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Objective: to analyze 31 resections of chiasmatic-sellar region (CSR) and anterior cranial fossa (ACF) tumors using the supraorbital trans-eyebrow approach (STA)., Material and Methods: We analyzed medical histories of 31 patients who underwent tumor resection using STA in the period between October 2013 and April 2017. We analyzed the age and gender of patients, size and location of the tumor, presence of a neurological deficit, vision and olfactory functions before and after surgery, surgery duration, amount of intraoperative blood loss, rate of frontal sinus trephination and nasal liquorrhea, hemorrhagic and ischemic complications after surgery, Simpson grade of tumor resection, patient's condition before and after surgery (Glasgow Outcome Scale and Karnofsky Scale), and degree of patient satisfaction with the cosmetic result of surgery. A total of 26 meningiomas (20 sphenoid plate, tubercle, and diaphragm tumors, 3 lesser sphenoid wing meningiomas, 2 orbital roof tumors, and 1 anterior clinoid process meningioma), 3 frontal lobe gliomas, and 2 pituitary adenomas were resected., Results: In all 31 operations, the approach was adequate and enabled tumor resection without lethal outcomes. The mean surgery duration was 174.6±64.4 min. The mean blood loss was 190±96.6 mL (50-380 mL). After surgery, none of the patients developed motor deficits and new epileptic seizures. Neurological deficit aggravation in the form of impaired vision and mental disorders occurred in 8 (25.8%) patients. Vision impaired in 4 (12.9%) patients, improved in 6 (19.3%) patients, and remained unchanged in 21 (67.7%) patients. An endocrinological deficit in the form of partial hypopituitarism developed in 3 (9.6%) patients; in 4 (12.9%) patients, there were mental disorders that regressed by the end of the first month of therapy. There were no intracerebral and subarachnoid hemorrhages. In 2 (6.4%) patients, small epidural hematomas were diagnosed, which did not require surgical treatment. There were only good outcomes (a GOS score of 4 or 5). After surgery, the median Karnofsky index in the STA group was 90±7. In all 31 (100%) patients, the postoperative wound healed by primary intention, without infectious complications and wound liquorrhea. One (4%) patient developed eyebrow palsy; 3 (12%) patients had hypoesthesia in the supraorbital region. The mean VAS score of patient satisfaction with the cosmetic result was 9.36 (median 10±1). The mean follow-up period was 16.2±13.5 months (2-38 months)., Conclusion: The STA is adequate for removal of CSR and ACF tumors under proper selection of patients. It provides an adequate view of anatomical structures and enables successful tumor resection through a less traumatic access.

Resection of anterior clinoidal meningiomas is a challenging task due to their localization, frequent involvement of the major cerebral arteries and cranial nerves, a high risk of postoperative neurological deficits, and low radicalness of surgery., Aim: To evaluate the radicalness of microsurgical removal and a neurological deficit in the early postoperative period in patients with anterior clinoidal meningiomas., Material and Methods: A total of 35 patients with anterior clinoidal meningiomas underwent surgery at the Department of Neurooncology of the Novosibirsk Federal Neurosurgical Center in the period from 2013 to July 2016. There were 29 (82.9%) females and 6 (17.1%) males. The mean patient age was 50.1 years (31-72 years). According to the Al-Mefty classification (1990), type 1 tumors occurred in 10 (28.6%) patients, type 2 tumors were in 22 (62.8%) patients, and type 3 tumors were in 3 (8.6%) patients. Twenty four (68.6%) patients had large (greater than 4.0 cm) tumors, 7 (20.0%) patients had medium (2.0-4.0 cm) tumors, and 4 (11.4%) patients had small (less than 2.0 cm) meningiomas. The tumor involved the major arteries in 21 (60.0%) patients., Results: The lateral supraorbital approach was used in 26 (74.3%) patients, and the pterional approach was used in 9 (25.7%) cases. The tumor was resected totally (Simpson II) in 25 (71.4%) cases and subtotally (Simpson IV, subtype A and B) in 10 (28.6%) patients. In the early postoperative period, cerebral symptoms regressed in 20 (57.1%) patients; visual acuity improved in 2 of 13 (15.4%) patients. Four (11.4%) patients developed IIIrd nerve palsy; 2 (5.7%) patients developed severe hemiparesis. The mortality rate was 2.9%., Conclusion: The completeness of resection directly depends on the tumor consistency: soft meningiomas can be totally resected (Simpson II) with a good functional outcome. In the case of solid tumors, total resection may lead to serious ischemic disorders with a high risk of death.

Unlabelled: The mediobasal temporal region (MTR) is located near the brain stem and surrounded by the eloquent neurovascular structures. The supracerebellar transtentorial approach (STA) is safe access to the posterior MTR structures, however its use for resection of anterior MTR lesions still remains controversial. The article describes the technique and outcome of surgery for different MTR structures using STA., Material and Methods: The paramedian STA was used in 18 patients (13 females and 5 males) for 7 years. Ten patients presented with glial MTR tumors, 3 patients with cavernomas, 2 patients with arteriovenous malformations (AVMs), 2 patients with intraventricular meningiomas, and 1 patient with mesial temporal sclerosis. The patient age ranged from 19 to 57 years. In 10 cases, lesions were localized on the left. Epilepsy was the leading symptom in 14 cases. Patients underwent preoperative high-resolution MRI, electroencephalography video monitoring before and after surgery, intraoperative corticography (if necessary), and postoperative CT and MRI., Results: Lesions were located in the anterior third of MTR in 5 patients, in the anterior and middle thirds in 2 patients, in the middle third in 5 patients, in the middle and posterior thirds in 2 patients, in the posterior third in 1 patient, in the anterior, middle, and posterior thirds in 1 patient, and in the ventricular triangle area in 2 patients. In all patients with intraventricular tumors, AVMs, and cavernous malformations and in 8 patients with glial MTR tumors, the lesions were totally resected. Two patients with intracerebral tumors underwent subtotal resection. A patient with intractable epilepsy and mesial temporal sclerosis underwent resection of the anterior two-thirds of the hippocampus and parahippocampal gyrus and, partially, amygdala using intraoperative corticography. There was no surgical mortality; 2 patients developed a transient neurological deficit, and 1 patient had a cerebellar hematoma that was successfully removed during surgery., Conclusion: STA enables resection of lesions localized in all parts of the MTR, without damage to the surrounding nerve and vascular structures.

The article presents an example of endoscopically assisted neurosurgical removal of petrous apex meningioma associated with trigeminal neuralgia. Endoscopy was used during the operation for control of completeness of tumor removal and for identification of offending vessel and control of position of protector. Total resection of the tumor was achieved, complete regression of trigeminal pain was observed in early postoperative period.

Background: Aim of the study was to evaluate effectiveness of intraoperative identification of oculomotor nerves (OMN) in resection of skull base tumors invading superior orbital fissure and cavernous sinus., Materials and Methods: 69 patients with cranioorbital tumors operated in Burdenko Neurosurgical Institute (Moscow, Russia) since 2000 until 2005 were included in the study. They were divided into 2 groups: 19 patients treated with intraoperative identification of OMN and 50 patients in the control group. Craniorbital meningiomas were in the majority among all cases. Intraoperative identification of OMN was performed using coaxial electrode while muscular response was registered through electrodes inserted in m. levator palpebrae superioris, m. obliquus superior and m. rectus lateralis (for III, IV and VI cranial nerves, respectively). Identification of IMN trunci was repeated throughout the whole stage of tumor resection for their preservation., Results: comparison of dynamics of oculomotor dysfunction in early postoperative period in patients of both groups demonstrated that intraoperative identification of OMN allowed to decrease the frequency of oculomotor deficit. The rates in main and control groups were: for III and IV nerves--37% and 68% (p < 0.05), for VI nerve--47% and 54% (p > 0.05), respectively., Conclusion: application of intraoperative identification of OMN allows to decrease the risk of oculomotor deterioration due to III and IV nerve dysfunction by 1.8 times. Technically the method is quite simple and not time-consuming procedure.

The paper analyzes surgical techniques for removal of hyperostotic cranial orbital meningiomas in 36 patients operated on in 1998 to 2000. In 19 cases hyperostosis extends to the upper and lower lid slits without involving the optic canal. It also spreads to the ethmoidal sinus in 6 cases to the frontal sinus in 3, and to the maxillary one in 2 patients. In 3 patients, hyperostosis was beyond the wing of the basic bone, by involving the temporal and frontal squamous. In 19 cases, hyperostosis was resected and the tumor was removed without creating any additional bone flaps. To make an additional basal bone flap can provide a much wider access by reducing the traction of both orbital and cerebral tissues. An orbitozygomatic flap was formed in 16 cases. To create a lateral orbital flap was sufficient to effectively eliminate hyperostosis in 3 patients. Impaired postoperative visual acuity was observed in 5 patients undergone resection for the hyperostotic optic canal, in 2 patients of them there was a decrease in visual acuity from 1.0 to 0.1 and in 1 patient it reduced from 1.0 to 0.2. A year later, visual acuity in these patients increased up to 0.5-0.8. After resection of the hyperostotic optic canal, blindness occurred in 2 patients, in one of them, photoperception appeared on day 5 after surgery and 3 months later visual acuity restored up to 0.6. Thus, the use of high-speed drill and the creation of an orbital or orbitozygomatic flap can increase the efficiency of removal of hyperostotic cranial orbital meningiomas.

This study presents the results of intraoperative ultrasonic Doppler measurements of the linear blood flow velocity in the superior sagittal sinus in patients with parasagittal meningiomas. Based on the obtained data, venous blood flow in the brain is analyzed.

The results of examining patients with parasagittal meningiomas were first compared by angiography and intraoperative ultrasound diagnosis. The significance of each method was defined. A correlation was found between the data obtained by the two techniques and the functional status of the upper sagittal sinus by taking into account each angiographic phase. It is concluded that intraoperative ultrasound diagnosis is of highly informative significance and it should be obligatorily used while removing parasagittal meningiomas in order to maintain the anatomic integrity of the upper sagittal sinus.

The method of stem auditory evoked potential was used in the examination of 39 patients with tumors of the posterior cranial fossa of various localization. The time indices of the response were analysed: the peak latency of components I, III, and V and interpeak I-III, III-V, and I-V intervals. The most coarse disorders were revealed in patients with tumors of the cerebellopontile angle (100% of cases), which were clearly lateralized. Changes of stem auditory evoked potential in patients with cerebellar tumors were encountered somewhat less frequently (in up to 90%) and the response was asymmetric in most cases. As compared to the first group, however, a high percentage of disorders of component V to stimulation of the intact side was noted. Among patients with median localization of the tumor (vermis cerebelli, floor of fourth ventricle) changes were found in 62% of cases (component V). No authentic differences to stimulation of different sides were revealed. The authors discuss problems on the levels of occurrence of disorders of stem auditory evoked potential in patients with lesions of posterior cranial fossa structures.

The peculiarities of the development of spontaneous fluctuations of the c.s.f. pressure (CSFP) (B- and plato-waves) in the early postoperative period in 169 neurosurgical patients were studied according to the location of the pathological process and the severity of the clinical condition. The dependence between the CSPF spontaneous fluctuations, the changes of intracerebral pressure, and the dynamics of bioelectrical activity of the brain was studied. The development of spontaneous wave CSFP fluctuations was found to be dependent on the location of the tumor and the severity of the clinical condition. These fluctuations occurred most frequently in patients who were in a critical state (12-8 marks on Glasgow's scale) with the process located in the diencephalo-stem brain areas. A hypothesis is suggested, according to which the cause of the wave CSFP fluctuations of the B-wave type is connected with the change of the vasomotor center to the cyclic regimen of work: the neurogenic change of the vascular tonus, causing in succession constriction and dilatation of the vessels, leads to rhythmic CSFP oscillations. CSFP plato-waves occur in cases in which the constriction phase fails to appear after the dilatation phase, i.e., the tonic pressor effect of the vasomotor center does not occur, which may be due to its exhaustion. In death of the brain and in terminal states the vasomotor center loses the ability to cause neurogenic regulation of the vascular tonus, to provide the pressor effect in particular, which leads to the disappearance of spontaneous CSFP fluctuations.

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 retinal blood flow was studied by fluorescent angiography of the fundus oculi in 22 patients with parasagittal meningiomas before and after surgery. A total of 82 fluorescence-angiographic examinations were performed and disorders of retinal hemodynamics were found irrespective of the presence or absence of intracranial hypertension. Prolongation of the venous phase of retinal circulation alone without signs of intracranial hypertension is an early symptom of impaired venous flow from the cranial cavity and deficient development of pathways compensating for venous drainage. The arterial phase is prolonged at a later stage of the tumorous process, when the cerebral blood flow is much slower. Marked disorders of retinal venous blood flow are still found one month after removal of parasagittal meningiomas. It is shown that the flow of venous blood from the cranial cavity is mainly impaired in patients with parasagittal meningiomas.

Analysis of thermograms recorded through intact skin and during operations in 61 patients with brain tumours differing in histobiological properties and in 63 patients with compressing forms of craniocerebral injury as well as analysis of the results of angiography and rheoencephalography and operative findings disclosed the mechanisms of the formation of pathological luminescence of the skin on the head.

The data presented may be of definite value in the prevention of hemorrhage and thrombosis in patients with malignant glial tumors. A malignant glioma may lead to increased activity of the blood coagulation system (BCS). Preoperative staining of the tumor was not attended by marked changes in the BCS and blood viscocity, though a tendency towards an increase in BCS activity according to some of the indices may sometimes be noted. Chemotherapy with nitrosourea and methotrexate was attended by thrombocytopenia but there was practically no changes in the other BCS indices. The postoperative period is usually marked by increased BCS activity according to most of the indices. Increased blood viscocity is often encountered in patients with glial cerebral tumors in the preoperative and postoperative periods, which is evidently due to the intensive dehydration therapy to which they are subjected in marked increase of intracranial pressure.

Combined use of radioisotope and impedance methods in the examination of cerebral and peripheral circulation and EEG recording in 40 patients with parasagittal meningiomas revealed a correlation between the rheographic characteristics of the tonus and blood filling of the cerebral vessels and the quantitative values of cerebral hemodynamics. Specific features of cerebral circulatory disorders characteristic of parasagittal tumors were revealed before operation and in the postoperative period. The prognostic significance of examination of the cerebral blood flow and impedance in the early postoperative period is demonstrated.

The reaction of cerebral electric activity to induced changes in the cerebrospinal fluid pressure during examination of P-V dependence of the craniospinal cavity was appraised in 8 neuro-oncological patients in the postoperative period by means of spectral EEG analysis. Among 41 tests with artificial changes in CSF pressure decrease in CSF pressure was attended in 60 per cent of cases by an increase in the EEG p]ower by 6.4% on the average, while an increase in CSF pressure caused a decrease in EEG power by 8.6% on the average. In 40% of cases, however, a decrease in CSF pressure was attended not by an increase, but by a reduction of EEG power by 3.5% on the average; an increase in CSF pressure induced a rise in EEG power (by 3.7% on the average). The degree of the reactive changes in EEG power in response to induced CSF pressure fluctuations increased with deterioration of the patient's condition. Thus, rapid compression and decompression of the CSF system induces short-term (7 minutes at most) changes in EEG power. These changes are ambiguous both in direction and in degree of conspicuity.

The functional activity of the adrenal cortex was studied pre- and postoperatively in patients with pituitary adenomas, craiopharyngiomas and supratentorial meningiomas. With the hypothalamus function preserved, the patients developed varying degrees of stress-responses in the postoperative period. Severe morphological injuries to the hypothalamus make the normal response to surgical trauma impossible. With some functional centers preserved, the diencephalo-catabolic syndrome develops. Severe injuries of the diencephalon, with its adaptative function completely lost, result in the development of the diencephalic areactive syndrome.

Clinical and biochemical examination carried out in 20 patients with tumors of the sellar-diencephalic area and 10 healthy persons revealed a dependence between functional disorders of the thalamus and hypophysis and the pancreatic beta-cells, which was attended by the development of obesity in patients with large endosuprasellar tumors of the hypophysis and diminution of glucose tolerance in all patients. Hyperinsulinemia revealed during intravenous glucose tolerance test and reduced glucose tolerance are evidence of relative insular insufficiency and substantiate pathogenetically the inclusion of insulin in the complex of intensive therapy applied in the early postoperative treatment of patients with tumors located in the sellar-diencephalic area.

The adequacy of the indirect method for the liquorodynamic evaluation of intrasinusal pressure has been established. It was found that in patients with parasagittal meningiomas intrasinusal pressure does not depend on the size of the tumour and its relation to the superior sagittal sinus, or on intracranial hypertension (up to 28 mm Hg). In the phase of decompensation of intracranial hypertension the effective pressure of resorption increases. The quantitative characteristics of venous cerebral circulation and of liquorodynamics is of importance in evaluating the condition of compensatory mechanisms of the cerebrospinal system in various forms of neurosurgical pathology.

Tests for blood plasma tryptophan in patients with various diseases of the nervous system showed a statistically significant increase of its content in tumors of the astrocytic series in patients with meningiomas and oligodendrogliomas. The character of the tryptophan excretion curve after a load in neurooncological patients was different from that in healthy individuals and patients with thrombosis of the sinus and arachnoencephalitis. Hydrocortisone injection normalized the tryptophan curve in patients and, consequently, also the tryptophanpyrrolase reaction which is evidently disturbed in neurooncological patients.