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The incidence of pancreatic neuroendocrine tumors has significantly increased for the last decades. Patients with multiple pancreatic neuroendocrine tumors require special attention to the diagnosis and treatment algorithms. The aim is to show possible treatment approaches for patients with multiple pancreatic neuroendocrine tumors. Materials and methods. 26 patients with multiple pancreatic neuroendocrine tumors were managed in the abdominal surgery department of Sechenov University for the last 20 years. Results. The rate of multiple tumors was 9% for sporadic tumors and 36.5% among patients with MEN-1. Sensitivity of the imaging techniques was significantly lower than in solitary insulinomas. Most patients underwent parenchymasparing procedures. Total pancreatectomy was performed only in two cases. Conclusion. Accurate imaging and identification of hormone-secreting tumors allows to offer patients parenchyma-sparing surgery and to provide more personalized approach to the treatment of patients with multiple pancreatic neuroendocrine tumors.

The lecture is dedicated to spinal dural arteriovenous fistula – infrequent disorder which not well known among wide range of neurosurgeons. The findings on etiology, clinic and treatment are presented.

In the period from 2000 to 2017, 52 children aged from 2 to 17 years, were operated for non-parasitic spleen cysts. Along with general clinical examination, the preoperative observation included enzyme immunoassay with Echinococcus diagnostics, determination of the serum level of carbohydrate antigen CA19-9, ultrasound, CT scan or MRI, spleen angiography. Evaluation of treatment results, along with clinical examination, was based on echographic monitoring using spleen mass ratio calculation technology and laboratory tests, including the study of serum immunoglobulins A, E, M, G. Depending on the location and pool of vascularization, 4 clinical and morphological variants of spleen cysts were selected - the upper, middle and lower parts of the organ, the region of the spleen's collar. Quantitative estimates of the pathological formation included small (up to 50 ml), medium (50-150 ml), large (150-300 ml) and giant (more than 300 ml) volumes of the cyst cavity. Three main minimally invasive surgical technologies are being introduced:- navigational interventions in which access to the pathological focus and therapeutic effects on the internal structures of the cyst were carried out under the control of an ultrasound image;- combined interventions with access to the pathological focus and therapeutic effect on the internal structures of the cyst under the control of an ultrasound image in combination with endovascular occlusion of the vessels of the spleen parenchyma with X-Ray control;- laparoscopic operations, including access to pathological foci and therapeutic effects on the internal structures of the cyst, provided by the endotelevision visualization. Recovery was achieved in 47 (90.4%) patients as a result of single interventions. Repeated surgeries completed with the recovery were required in 5 (9.6%) clinical observations. Subsequent follow-up with a duration of up to 3 years of disease recurrence did not show relapses. The choice of tactics of surgical treatment of children with NCC was shown to have to be based on the results of multifactorial planning, taking into account the anatomical and topographical features of the localization and growth rate of spleen cysts. The high reparative potential of the spleen in childhood determines the postoperative recovery of the organ’s morphofunctional characteristics, regardless of the volume of the cyst present. The use of quantitative parameters to estimate the mass of the spleen makes it possible to objectify the course of the postoperative period, the effectiveness of the intervention and the adequacy of the reparative regeneration processes.

The prevalence of benign tumors of the salivary glands is increasing. The complexity of the anatomical areas and the proximity of the of the facial nerve’s branches lead to frequent complications in the postoperative period. Nowadays there are several instrumental diagnostic methods for determining salivary gland tumors and among which the use of magnetic resonance imaging with contrast enhancement made it possible to estimate the exact location of neural and vascular structures in relation to the neoformation.

Aim. To reflect the main approaches and trends in neuroendocrine tumors imaging. Materials and Methods. 255 patients with hormonally active pancreatic neuroendocrine tumors were examined and operated for the period 1990–2015. There were insulinomas predominantly. Sensitivity of ultrasonography, CT, endoscopic ultrasound, arterial-stimulated blood sampling, IOUS was analyzed to reveal changes in diagnostic algorithm for this period. Results. Multiple pancreatic lesions occurred in 30%. Over the 25 years endosonography as new “gold” standard for pancreatic visualization was introduced. Indications for arterial-stimulated blood sampling were narrowed. However, this method is still actual and effective in the most difficult diagnostic situations. Conclusion . Accurate preoperative topical diagnosis allows to offer optimal, organ-sparing procedure and reduce intraoperative trauma of the pancreas and number of postoperative complications.

Ulcerative lesions of the upper digestive tract often occur in malignant obstructive jaundice due to multiple changes in the coagulation system. Emergency percutaneous arterial embolization is an effective and safe procedure to treat acute massive duodenal bleeding; it is most commonly performed via the standard transfemoral access, which can lead to complications in this area. The paper describes a clinical case of the double use of a unilateral radial access for emergency embolization of life-threatening duodenal bleeding in complications of malignant obstructive jaundice.

The paper describes a clinical observation showing the capabilities of three-dimensional dynamic 640-slice CT coronary angiography in the postoperative period after coronary artery stenting and in the presence of anomalous origin of coronary arteries from a single coronary sinus. Patient K. aged 76 years who had sought medical advice for his complaints of pressing retrosternal pain radiating to the inter-scapular region when walking 20–30 meters, as well as intermittent episodes of crushing pain at rest was examined. The patient underwent coronary angiography, circumflex artery stenting, and three-dimensional dynamic 640-slice CT-coronary angiography in the early postoperative period. Three-dimensional dynamic 640-slice CT coronary angiography after circumflex artery stenting could determine the status of the operated artery and stent and identify a variant of anomalous origin of the right coronary artery, which had not been previously diagnosed using two invasive coronary angiographies.

In this work, the effectiveness of the superselective embolization of the arteries feeding the tumor prior to performing partial nephrectomy (open and laparoscopic) was evaluated. The results received show that this method can prevent long-term thermal ischemia of the normal renal parenchyma, and make it possible to perform resection in cases of complex vascular anatomy, when the mobilization of the renal artery and, moreover, segmental vessels is technically difficult or impossible, and in the third, Zero ischemia leads to decrease of intraoperative blood loss. The necessity of performing preoperative three-dimensional modeling of the pathological process is indicated in order to identify nephrometric indicators according to the R.E.N.A.L. scale.

The paper describes spinal dural arteriovenous fistulas (SDAVF), the most common type of spinal cord vascular anomalies. SDAVFs account for 60–80% of the spinal cord vascular anomalies. The causes of SDAVFs, the specific features of their hemodynamics, and their classification remain the subject matter of disputes. SDAVFs form in dura mater tissue, on the dorsal surface of radicular cuffs. The pathogenesis of neurological disorders in SDAVF has determined the name «venous hypertensive myelopathy», a spinal cord injury occurring in their presence. Pain and paresthesias, cacesthesia (more commonly in their distal parts), and motor disorders as flail legs are observed at the onset of SDAVF in typical cases. On average, 12 to 44 months elapse to establish its diagnosis. In addition of motor and sensory disorders, sphincter impairments and sexual dysfunction are detected in the patients at the time of diagnosis. By this time, most patients have already neurological disability. The paper presents the history of studying SDAVF, the existing classifications of arteriovenous malformations and fistulas, the clinical manifestations of venous hypertensive myelopathy in SDAVF, neuroimaging findings, and treatment options.