Russian Scientific Research Neurosurgical Institute

Today, thanks to recent advances in stroke treatment, mortality rates are declining and life expectancy is increasing for patients who have suffered a cerebrovascular accident. However, hemorrhagic stroke remains a leading cause of disability. The occurrence of adverse outcomes such as post-stroke seizures and epilepsy undoubtedly impairs patients’ quality of life. One approach to addressing the important clinical and research challenge of preventing post-stroke seizures is the administration of antiepileptic drugs in the early stages of hemorrhagic cerebrovascular accidents.

For patients with glioblastoma, the LMR serves as a diagnostically significant inflammatory biomarker independent of glucocorticoid administration. In patients with metastatic brain lesions, the most significant diagnostic value was demonstrated by monocyte counts, PIV and LMR.

To evaluate the effect of fluorescence navigation and endoscopic assistance on resection quality and outcomes; to analyze whether endoscope in fluorescence mode can overcome some limitations of resection following surgery under fluorescence-guided microscope. The study included 10 patients who underwent glioblastoma resection under fluorescence microscopic and endoscopic control. In 5 patients, 5 ALA (Alasens) at a dose of 20 mg/kg was used as a fluorescence inducer, in 5 patients - chlorin e6 (Photoditazine) at a dose of 1 mg/kg. Initially, microsurgical resection of all fluorescent tissue was performed using a microscope. Then, resection cavity was scanned with endoscope. Fluorescent tissue not visualized by microscope was additionally removed with subsequent morphological analysis. Endoscope fluorescence detection thresholds were lower than microscope thresholds at working distances of 30 and 10 mm. In all patients, additional fluorescent tissue was detected after endoscopy. This tissue was completely resected in all cases. Histological examination confirmed tumor tissue in additionally resected areas. Total resection was achieved in all cases as evidenced by postoperative contrast-enhanced MRI. Endoscopic resection of glioblastomas with fluorescence navigation significantly increases the rate of total resection. It is a useful adjunct to microscopic resection under fluorescence control.

Peripheral nerve sheaths tumors (PNST) account for about 8 % of all nervous system cancers. The relapse rate ranges from 17.3 to 26.4 %, showing an upward trend. The causes and provoking factors for the development of relapses of PNST have not been fully studied. Purpose of the study: to establish criteria for predicting recurrence of PNST. Material and Methods. The study included 122 patients who were treated at the Department of Spine and Peripheral Nerve Surgery of A.I. Polenov Russian Research Neurosurgical Institute from 2009 to 2021. Among them, there were 87 (71.3 %) patients with primary PNST and 35 (28.7 %) patients with recurrent PNST. All patients underwent MRI and ENMG both before and after surgery. An immunohistochemical study of Ki67 and SO X10 markers was performed. Results. The majority of relapses occured within 1 year after surgery. In cases with radical removal of PNST, the risk of relapse was: 28.6 % for schwannomas 28.6 %, 37.1 % for neurofibromas and 34.3 % for MP NST 34.3 % (p≥0.05). The risk of developing relapse of PNST was 2.9 times higher in patients aged ≥49 years than in patients aged ≤48 years (p<0.004). The larger the initial size of the tumor, the higher the risk of relapse in the late postoperative period. The risk of developing relapse of MP NST was 8.79 times higher in patients with tumor size of greater than 11.5 cm than in patients with smaller tumor size (p<0.02). The of Ki67 level above 4.85 % in schwannomas and above 5.17 % in neurofibromas can predict relapse of PNST (p<0.05). Loss of SO X10 protein expression was associated with an increase in histological anaplasia of the tumor, which causes a high risk of relapse and an unfavorable clinical course of the disease. Conclusion. Despite radical (total) resection of PNST, the risk of relapse remains high. The pathological type of tumor, its size, levels of SO X10 and Ki67 markers, patient’s age, degree of preoperative neurological deficit and extent of surgery are significant criteria for predicting the development of relapse of PNST.

It is known that the clinical course of glial tumors often shows similarities with inflammatory diseases of the brain, which made it possible to distinguish a special inflammatory type of gliomas. Chronic processes associated with the persistence of an infectious etiological factor proceed as a productive inflammation, while the etiological factor itself causes a proliferative cellular response.AIM OF THE STUDY: biopsies of 1424 glial tumors contaminated with hSV (glioblastomas (748), anaplastic astrocytomas (103), astrocytomas (248), oligodendrogliomas (126), anaplastic oligodendrogliomas (25), mixed gliomas (60), anaplastic mixed gliomas (15), ependymomas (85), anaplastic ependymomas (14)).The control groups consisted of tumors that did not express antibodiEs to hSV, in which intranuclear inclusions characteristic of hSV were not detected.Staining with hematoxylin-eosin was carried out in an automatic staining apparatus according to the generally accepted histological method. To detect hSV in tumors, an immunohistochemical study was used with antibodies to the antigen of hSV type I and II. Proliferative activity (Ki-67) was determined. Vessels were counted (CD 34). To identify inflammatory infiltration, an IhC study was performed with a set of monoclonal antibodies CD 45 (total leukocyte factor), CD 8 (T-lymphocytes). The IhC assay with p53 and bcl-2 was used to study apoptosis. To study the aggressiveness of tumor growth, the epidermal growth factor receptor (EGFR) was studied.RESULTS. It was found that glioblastomas occurring against the background of chronic inflammation have a median difference in the expression of bcl-2 and p53 in the vascular endothelium equal to 7.9 %. With an exacerbation of a chronic inflammatory process — 8.7 %. For anaplastic astrocytomas, the difference in chronic inflammation was 7.9 %, with its exacerbation — 8.2 %, for anaplastic oligodendrogliomas — 6.9 % and 7.1 %, for anaplastic oligoastrocytomas — 7.4 and 8.1 %, for anaplastic ependymomas — 7.2 % and 7.8 %, respectively. The difference between the expression of bcl-2 and p53 in tumor cells during chronic inflammation and its exacerbation for glioblastomas was 1.4 % and 1.5 %, for anaplastic astrocytomas — 0.73 % and 0.8 %, for anaplastic oligodendrogliomas — 0.7 % and 0.8 %, for anaplastic oligoastrocytomas — 0.7 % and 0.8 %, for anaplastic ependymomas — 0.6 % and 0.7 %. The difference in the expression of anti-apoptotic (bcl-2) and apoptotic (p53) factors for endothelial cells is significantly greater than for tumor cells (p<0.01), which determines the primacy of vessel growth. When comparing each of the groups of high-grade glial tumors with the control group, the amount of Ki-67 expression in endothelial cells was increased by an average of 3 times in each of the groups. This was manifested by a significant increase in the number of vessels in the «hot spot», accompanied by an acceleration of tumor growth.The correlation analysis between the amount of expression of antibodies to hSV and EGFR in high-grade glial tumors showed that there is a positive correlation between the amount of expression of antibodies to hSV and EGFR.Glial tumors of low malignancy progress due to an increase in the cell population, with a twofold increase in which the appearance of a proliferating vessel is fixed, which increases the degree of aggressiveness of tumor growth.CONCLUSION. The main growth mechanism of high-grade glial tumors is that the difference in the expression of antiapoptotic (bcl-2) and apoptotic (p53) factors for endothelial cells is significantly greater than for tumor cells (p<0.01), which determines the primacy of vessel growth. The main growth mechanism of low-grade glial tumors is characterized by an increase in their cell population. With an increase in the number of cells by 2 times, a proliferating vessel is formed, which increases the degree of aggressiveness of the tumor process. The aggressiveness of the disease depends on the presence of signs of exacerbation of inflammation caused by contamination of glial tumors with hSV, since EGFR activation is directly related to a high degree of tumor malignancy, aneuploidy, and a proliferative index. When planning the volume of surgical intervention during operations to remove glial tumors, the removal of the maximum number of proliferating vessels in the peritumorous zone should be taken into account as a cause provoking the onset of relapse, which will significantly increase the radicalness of the surgical intervention without reducing the quality of life of the patient.

Aim of the work was to analyze the content of factors with neuroprotective, neurotoxic and apoptotic eff ects in the blood of patients with prolonged disorders of consciousness (pDOC), depending on the level of consciousness disorder and neuroprotective therapy.Material and methods. Research included 53 patients with pDOC, who were divided into 2 groups. Group 1 included 19 vegetative state/unresponsive wakefulness syndrome (VS/UWS) patients, group 2–34 minimally conscious state (MCS “minus” and “plus”) patients. Firstly at admission and then at the end of treatment course (after 1 month on average), plasma concentrations of brain neurotrophic factor (BDNF), apoptosis antigen (APO-1), apoptosisinducing ligand (Fas-L) and glutamate were studied. Control group consisted of 16 patients without measured once.Results. Decrease of BDNF serum level was revealed in patients with pDOC,which was less pronounced those who had TBI as a etiological factor of pDOC. BDNF level signifi cantly increased after a month against the background of neuroprotective therapy. Glutamate level was higher in the fi rst group (VS/UWS). No signifi cant diff erence in the content of apoptosis factors was observed.Conclusion. In patients with pDOC, decrease serum BDNF level was observed, less pronounced in TBI as etiology of pDOC. In patients who matched MCS criteria at the admission, there was a signifi cant increase of BDNF serum level during treatment course, which could indicate that patients with a higher initial level of consciousness have better potential for realizing the eff ect of neuroprotective therapy. Levels of apoptosis factors did not correspond to the consciousness level.

Disturbance in circadian rhythms and the sleep-wake cycle is typical for patients in the intensive care unit, which retards rehabilitation. To assess the effect of exogenous melatonin and simultaneous mitigation of intensive care unit environmental factors on sleep duration. We studied five patients with chronic disorder of consciousness caused by anoxic brain injury. In addition, we varied the level of melatonin secretion in blood plasma to assess melatonin’s bioavailability and elimination time. We evaluated the sleep-wake cycle using continuous videoelectroencephalogram monitoring with the addition of oculographic and myographic channels for 72 hours. All the patients received melatonin tablets on the second day, wore masks and ear plugs, and had no feeding and nursing manipulations at night on the second and third days. There was no significant difference in sleep time between the first, second, and third days. Future studies of the circadian rhythm should aim at gaining a deeper analysis of the characteristics of the sleep-wake cycle in patients with severe anoxic brain injury together with further research for possible ways to influence the circadian component of sleep.

Immunotherapy is a promising and rapidly developing method of therapy patients with different oncological pathology. Considering the demonstrated efficacy in the treatment of patients with some solid tumors, as well as low survival rates and the absence of a significant effect in the standard treatment of most patients with glioblastomas, the question of the use of immunotherapy for malignant gliomas of the brain was raised. However, to decision this problem, it is necessary to consider the interaction of the immune system with tumors of this group. The modern view of the interaction of immunity and glioblastoma is presented. Special attention is paid to the mechanisms of tumor escape and suppression of the functional activity of immune system. The current immunotherapeutic approaches in the treatment of patients with glioblastoma are presented. Interaction of glioblastoma with immune system at all the stages of tumor growth is a complex process. While planning the immunotherapy of this pathology its necessary to take into consideration all mechanisms used by the tumor cells to avoid the immune response and suppress it. However, the clinical studies of this type of therapy proved to be less successful than expected. Further detailed studies of immune-resistance and escape of gliobloastoma must contribute to working out more effective immunotherapy tactics.

Postoperative macroglossia ( PM ) is a rather rare complication after craniofacial operations. The largest number of observations relate to neurosurgery especially in children. Prevention of risk factors, such as mechanical compression of the tongue, improper position on the operating table allows minimizing the amount and intensity of PM . The article presents a case when PM was the first symptom of dysgemic disorders in the brain stem.