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The aim. To analyze the results of surgical treatment of sacral schwannomas with their extension into lower pelvis.Materials and methods. We analyzed the clinical results of surgical treatment of 25 patients with sacral schwannomas, including those with ventral extension and growth into pelvic cavity. All patients were operated at the Clinic of Neurosurgery of the Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan for a 10-year period. The analysis of literature describing prevalence, classification, diagnosis and surgical treatment of sacral tumors and schwannomas in particular was carried out. The features of the course, diagnosis and surgical treatment of sacral schwannomas and accepted surgical methods for their treatment are described.Results. The average follow-up period of the patients in our study was 61.6 ± 2 months. Compared with the initial indicators of patients in the postoperative period (1 year after the surgery), a good clinical result with the regression of symptoms was registered in 17 (68 %) out of 25 patients, and 10 (40 %) of them had a significant regression of neurological disorders. 3 (12 %) operated patients had a deterioration of neurological disorders in the form of aggravation of sensitive disorders; one patient had an aggravation of pelvic organ dysfunction. Radical removal of the tumor was achieved in 24 (96 %) out of 25 cases; subtotal resection was performed in 1 (4 %) patient. The number of relapses and continued growth of tumors in our series was 12 % (3 out of 25 patients). The mortality rate was 0 %. The complications were registered in 3 (12 %) cases and manifested as wound liquorrhea in cases of using posterior approach.Conclusion. The degree of radicality of tumor resection and clinical outcomes is directly related to the selected surgical approach.

The article describes the treatment of a 20-year-old patient with a spinal hourglass schwannoma (neurinoma) in the thoracic spine, growing from the right Th3 spinal root, spreading into the thoracic cavity and compressing the apex of the right lung. The introduction presents the frequency of occurrence of such neoplasms among all spinal cord tumors. Complaints, neurological symptoms, neoplasm diagnosis methods and its clinical and radiological manifestations are presented. The article describes stages and techniques of total surgical removal of the spinal hourglass schwannoma through the posterior paravertebral minimally invasive approach without opening the pleural cavity and with using neurophysiological monitoring of spinal cord function performed at the Neurosurgical Clinic of the Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan. The data of histological examination and MRI control in the early postoperative period are presented. The follow-up was carried out at 6 and 12 months after surgical treatment. The publications describing the surgical treatment of paravertebral tumors through different approaches, the technique of their removal, possible complications and methods of their prevention are analyzed, and the classification according to Eden (1941), which characterizes the type of tumor growth, is presented.

Aim of the study was to evaluate the surgeries of tentorial meningiomas in Neurosurgical Department No.1 of the Novosibirsk Institute of Traumatology and Orthopedics. Material and methods. Study includes 64 patients with tentorial meningiomas of different location, treated surgically from 2008 to 2017. Among them 55 (85.9 %) were female patients and 9 were male (14.1 %) with average age of 62.9 years in females and 56.7 years in males. For diagnostic purposes, the patients were performed brain magnetic resonance imaging and/or computed tomography with or without contrast agents. In this series, 83 % of the tumors were of large or giant (with diameter of more than 4 cm). In 63 cases the tumors were typical meningiomas and only 1 case was a malignant anaplastic meningioma. Results. All patients were treated surgically in one or two steps. Overall, there were 70 standard microsurgical resections. Electromyography with Neuropack-2 («NIHON KOHDEN Corp.», Japan) was performed to control brain stem function during the surgery, with short latency auditory evoked potentials (SLAEPs) received. When sinus walls were affected, the tumor matrix was processed with 20W neodymium laser in coherent mode and ablation. In 63 cases, gross-total resection was achieved: Simpson I (76.6 %, n = 49) and Simpson II (21.8 %, n = 14). One patient (1.6 %) was treated with subtotal resection because of complicated surgical approach and massive transverse sinus and sinus confluence bleeding. Post-operative mortality was 3.1 % (2 cases). SLAEP data did not demonstrate any significant irritation or damage to the brain stem with performed surgical approaches. There were no infections of the surgical wound, meninges, brain or CSF leaks after the surgery. Discussion. Tentorial meningiomas are rare brain tumors treated with gross-total tumor resection when possible. Performed surgeries resulted in mild functional decrease in quality of life, but Karnofsky scale for each patient was returning to its original state in 2 weeks. Complications, including neurological disability, presented in 19 % (n = 12) of the patients, and post-operative mortality did not exceed the common literature data. Most of the focal neurological disabilities have disappeared in 2 weeks after the surgery.

The article is devoted to the description of three clinical cases of patients with rare pathology - cavernous hemangioma of the orbit cavity operated in the neurosurgery clinic of Novosibirsk Research Institute of Traumatology and Orthopedics. The aim of the study was to evaluate the results of surgical treatment of orbital masses through the example the Krenlane method of cavernous angioma orbitotomy in the neurosurgical clinic. Material and methods. 20 people with primary and secondary (growing into the orbit cavity) orbit tumors were operated in the neurosurgery clinic from 2007 to 2016. Among these 20 tumor cases (0.65 % of all brain tumors have been removed in the clinic during this period) there were 13 meningiomas (65 %); 4 gliomas of the optic nerve (20 %); 3 cavernous angiomas (15 %). 3 patients had volumetric formations localized directly into the orbital cavity without spreading into the optic nerve canal and intracranial. In all 3 cases, tumors were cavernous hemangiomas confirmed by pathomorphological studies. Results. All operated cavernous hemangiomas were removed totally. The patients’ postoperative course was smooth, wound healing went by primary tension. Visual acuity deterioration was not observed. According to the results of MSCT control, there were no tumor signs in the early postoperative period (the next day after the operation). All patients were dismissed in satisfactory condition on the seventh day. Control tests, including an MRI after 5 years from the time of the operation showed that the operated patients did not complain. Exophthalmos regressed completely. Visual acuity in all patients recovered to 1.0. Cosmetic defect was absent. All patients had a good functional result - a complete restoration of eyeball movement. Conclusions. Patients with primary volume formations of the orbit cavity in the form of cavernous hemangiomas of lateral localization can be successfully operated with the use of minimally invasive access - bone-plastic orbitotomy, by the method of Krenlane with its proper technical execution. The access is of low-traumatic nature, allows for a wide view of the orbit cavity, provides the necessary operational space and visualization of the surgeon’s manipulation zone, which allows to perform radical removal of the tumor as much as possible without damaging healthy tissues, large vessels and the optic nerve, is well tolerated by patients.

In present work, a comparative analysis of cytostatic and cytotoxic activity of IL-4 and IFNα-induced dendritic cells (IL-4- and IFN-DCs) has been performed in healthy donors and patients with brain tumors. Cytostatic activity was evaluated, as a capacity of DCs to inhibit growth of NK-resistant HEp-2 and A-549 tumor cell lines, whereas cytotoxic activity was measured by assessment of HEp-2 lysis. As compared with IL4-DC, IFN-DCs from healthy donors displayed a more pronounced cytostatic effect and similar cytotoxic activity against HEp-2 cells. In the patients with brain tumors, IFN-DCs were characterized by decreased cytotoxic activity. Meanwhile, DCs from the patients with malignant gliomas virtually did not exhibit a cytotoxic potential, whereas IFN-DCs from the patients with benign brain tumors retained their cytotoxic properties. A comparative study has shown that, in contrast to healthy donors, IFN-DCs from the patients with either malignant or benign brain tumors did not inhibit HEp-2 proliferation. The loss of DC-mediated cytostatic activity was not associated with decrease of CD123+ DCs (known as cells with maximal tumor-inhibitory potential), and, most likely, it resulted from functional changes in IFN-DC populations.

The problem of search and development of new approaches to integrated treatment of patients with malignant brain glioma remain one of the most urgent issues for contemporary neurosurgery and neurooncology. In spite of the applied efforts the results of a complex therapy for malignant glioma, especially for glioblastoma, are utterly unsatisfactory. Immunotherapy is one of the directions searching for a generation of cytotoxic cells able to lyse the tumor. Combination of various immunotherapeutic approaches is regarded the most perspective way. Since 1999 Neurosurgical Clinic of Novosibirsk Research Institute of Traumatology and Orthopaedics was carrying out clinical trials of combined immunotherapy within complex therapy of patients with malignant brain glioma in compliance with two protocols.