Postherpetic neuralgia is a chronic and debilitating condition that can occur following an episode of herpes zoster (shingles). It is characterized by severe, persistent pain in the area where the shingles rash occurred. While various treatment approaches exist, including medications and non-invasive therapies, some cases of postherpetic neuralgia may require neurosurgical intervention. Neurosurgical treatment options for postherpetic neuralgia aim to alleviate the pain by targeting the affected nerves or neural pathways. One common approach is spinal cord stimulation (SCS). In SCS, electrodes are implanted along the spinal cord, and electrical impulses are delivered to interfere with the transmission of pain signals. This technique can modulate pain perception and significantly reduce the intensity and frequency of postherpetic neuralgia symptoms. Neurosurgical treatment of postherpetic neuralgia is typically considered when conservative measures have failed to provide sufficient relief. However, it is crucial for patients to undergo a comprehensive evaluation and consultation with a neurosurgeon to determine the most appropriate treatment approach based on their specific condition and medical history. The risks, benefits, and potential outcomes of neurosurgical interventions should be carefully discussed between the patient and their healthcare provider to make an informed decision.

Introduction. Malignant brain tumors, such as anaplastic astrocytomas and anaplastic oligodendrogliomas grade 3, are characterized by high aggressiveness and pose a serious clinical problem. This study focuses on assessing intratumoral heterogeneity in anaplastic astrocytomas and anaplastic oligodendrogliomas and its impact on disease prognosis.Aim. To study characteristics of intratumoral heterogeneity, in particular such morphological criteria as necrosis, vascular proliferation, mitoses, and mutations in the most significant for glioma progression genes in the groups of grade III astrocytomas and oligodendrogliomas, as well as analysis of prognostic significance of these parameters.Materials and methods. The study included 389 patients with IDH-mutant astrocytomas and 200 patients with oligodendrogliomas. The mean Ki-67 labeling index of astrocytomas was 12.78 %, while that of oligodendrogliomas was 8.54 %.Results. The presence of vascular proliferation, necrosis, of more than 20 % of the area of the specimen occupied by sarcomatous-like areas and the number of mitoses significantly affected not only disease-free survival but also overall survival of patients. In the clinical setting, mutations in the TERT promoter gene, amplification and mutation of the EGFR gene, deletion of the CDKN2A gene, and TP53 gene had a significant negative impact on recurrence-free and overall survival.Conclusion. The results of single-cell RNA sequencing showed additional factors, including sarcomatous-like areas, as well as TERT, EGFR, CDKN2A and TP53 mutations, in the progression of the tumors under consideration and in ensuring an increase in their malignant potential.

During the last 30 years, unique international experience has been accumulated in the treatment of children with medulloblastoma, especially in the age group over 3 years. Evolutionary representations about one of the most well – known international protocols – SJMB (in versions since 1996 – SJMB96, since 2003 – SJMB03, since 2012 – SJMB12) are shown in this article. Innovative criteria for stratifying patients into risk groups were established according to clinical, therapeutic, morphological and molecular-biological prognostic factors. Despite the accumulated experience, it is necessary to continue studying the relationship between age groups and the molecular biology of tumor cells for the purpose of subsequent optimization of the treatment program.

BackgroundOne-piece modified orbitozygomatic approach (OZA) is an extended version of the pterional approach that also includes orbital walls and frontal process of the zygomatic bone. For this craniotomy one burr hole must be placed in MacCarty keyhole and another - in the temporal region. ObjectiveTo develop a technique of the one-piece modified OZA with single a burr hole in the alternative sphenoid ridge keyhole that allows access to orbit, anterior cranial fossa and middle cranial fossa and apply it intraoperatively. MethodsA single human head specimen was used. The dissection was performed using standard surgical instruments high-speed Stryker drill. Every stage of the approach was photographed. We also report a surgical case of a patient with orbital cavernous hemangioma that was resected using the described technique. ResultsThe technique of the one-piece modified OZA with a single burr hole in the alternative sphenoid ridge keyhole is described, and its advantages and limitations are analyzed. The technique is used to totally resect an orbital cavernous hemangioma with good functional and cosmetic result. ConclusionModified OZA with a single burr hole in the sphenoid ridge keyhole is possible and may be an alternative to the classic technique. The advantages of this variation are the placement of just one burr hole and the preservation of a larger portion of the orbital roof. The latter facilitates better bone reconstruction and better cosmetic outcome. Disadvantages are the difficulty of identifying the location of the sphenoid ridge keyhole and risk of damaging the dura.

Medulloblastomas of the WNT molecular group (MB-WNT) represent the smallest group of MB and account for only 10 % of the total. This molecular group is characterized by a favorable prognosis. Given the aggressive treatment regimens for MB, reducing the intensity of therapy for prognostically favorable tumors seems justified. Purpose of the study – to demonstrate the results of treatment of children with MB-WNT and to determine the impact on survival of various prognostic factors. The study included 85 patients with MB-WNT under the age of 18 who received treatment and were followed up from 1993 to 2022. Median age at diagnosis was 10 years (min – 3, max – 17). All patients had classical MB. Metastatic spread of the tumor at the time of diagnosis was detected in 18 (21.2 %) patients, the presence of a residual tumor according to postoperative magnetic resonance imaging – in 32 (37.7 %). Somatic mutations in the TP53 gene were detected in 10 (7.1 %) patients, in the CTNNB1 gene – in 79 (92.9 %), in the APC gene – in 5 (5.9 %), chromosome 6 monosomy – in 76 (89.4 %) children. At the time of the analysis, 74 (87.1 %) patients were alive, 11 (12.9 %) patients died, a relapse was diagnosed in 6 (7.1 %) patients, of which 5 died from disease progression, 1 patient is alive in the second remission. One patient in long-term remission developed secondary meningioma 20 years after the diagnosis of MB. The 10-year progression-free survival (PFS) was 0.92. 5-year overall survival (OS) was 0.90, 10-year – 0.86. The median OS is 112 months. When analyzing the sample of patients with MB-WNT in our study, PFS and OS were statistically significantly higher in girls without metastatic tumor spread, with total resection of the tumor, stratified into the low-risk group, and in the absence of a somatic mutation in the TP53 gene in the tumor tissue. In multivariate analysis, PFS was influenced by the stage of the disease and the presence of a somatic mutation in the TP53 gene in the tumor tissue; on OS – only the presence of a somatic mutation in the TP53 gene in the tumor tissue.

Glioblastomas are malignant tumors that belong to the central nervous system and are challenging to diagnose due to their significant intratumoral heterogeneity, which makes molecular testing and diagnosis confirmation particularly difficult. In addition to identifying typical genetic mutations such as IDH, H3F3A G34 and K27, WHO recommendations emphasize the importance of analyzing the tumor epigenome to define its class based on DNA methylation patterns and methylation status of specific genomic regions, particularly the MGMT promoter region. Based on our clinical experience, molecular genetic studies sometimes yield contradictory results due to the heterogeneous cellular composition of glioblastomas. In this study, we present a series of observations made on 35 glioblastoma samples in which we compare the morphological features and the results of cell type detection by deconvolution method based on total DNA methylation profiles. Our results suggest that samples of mesenchymal class glioblastomas may contain over 50 % non-tumor immune cells, which should be considered in genetic testing of these tumors.

Reset osmostat syndrome (ROS) is characterized by a change of normal plasma osmolality threshold (decrease or increase), which leads to chronic dysnatremia (hypo- or hypernatremia). We have described a clinical case of ROS and chronic hyponatremia in a patient with chordoid glioma of the III ventricle. It is known that the patient had previously been diagnosed with hyponatremia (131-134 mmol/l). She has not hypothyroidism and hypocorticism. There is normal filtration function of the kidneys was (CKD-EPI 91.7 ml/mi/1,73m2). Urine osmolality and sodium level were studied to exclude of concentration kidney function disorder. During first three days after removal of the tumor of the third ventricle (chordoid glioma, WHO Grade II), the sodium level decreased to 119 mmol/l. Repeated infusions of 200-300 ml hypertonic 3% sodium chloride solution, gluco- and mineralocorticoid therapy was ineffective, increasing plasma sodium levels by 2-3 mmol/l with the return to the initial level during 6-8 hours. Hypopituitary disorders did not develop after surgery. With further observation, the sodium level remained within 126-129 mmol/l for 6 months after surgery. The water load test make exclude the classic syndrome of inappropriate secretion of antidiuretic hormone, and confirmed the diagnosis of RSO. Because of absence of clinical symptoms associated with hyponatremia, no medical correction was required, patient was recommended to clinical follow-up.

The analysis of inaccuracies in software products of different manufacturers on the presentation of EEG coherence indicators was carried out, the essence of the problem was described in detail. The authors specifically marked the dependence of quantitative indicators of coherence depending on the regime conditions for their calculation. Variants of visual display of the results obtained depending on the objectives of the study are analyzed. An optimal variant of topographic mapping of coherence values and an algorithm for their clinical interpretation are proposed.