IV and I-II gliomas, respectively. One of the methods to improve the efficiency of fluorescent diagnosis is to use vector systems for delivering fluorescent drugs into the tumor. This paper reports the results of an experimental study of systems for delivering fluorescent agents (protoporphyrin IX, Alexa 488, Alexa 660) using connexin-43 antibodies in rats with transplanted C6 glioma.

[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.

[fMRI study of the dominant hemisphere for language in patients with brain tumor].

THE AIM OF THE STUDY: Paper describes a study of language lateralization of patients with brain tumors, measured by preoperative functional magnetic resonance imaging (fMRI) and comparison results with tumor histology and profile of functional asymmetry. METHODS: During the study 21 patient underwent fMRI scan. 15 patients had a tumor in the left and 6 in the right hemisphere. Tumors were localized mainly in the frontal, temporal and fronto-temporal regions. Histological diagnosis in 8 cases was malignant Grade IV, in 13 cases--Grade I-III. fMRI study was perfomed on scanner "Signa Exite" with a field strength of 1.5 As speech test reciting the months of the year in reverse order was used. fMRI scan results were compared with the profile of functional asymmetry, which was received with the results of questionnaire Annette and dichotic listening test. RESULTS: Broca's area was found in 7 cases in the left hemisphere, 6 had a tumor Grade I-III. And one patient with glioblastoma had a tumor of the right hemisphere. Broca's area in the right hemisphere was found in 3 patients (2 patients with left sided tumor, and one with right-sided tumor). One patient with left-sided tumor had mild motor aphasia. Bilateral activation in both hemispheres of the brain was observed in 6 patients. All of them had tumor Grade II-III of the left hemisphere. Signs of left-handedness were revealed only in half of these patients. Broca's area was not found in 4 cases. All of them had large malignant tumors Grade IV. One patient couldn't handle program of the research. CONCLUSIONS: Results of fMRI scans, questionnaire Annette and dichotic listening test frequently were not the same, which is significant. Bilateral activation in speech-loads may be a reflection of brain plasticity in cases of long-growing tumors. Thus it's important to consider the full range of clinical data in studying the problem of the dominant hemisphere for language.

[Intraoperative combined spectroscopy (optical biopsy) of cerebral gliomas]. / Intraoperatsionnaia kombinirovannaia spektroskopiia (opti-cheskaia biopsiia) gliom golovnogo mozga.

Clinical studies have revealed high selectivity of 5-ALA-induced protoporphyrin IX accumulation in different brain tumors. Modern methods of evaluation of tissues visible fluorescence are based on the qualitative analysis of the images. Up-to-date methods of combined spectral analysis allow fulfilling the intraoperative quantitative evaluation of the protoporphyrin IX content, as well as the scattering and absorption properties of a tissue. This paper presents a new method of the simultaneous analysis of hemoglobin concentration in oxygenated and reduced forms, tumor marker concentration (5-ALA-induced PP IX) and a new way to analyze the changes in the scattering properties of the tissues. The method is implemented by splitting the visible spectrum into intervals where hemoglobin and protoporphyrin IX have the characteristic peaks of absorption and fluorescence. The present method shows the dependence of the fluorescence index from the tumor grade. Combined spectroscopy (optical biopsy) can detect the differences between the subtypes of gliomas that are similar in the protoporphyrin IX fluorescence index. This method complements and enhances the diagnostic capabilities of spectroscopy, which is particularly important in the non-fluorescent glioma surgery.

[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.

[Implantation metastasizing of craniopharyngioma].

The paper describes two cases of implantation metastasizing of craniopharyngioma after its resection using combined (transcallosal and subfrontal) and pterional approach. The mechanisms of metastasizing and possible ways of prevention are discussed.

[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.

[Ventriculoperitoneal and ventriculoatrial shunts in treatment of patients with brain tumors].

Two 234 patients with tumor-associated hydrocephalus underwent their first shunt implantation at Burdenko Neurosurgery Institute between 2004 and 2008. Age of the patients ranged from 18 to 77 years (mean 44). The follow-up was available in 162 patients (72%). The median follow-up was 10 months. Shunt failure occurred in 29,2% of 162 patients. Kaplan-Mayer analysis showed that the probability of shunt failure free interval was 72, 69, 60% at one, two and three years after insertion, respectively. The most frequent cause of shunt failure was malposition of the ventricular catheter (30,6%), occlusion of the ventricular and abdominal catheter occurred in 20,4 and 22,2%, respectively. Shunt infection was encountered in 24,5% of cases. Among the analyzed factors (position of the catheter within the ventricle, additional operations such as tumor resection, implantation of external ventricular drain before shunt surgery, malignancy of the tumor and type of hydrocephalus) only presence of external ventricular drain increased the risk of shunt infection. The duration of external drainage positively correlated with the risk of shunt infection. In most cases shunt failure can be prevented. The results of the study may help the surgeon to choose the optimal treatment strategy for patient with tumor-associated hydrocephalus.

[Planning of surgical approach to intracerebral tumors of the hemispheres using fMRI, neuronavigation, and electrophysiological monitoring].

The paper discusses pre- and intraoperative application of different guiding techniques (frameless neuronavigation, fMRI, electrophysiological monitoring). We performed comparative analysis of different combinations of these methods. 74 patients with intracerebral tumors involving eloquent areas (sensorimotor cortex in 56 and speech zones in 18) were operated. In 9 cases 'awake surgery' was applied. We found that frameless navigation combined with brain mapping allows to optimize planning of surgical approach and to decrease postoperative neurological deficit. Also in certain cases 'awake craniotomy' can be replaced by fMRI and neuronavigation.

[Fatal outcome caused by lysthenon in a child at the early stage of primary myopathy]. / Letal'nyi iskhod, vyzvannyi listenonom u rebenka s nachal'noi stadiei pervichnoi miopatii.

A child aged 3 years 10 months with latent early stage of primary myopathy died during surgery for left-side cryptorchidism after injection of lysthenon. Asystole, the immediate cause of death, was caused by release of potassium ions from skeletal muscles into the blood. Myopathy was diagnosed at autopsy by histological examination of the diaphragm and mm. pectoralis major and gastrocnemius.