Experience of surgical management of trigeminal schwannomas that simultaneously spread to the middle and posterior cranial fossae.

Introduction: trigeminal schwannomas account for 0.07-0.36% of all intracranial tumors and 0.

[Application of shot-latency cortical somato-sensory evoked potentials for evaluation of swallowing disorders in early period after posterior fossa surgery].

Unlabelled: Main tasks of early postoperative period in patients after posterior fossa surgery are the timely and safe weaning from mechanical ventilation and extubation. For clinical assessment of the hypopharynx function we use an algorithm developed in the intensive care unit (ICU) of the Burdenko Scientific Research Institute of Neurosurgery. Disadvantages of the clinical test for assessment of patient's readiness for extubation are subjectivity and impossibility to use it in conditions of even superficial sedation.

[Patient positioning on the operating table in neurosurgery: sitting or lying].

Efficacy and safety of microvascular decompression of trigeminal nerve depending on the position on the operating table were assessed in 200 neurosurgical patients in retrospective observational study It was shown that efficacy doesn't depend on positioning. Lying position eliminates probability of such complications as postural hypotension, hypotension during surgery, tension pneumocephalus and peripheral nerves injury. Sitting position increases risk of air venous embolism by 25 times.

[Botulotoxin type A (lantox) for inducing temporal ptosis in neurosurgical patients].

The aim of our study was to assess the effectiveness of the ptosis induced by injection of Lantox (botulotoxin type A) into levator muscle projection in neurosurgical patients with lagophthalmos and trophic keratitis. The study included 66 patients at the age from 11 to 67 years. Lantox dose used was 10-25 U.

[Endoscopic assistance in microvascular decompression of cranial nerves].

Microvascular decompression (MVD) is an effective method for treatment of trigeminal neuralgia (TN), hemifacial spasm (HFS), glossopharyngeal neuralgia (GPN). The aim of this study was to assess the role of endoscopic assistance in MVD for the treatment of cranial neuropathies. Since 2009 till 2011 133 patients with cranial neuropathies were treated by MVD in Burdenko Neurosurgical Institute, Moscow.

[Monitoring the depth of anesthesia in neurosurgical patients].

The study reports the results of monitoring the depth of anesthesia with BIS technology in 456 neurosurgical patients with different neurosurgical pathology: sub- and supratentorial tumors, aneurisms, arteriovenous malformations, spinal pathology, etc. BIS reflects hypnotic state of the brain during anesthesia in almost all the cases, except for bifon-tal surgical approach when sensor placement is impossible. BIS monitoring of the depth of anesthesia is most advantageous in the following cases: epilepsy surgery, spine surgery with neurophysiological monitoring, awake craniotomy, severe cardiovascular pathology, massive blood loss, neurosurgery in pregnant patients.

[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.

[Bilateral bispectral index monitoring during surgery for posterior cranial fossa tumors].

The analysis of the results of bilateral monitoring of the depth of anesthesia in 22 patients with neurosurgical pathology of the posterior cranial fossa using the technique bispectral index (BIS). The results showed that more than half of the observations (at 19 and 22 patients) during the main phase of the operation (removal of the tumor) were observed differences in the BIS index values between the right and left side. In 1/3 of patients, these differences were driven by higher values of BIS on the side of surgery.

[Endoscopically assisted removal of posterior fossa meningioma combined with microvascular decompression of trigeminal nerve root (early experience)].

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.

[Stereotactic radiotherapy and radiosurgery in treatment of patients with intracranial schwannomas].

Aim of this study is to assess the role of stereotactic radiosurgery (SRS) and radiotherapy (SRT) in management of cranial nerves schwannomas by analysis of tumor control, clinical response and variables affecting treatment outcomes. Between April 2005 and January 2009 patients with schwannomas of VIII (63), V (14) and caudal nerves (2) were treated in Burdenko Moscow Neurosurgical Institute using linear accelerator. Mean age was 49 years (13-82).

[Histobiological features of posterior cranial fossa meningiomas and their impact on follow-up].

Total removal of posterior cranial fossa meningiomas often leads to complications due to localization, direction and nature of tumor growth. Radical excision as well as histological grade are the principal factors determining recurrence of disease in follow-up period. The paper evaluates the role of ki67 in progression of posterior cranial fossa meningiomas.

[Rare observation of giant pituitary adenoma spreading into posterior cranial fossa].

A case observation of unusual course of pituitary adenoma is presented. In 47-year old male patient with endo-supra-laterosellar pituitary adenoma and active acromegaly 2 different tumors were discovered intraoperatively during surgery for recurrence of the primary tumor. The first tumor was pituitary adenoma with nuclear polymorphism and the second was meningotheliomatous meningioma with solitary mitoses.

[Topographic variants of cranial chordomas].

The objective of this study was to investigate variants of localization of cranial chordomas. We examined 220 patients treated in Burdenko Neurosurgical Institute (Moscow, Russia) since 1985 till 2007. In the vast majority of cases (93%) tumors were localized in sellar region (34%), clivus (32%) and craniovertebral junction (27%).

[Identification of the cochlear nerve in surgical removal of vestibular schwannomas].

Review of methods which allow intraoperative identifying and monitoring of cochlear and facial nerves in resection of vestibular schwannomas is presented. We describe a case of successful identification and functional preservation of facial and cochlear nerves in a patient with acoustic neuroma. Detailed description of neurophysiological and neurosurgical aspects of surgical technique intended to preserve auditory functions is given.

[Positional damage of the sciatic nerve during neurosurgical intervention into the posterior cranial fossa in the sitting position].

The paper describes a rare case of severe, but reversible bilateral damage to the sciatic nerve (compression neuropathy) in a patient with Blumenbach's clivus meningioma developing during 12-hour operation removing the tumor in the patient's sitting position on the operating table. The etiology and prevention of this complication are discussed.

[Surgical treatment of skull base chordomas].

The paper analyses the series of 220 observations of patients with cranial chordomas operated in Burdenko Neusurgical Institute (Moscow, Russia) since 1984 till 2007. Tumors were localized in sellar region (34.1%), clival region (32.

[Vascular decompression in the treatment of trigeminal neuralgia].

Trigeminal neuralgia is characterized by unilateral paroxysmal facial pain. Patients often describe this pain as "the most sever pain one can suffer". Vascular compression of trigeminal nerve root directly near brainstem by artery or vein is considered the main etiology of trigeminal neuralgia.

[Malignant tumors involving the skull base: methods of treatment and results].

The paper presents experience with surgical and combined treatment of 197 patients with malignant tumors involving the skull base and extracranially originating. The authors have defined indications for and contraindications to different types of surgical treatment, developed methods for radical and palliative tumor removal, which are based on a comprehensive approach considering the basic principles of oncology and neurosurgery. Assessing the immediate and long-term results of surgical treatment by mathematical statistical methods could reveal the major factors influencing survival rates in patients after surgery and the duration of a relapse-free period.

[Multiple cerebral abscess caused by Nocardia brasilientis].

Streptococcus aureus, streptococci, and enterobacteria were major causative agents of abscesses of the brain. At present, associated infection is responsible for 60% of cerebral abscesses. When systemic and specific immunities are diminished, a risk for cerebral abscesses caused by fungi increases.

[Hemangioblastomas of central nervous system].

Hemangioblastomas of the central nervous system are benign, richly blood-supplied tumors that may be encountered in its any part, more commonly in the cerebellar hemispheres. Supratentorially, they occur rarely. In the literature there are reports on less than 100 cases of tumors at this site.

[Preoperative embolization of the internal carotid artery in surgical treatment of meningioma in the base of the anterior and middle cranial fossae].

Preoperative embolization is a widely used technique that may decrease blood supply to rich-vascurized tumors of the brain. Its use allows a neurosurgeon to safely remove a tumor of different histological nature and site. The objects of preoperative embolization are most commonly meningiomas at convexital or parasagittal sites.

[Primary meningioma of the ventricle IV].

A clinical observation of a rare neurosurgical pathology, i.e. meningioma growing in the cavity of ventricle IV, is reported.

[Surgical treatment of meningiomas of the craniovertebral junction].

The results of surgical treatment in 21 patients with meningiomas of the craniovertebral junction are presented. Main clinical diagnostic criteria in relation to the site of a tumor relative to the brain stem are considered. The basic surgical approaches used in the surgical treatment of meningiomas of the craniovertebral junction are described.

[Retrosigmoid suboccipital access].

Retrosigmoid suboccipital access has been widely used in neurosurgical care for more than a century. It has been employed in different vascular diseases and tumors of the brain. The authors provide examples of how to use the retrosigmoid suboccipital access, a patient's position during its application and techniques.