Surgical Treatment Of Brain Tumors Research Articles

Laser interstitial thermal therapy (LITT) for pediatric low-grade glioma-case presentations and lessons learned.

The surgical treatment of brain tumors has developed over time, offering customized strategies for patients and their specific lesions. One of the most recent advances in pediatric neuro-oncological surgery is laser interstitial thermal therapy (LITT). However, its effectiveness and indications are still being evaluated. The aim of this work is to review the current literature on LITT for pediatric low-grade gliomas (pLGG) and evaluate our initial results in this context. We retrospectively reviewed our pediatric neurosurgery database for patients who received LITT treatment between November 2019 and December 2023. We collected data on the indications for LITT, technical issues during the procedure, and clinical and radiological follow-up. Three patients underwent 5 LITT procedures for pLGG. The lesion was thalamo-peduncular in one patient, cingulate in one, and deep parietal in one patient. Two patients had a previous open resection done and were diagnosed with pLGG. One patient underwent a stereotaxic biopsy during the LITT procedure that was non-diagnostic. The same patient underwent a later open resection of the tumor in the cingulate gyrus. There were no surgical complications and all patients were discharged home on the first post-operative day. The follow-up period was between 20 and 40 months. Radiological follow-up showed a progressive reduction of the tumor in patients with LGG. Laser interstitial thermal therapy is a minimally invasive treatment that shows promise in treating deep-seated pLGG in children. The treatment has demonstrated a reduction in tumor volume, and the positive results continue over time. LITT can be used as an alternative treatment for tumors located in areas that are difficult to access surgically or in cases where other standard treatment options have failed.

NeuroIGN: Explainable Multimodal Image-Guided System for Precise Brain Tumor Surgery.

Precise neurosurgical guidance is critical for successful brain surgeries and plays a vital role in all phases of image-guided neurosurgery (IGN). Neuronavigation software enables real-time tracking of surgical tools, ensuring their presentation with high precision in relation to a virtual patient model. Therefore, this work focuses on the development of a novel multimodal IGN system, leveraging deep learning and explainable AI to enhance brain tumor surgery outcomes. The study establishes the clinical and technical requirements of the system for brain tumor surgeries. NeuroIGN adopts a modular architecture, including brain tumor segmentation, patient registration, and explainable output prediction, and integrates open-source packages into an interactive neuronavigational display. The NeuroIGN system components underwent validation and evaluation in both laboratory and simulated operating room (OR) settings. Experimental results demonstrated its accuracy in tumor segmentation and the success of ExplainAI in increasing the trust of medical professionals in deep learning. The proposed system was successfully assembled and set up within 11min in a pre-clinical OR setting with a tracking accuracy of 0.5 (± 0.1) mm. NeuroIGN was also evaluated as highly useful, with a high frame rate (19 FPS) and real-time ultrasound imaging capabilities. In conclusion, this paper describes not only the development of an open-source multimodal IGN system but also demonstrates the innovative application of deep learning and explainable AI algorithms in enhancing neuronavigation for brain tumor surgeries. By seamlessly integrating pre- and intra-operative patient image data with cutting-edge interventional devices, our experiments underscore the potential for deep learning models to improve the surgical treatment of brain tumors and long-term post-operative outcomes.

Prognostic evaluation of children diagnosed with intracerebral tumors associated by an obstructive hydrocephalus (own results)

Tumors of the Central Nervous System (CNS) in children are a special chapter of morbidity, caused by organic and neuropsychological damage. Intracerebral tumors are the most common solid forms at child (2.7 per 100,000 children annually), occupying a large part of the medical care of the child.Having different forms, from the point of view of tissue origin, localization, dissemination, clinical picture, evolution over time and onset (from neonatal to adolescent), significant advances have been made in the diagnosis and treatment of brain tumors. So that at present, the therapeutic approach and their dispensarisation involve a multidisciplinary pediatric neuroscience team consisting of neuropediatry, pediatric, neurosurgeon, oncologist, neuroradiologist, psychologist. The therapeutic decision in brain tumors in the child should be based on the conclusions of a multidisciplinary team. The goal of surgical treatment of brain tumors by a neurosurgeon is to improve the state and avoiding therapeutic errors, preventing long-term neurological sequelae and quality of life of the child.

Hemorrhagic complications during stereotactic biopsy of brain tumors

Relevance. Stereotactic biopsy (STB) is one of the main methods for diagnosing deep brain lesions. STB has several advantages over conventional intraoperative biopsy, as it is less traumatic and safer, especially for patients in critical condition. However, the most common complications of STB are hemorrhages, with a risk ranging from 0.9 % to 59.8 % depending on various studies. Intracranial hemorrhages are serious complications of surgical treatment of brain tumors, especially during biopsy using stereotactic techniques.Objective. To assess the risk of intracranial hemorrhages during STB of brain tumors and investigate possible factors influencing this risk, such as involvement of different brain regions in the neoplastic process, patient’s gender and age, degree of malignancy of the tumor, and use of different stereotactic devices.Materials and Methods. A retrospective study of data from 20 patients who underwent STB of brain tumors was conducted. Clinical data, examination results including coagulogram and aggregatogram, as well as data on involvement of different anatomical brain regions in the neoplastic process, degree of malignancy of the tumor, and use of a specific stereotactic device were analyzed.Results. Analysis of the frequency and structure of hemorrhagic complications of STB was performed, prognostic factors for high risk were identified, and preventive measures were proposed to reduce the number of hemorrhages.Conclusions. The introduction of the modern CRW Radionics stereotactic device into practice has reduced the frequency and severity of hemorrhagic complications after STB by two times. Lymphoproliferative processes and glioblastomas have a higher frequency of hemorrhages, but in most cases, they are clinically insignificant. There is a correlation between the degree of anaplasia of astrocytic tumors and the severity of hemorrhages. Ways to reduce the risks of intracranial hemorrhages during STB of brain tumors may include: careful preoperative planning of the biopsy trajectory; use of informative neurovisualization methods in planning the needle insertion trajectory; use of modern stereotactic systems by neurosurgeons who have undergone additional specialization and training on the specific device; use of modern biopsy needles. In addition, it is advisable to consider preoperative preventive hemostatic therapy in patients suspected of having a high degree of tumor anaplasia.

Laser interstitial thermal therapy (LITT) for pediatric patients affected by intracranial tumors.

The surgical treatment of brain tumors has evolved over time, offering different strategies tailored to patients and their specific lesions. Among these strategies, Laser Interstitial Thermal Therapy (LITT) is one of the most recent advances in pediatric neurooncological surgery, and its results and evolution are still under assessment. We retrospectively analyzed data from six pediatric patients with deep-seated brain tumors treated with LITT at a single center between November 2019 and June 2022. A total of four patients underwent a stereotaxic biopsy during the same operating session. The indications and preparation for LITT, technical issues, clinical and radiological follow-up, impact on quality of life, and oncological treatment are discussed. The mean patient age eight years (ranging from 2 to 11 years). The lesion was thalamic in four patients, thalamo-peduncular in one, and occipital posterior periventricular in one. In total, two patients had been previously diagnosed with low-grade glioma (LGG). Biopsies revealed LGG in two patients, ganglioglioma grade I in one, and diffuse high-grade glioma (HGG) in one. Postoperatively, two patients presented with transient motor deficits. The mean follow-up period was 17 months (ranging from 5 to 32 months). Radiological follow-up showed a progressive reduction of the tumor in patients with LGG. Laser interstitial thermal therapy is a promising, minimally invasive treatment for deep-seated tumors in children. The results of lesion reduction appear to be relevant in LGGs and continue over time. It can be used as an alternative treatment for tumors located at sites that are difficult to access surgically or where other standard treatment options have failed.

Usefulness of intraoperative rapid immunohistochemistry in the surgical treatment of brain tumors.

In the treatment of primary central nervous system lymphoma (PCNSL), intraoperative rapid pathological diagnosis can dramatically change the surgical strategy, and more accurate diagnostic methods are required. In April 2020, we adopted intraoperative rapid immunohistochemistry (IHC) in addition to conventional rapid intraoperative diagnosis based on morphological assessment, mainly for patients with PCNSL. Here, we investigate the usefulness and significance of intraoperative rapid IHC based on our initial experience. We performed intraoperative rapid IHC using antibodies for cluster of differentiation (CD)20, CD3, leukocyte common antigen (LCA) and glial fibrillary acidic protein (GFAP) using enzyme-labeled antibody methods in 25 patients, including PCNSL patients, from April 2020 to July 2022. We examined the utility of this approach in determining treatment strategies for brain tumors. Postoperative final pathological diagnoses from paraffin-embedded sections were as follows: diffuse large B-cell lymphoma, 16 cases; glioblastoma, six cases; pilocytic astrocytoma, one case; adenocarcinoma, one case; and inflammatory disorder, one case. The entire process took 32 min and staining for CD20, CD3, LCA, and GFAP was comparable to that using paraffin-embedded sections. In all cases, the results of intraoperative rapid IHC were consistent with final pathological diagnoses from paraffin-embedded sections. In addition, in two cases, the results of conventional intraoperative rapid pathological diagnosis based on morphological assessments using frozen sections were drastically changed by adding intraoperative rapid IHC. Intraoperative rapid IHC contributes to deciding appropriate treatment strategies and facilitating early initiation of chemotherapy for PCNSL. This may allow new therapeutic strategies not only for PCNSL but also for other brain tumors.

Quality of Life after Surgical Treatment of Brain Tumors.

Quality of life is one of the parameters that characterize the success of brain tumor treatments, along with overall survival and a disease-free life. Thus, the main aim of this research was to evaluate the quality of life after the surgical treatment of brain tumors. The research material included 236 patients who were to undergo surgery for brain tumors. The participants completed the quality of life questionnaires EORTC QLQ-C30 (version 3.0) and EORTC QLQ-BN20 on the day of admission to the department, on the fifth day after the removal of the brain tumor, and thirty days after the surgical procedure. Descriptive statistics, Student’s t-test, the Kruskal–Wallis test, the Shapiro–Wolf test, ANOVA, and Fisher’s least significant difference post hoc test were performed. The mean score of the questionnaire before the surgical procedure amounted to 0.706, 5 days after surgery it amounted to 0.614, and 30 days after surgery to 0.707. The greatest reduction in the quality of life immediately after the procedure was observed in patients with low-grade glial tumors (WHO I, II) and extracerebral tumors (meningiomas and neuromas). Thirty days after surgery, an improvement in the quality of life was observed in all included groups. The greatest improvement was recorded in the group of patients operated on for meningioma and neuroblastoma, and the lowest in patients treated for metastatic tumors. Contemporary surgical procedures used in neurosurgery reduce the quality of life in patients with brain tumors only in the early postoperative period. Histopathological diagnoses of these tumors impact the quality of life of patients.

Application of Intraoperative Contrast-Enhanced Ultrasound in the Resection of Brain Tumors.

To investigate the value of routine intraoperative ultrasound (IU) and intraoperative contrast-enhanced ultrasound (ICEUS) in the surgical treatment of brain tumors, and to explore the utilization of ICEUS for the removal of the remnants surrounding the resection cavity. In total, 51 patients who underwent operations from 2012 to 2018 due to different tumors in the brain were included in this study. The clinical data were evaluated retrospectively. IU was performed in all patients, among which 28 patients underwent ICEUS. The effects of IU and ICEUS on tumor resection and recurrence were evaluated. Semiquantitative analysis was performed to compare ICEUS parameters of the brain tumor with those of the surrounding tissue. In total, 36 male and 15 female patients were included in this study. The average age was 43 years (range: 14-68 years). The follow-up period was from 7 to 74 months (mean follow-up 32 months). IU was used in all patients, and no lesion was missed. Among them, 28 patients underwent ICEUS. The rate of total removal of the ICEUS group (23/28, 82%) was significantly higher than that of the IU group (11/23, 48%) (P<0.05). The recurrence rate of ICEUS and IU was 18% (5/23), and 22% (5/28), respectively, and the difference did not reach statistical significance (P>0.05). The semiquantitative analysis showed that the intensity and the transit time of microbubbles reaching the lesions were significantly different from the intensity and the transit time of microbubbles reaching the surrounding tissue (P<0.05) and reflected indirectly the volume and the speed of blood perfusion in the lesions was higher than those in the surrounding tissue. ICEUS is a useful tool in localizing and outlining brain lesions, especially for the resection of the hypervascular lesions in the brain. ICEUS could be more beneficial for identifying the remnants and improving the rate of total removal of these lesions than routine intraoperative ultrasound.

Diagnosis and Treatment of Pediatric Brain Tumors.

Tumors of the brain and spine make up about 20% of all childhood cancers; they are the second most common form of childhood cancer after leukemia. Brain tumors are the most common solid tumor in children. Symptoms depend on a variety of factors, including location of the tumor, age of child, and rate of tumor growth. The aim of study was to present our experience with the diagnosis and treatment of brain tumors in children. The aim of this study is to analyze clinicopathological characteristics, treatments, complications, and outcomes in children with brain tumors. This study is a retrospective analysis of 27 consecutive patients younger than 16 years and hospitalized for surgical treatment of brain tumors. Intracranial hypertension, neurological status, radiological computerized tomography (CT) or magnetic resonance imaging (MRI) findings, tumor localization, type of resection, hydrocephalus treatment, histopathology, complications, and outcome were analyzed. Twenty-seven surgeries were performed in patients for brain tumors. There were 9 females and 18 males. The average patient age was 7.8 years. There were 11 (40%) children with astrocytoma; of these, there were 9 (82%) pilocytic astrocytomas and 2 (18%) ordinary histopathological subtypes of high-grade tumors. As with any cancer, prognosis and long-term survival vary greatly from child to child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a child diagnosed with a brain tumor.

COVD-16. THE COVID-19 PANDEMIC FROM A NEURO-ONCOLOGY PERSPECTIVE: STRATEGIES, PROTOCOLS, AND LESSON LEARNED

INTRODUCTIONThe COVID-19 pandemic has had an incalculable impact on our national healthcare system, and elective surgical procedures have been particularly affected. Given that brain tumors often straddle the line between elective and emergent procedures, the pandemic has presented unique challenges to the neuro-oncology community. Here, we present our institutional protocols to (1) maintain an active outpatient neuro-oncology practice, (2) triage surgical cases under limited operating room availability, and (3) safely resume research efforts.METHODSGiven the rapidly evolving nature of the pandemic, we based the development of our protocols on the Delphi system to achieve consensus across a multi-disciplinary panel of experts. Specifically, we used this system to develop (1) a standardized physical examination that could be implemented over tele-medicine and (2) a triage system for surgical cases. Research efforts were largely suspended in the early days of the pandemic, however protocols for enrollment in clinical trials as well as the resumption of benchwork were also developed.RESULTSFrom the COVID-19 shelter-in-place order (March, 2020) through May 2020, our department performed 96 surgeries for the resection of brain tumors compared to 127 such surgeries from the three months prior. During this time, using a modified Delphi procedure, we developed detailed protocols to triage tumor cases. Implementation of telemedicine outpatient visits allowed the continuation of the neuro-oncology clinic and, ultimately, the resumption of clinical trials.CONCLUSIONSThe protocols presented here offer several strategies to continue neuro-oncological care during the pandemic, including the surgical treatment of brain tumors. As we prepare for future outbreaks, these treatment algorithms will help ensure that patients with brain tumors receive the highest level of care independent of COVID-19.

Surgical treatment of brain tumors without informed consent - medical, organizational and legal aspect

Brain tumors are often manifested by mental disorders. Changes in personality, behavior and logical functions are often the dominant pathological symptoms in patients with brain tumors. There are also cases where brain tumors occur in patients with psychotic disorders or mental retardation and in these particular cases, they aggravate the already advanced mental disability. As a result, patients with brain tumors are often intellectually disabled and it is not possible to perform informed consent to treatment. In clinical practice, those patients who require neurosurgical treatment must give their informed consent, and when it is not possible, the judicial consent must be adjudicated. In urgent cases, medical decision on surgery is necessary in algorithm of life saving surgery, due to size of tumor and brain edema. We present the current state of knowledge and the facts about neurosurgical prcedures performed in patients with brain tumors without obtaining informed consent. We analyze the medical, legal and organizational status, pay attention to the nuances and the need for outstanding clinical experience in such a delicate matter. Clinical experience and legal awareness is essential for a qualifying neurosurgeon.

Neurosurgery for brain metastasis from breast cancer.

Breast cancer is the most common malignancy among women worldwide, and the main cause of death in patients with breast cancer is metastasis. Metastasis to the central nervous system occurs in 10% to 16% of patients with metastatic breast cancer, and this rate has increased because of recent advancements in systemic chemotherapy. Because of the various treatments available for brain metastasis, accurate diagnosis and evaluation for treatment are important. Magnetic resonance imaging (MRI) is one of the most reliable preoperative examinations not only for diagnosis of metastatic brain tumors but also for estimation of the molecular characteristics of the tumor based on radiographic information such as the number of lesions, solid or ring enhancement, and cyst formation. Surgical resection continues to play an important role in patients with a limited number of brain metastases and a relatively good performance status. A single brain metastasis is a good indication for surgical treatment followed by radiation therapy to obtain longer survival. Surgical removal is also considered for two or more lesions if neurological symptoms are caused by brain lesions of >3 cm with a mass effect or associated hydrocephalus. Although maximal safe resection with minimal morbidity is ideal in the surgical treatment of brain tumors, supramarginal resection can be achieved in select cases. With respect to the resection technique, en bloc resection is generally recommended to avoid leptomeningeal dissemination induced by piecemeal resection. An operating microscope, neuronavigation, and intraoperative neurophysiological monitoring are essential in modern neurosurgical procedures, including tumor resection. More recently, supporting surgical instruments have been introduced. The use of endoscopic surgery has dramatically increased, especially for intraventricular lesions and in transsphenoidal surgery. An exoscope helps neurosurgeons to comfortably operate regardless of patient positioning or anatomy. A tubular retractor can prevent damage to the surrounding brain tissue during surgery and is a useful instrument in combination with both an endoscope and exoscope. Additionally, 5-aminolevulinic acid (5-ALA) is a promising reagent for photodynamic detection of residual tumor tissue. In the near future, novel treatment options such as high-intensity focused ultrasound (HIFU), laser interstitial thermal therapy (LITT), oncolytic virus therapy, and gene therapy will be introduced.

The Greek linguistic assessment for awake brain surgery: development process and normative data

ABSTRACT Language mapping with direct electrical stimulation is considered the gold standard in surgical treatment of brain tumors. Assessing a variety of language functions intraoperatively can affect the extent of the tumor resection as well as the patient’s postoperative quality of life. Although most tests include preoperative sessions where tasks are personalised to each patient, normative data are essential since they can ensure that the presented stimuli can be responded appropriately. In this study, we describe the development and standardisation procedures of the first linguistic test in Greek, designed specifically for brain mapping during awake craniotomies. The tasks are developed to comply with the special conditions and restrictions of language assessment inside the operating room. Each task is controlled for various psycholinguistic and lexical variables and it is associated with specific neuroanatomical areas and linguistic processes. Our population consists of 80 right-handed, healthy, Greek-speaking individuals aged 20–60 years. We found only a few main effects and interactions of demographic variables on our test scores. Most differences were found between age groups, since older participants tend to perform slightly worse than younger ones. Therefore, percentiles and cut-off scores were calculated separately for each demographic group. Regarding the clinical application of GLAABS, we describe the procedures we followed to administer it to brain tumor patients from our department and also discuss how sensitivity and specificity can affect patients’ postoperative course.

Sergei Ivanovich SPASOKUKOTSKY - academician, Professor, chief surgeon of the Kremlin Medical and sanitary Department&#x0D; (to the 150th of birthday)

Sergei Ivanovich Spasokukotsky was born in Kostroma in 1870 in the family of a Zemstvo doctor. In 1879 he entered the Yaroslavl provincial gymnasium, in 1888 the medical faculty of Moscow University. Having received a doctor's degree, Sergey Ivanovich supervised the construction of the hospital on the Arkhangelsk railway, worked in the clinic of Professor L. L. Levshin in Moscow. In 1898, S. I. Spasokukotsky defended his thesis on" Bone grafting in amputation of limbs." In 1900. he makes a report on hernias at the I Congress of Russian surgeons, and 3 years later publishes his report on 600 performed hernias. In 1902, he presented a scientific study on "the gatekeeper's Obstruction and its surgical treatment". By the end of the 1900s, half of the stomach operations in Russia were performed by S. I. Spasokukotsky. In 1909-1911 he worked as the head of the surgical Department of Saratov city hospital, since 1912. Professor of the Department of topographic anatomy and operative surgery, then head of the Department of hospital surgical clinic of Saratov University. S. I. Spasokukotsky studied various aspects of the treatment of ulcers and stomach cancer, problems of acute appendicitis, liver surgery, biliary tract and postoperative complications, neurosurgery. He was the first to use fat swabs to fight bleeding in brain surgery (1913). In 1915, during the First world war, he worked as a consultant surgeon on the South-Western front. Invented a method of skin-bone flap, suggested puncture method of treatment of abscesses of the brain. In 1923 S. I. Spasokukotsky for the first time in the USSR made and highly estimated diagnostic value of encephalography; one of the first began to develop a problem of surgical treatment of brain tumors, made resection of a share of a lung, for the first time pointed to the actinomycotic nature of group of pulmonary suppuration. He demonstrated the advantages of thoracoplasty in his work "the Role of surgery in the treatment of purulent pulmonary diseases. Thoracoplasty" (1925). Since 1926 Sergey Ivanovich is the head of the faculty clinic and the Department of faculty surgery of the 2nd Moscow medical Institute. N. And. Pirogov (now Russian national research medical University named after N. And. Pirogov). He introduced a polyclinic reception, strict adherence to asepsis, visiting patients at certain hours, local anesthesia, developed a method of treating the surgeon's hands. Since 1927, S. I. Spasokukotsky chief surgeon of the Medical and sanitary Department of the Kremlin, head of the surgical sector of the Institute of blood transfusion in Moscow. His experience was summarized in the monograph "blood Transfusion in surgery" (1935). From 1935 to the end of his life S. I. Spasokukotsky was a member of the Board of the all-Union society of surgeons. He was a member of the editorial Board of a number of medical journals and from 1921 to 1932 was editor of the journal "New surgical archive". S. I. Spasokukotsky was awarded the Stalin prize of I degree (1942), the government cash prize of 30 thousand rubles and the ZIS car, orders of Lenin, the red banner of Labor and medals In 1942. Sergey Ivanovich was elected a full member of the Academy of Sciences of the USSR. The scientific school of S. I. Spasokukotsky consists of 35 professors, 33 associate professors and candidate of medical Sciences. He published more than 143 scientific publications, including monographs. On November 17, 1943 Sergey Ivanovich died of liver cancer and was buried at Novodevichy cemetery in Moscow. His name is called surgery (herniation, gastric resection, amputation). The street was named after Spasokukotsky in Kostroma; in Moscow: faculty surgical clinic of the Russian national research medical University named after N. So. Pirogov and city hospital №50 (2015). In front of the main building of the City clinical hospital №1 on Leninsky Prospekt it has a monument-bust.

Immunoreactivity of the Body During the Surgical Treatment of Brain Tumors

Background: The cells of the immune system are actively involved in the tumor development process and can either suppress or stimulate tumor growth. Objective: to determine the role and significance of immunological indications of patients with brain tumors of different histostructure before and after surgical treatment. Methods: The number of lymphocytes, neutrophilic granulocytes, and platelets was analyzed in 246 patients with brain tumors of various histostructures. Results: It was determined that there were significant fluctuations in the content of leukocytes in the blood of patients with brain tumors of various histogenesis. The largest number of leukocytes was observed in neuroectodermal and mesenchymal tumors. However, neuroepithelial tumors (pituitary adenomas) did not show a considerable increase in the number of leukocytes compared with that in healthy individuals. Conclusions: It is revealed that the determination of the immune response is an essential component of clinical examination. These immune response options allow to develop targeted immunotherapy. The determination of immunoreactivity for these options was determined to be clinically feasible. In addition, belonging to a particular group based on the immune status considerably determines the further course of the tumor process and the effectiveness of the surgical treatment of brain tumors.

Application of diffusion tensor tractography in the surgical treatment of brain tumors located in functional areas

The present study aimed to explore the application of diffusion tensor tractography (DTT) in the preoperative planning and prognostic evaluation of tumors located in the functional areas of the brain. A total of 42 patients diagnosed with intracranial tumors were randomly assigned to either the trial or the control group. DT imaging (DTI) was performed on the basis of preoperative conventional magnetic resonance imaging (MRI) and analyzed for patients in the trial group. Patients in the control group underwent only routine MRI scans. The effect of DTT on the prognosis of patients was evaluated by tumor resection rate and quality of life evaluation using Karnofsky performance score (KPS) comparison between the trial and control groups. There were no significant differences for total tumor removal rate in the trial group (85.71%) compared with that in the control group (71.43%) (P>0.05). The rate of postoperative symptom improvement in the trial group (85.71%) was significantly higher compared with that in the control group (47.62%) (P<0.05). The KPS value of the trial group was significantly higher postoperatively (78.57±17.40) compared with that preoperatively (66.67±16.23) (P<0.05). The KPS value of the control group postoperatively (72.38±19.21) was significantly higher compared with that preoperatively (66.67±16.00) (P<0.05). The postoperative KPS improvement rate [postoperative value-preoperative value)/preoperative value] of the trial group was significantly higher compared with that in the control group. In conclusion, the use of DTT is an effective supplement to traditional MRI, with particular relevance in preoperative planning, particularly for tumors in the functional area of the brain, and can significantly improve the prognostic function of patients.

Outcomes of Total Hip Arthroplasty in Patients with Osteonecrosis of the Femoral Head Following Surgical Treatment of Brain Tumors.

Corticosteroids have been widely used in patients with brain tumors to reduce tumor-associated edema and neurological deficits. This study examined the outcomes of total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH) following brain tumor surgery. We identified 34 THAs performed in 26 patients with steroid-induced ONFH among 9254 patients undergoing surgical treatment for primary brain tumors. After propensity score matching with demographics, 68 THAs (52 patients) in ONFH unrelated to brain tumors were selected as the control group. At the time of THA, 54% of brain tumor patients had neurological sequelae and 46% had adrenal insufficiency. After THA, patients with brain tumor required longer hospital stay, reported a lower functional score, and showed a higher rate of heterotopic ossification compared to the control group. However, hip pain score improved significantly after THA in the brain tumor group, and did not differ from that of the control group (P-value = 0.168). Major complication rates were similar (2.9% and 1.5% for the brain tumor and control groups, respectively; P-value = 1.000), and implant survivorships were not different at 7 years (100% and 98.1% for the brain tumor and control groups, respectively; P-value = 0.455). Our findings suggest that THA can be safely performed to reduce hip pain in patients with steroid-induced ONFH after surgical treatment of primary brain tumors.

Evaluation of Postoperative Deficits following Motor Cortex Tumor Resection using Small Craniotomy.

Introduction Surgical treatment of brain tumors in eloquent areas has always been considered a major challenge because removal-related cortical damage can cause serious functional impairment. However, few studies have investigated the association between small craniotomies and the higher risk of incidence of motor deficits and prolonged recovery time. Here, we analyzed neurologic deficits and the prognostic variables after surgery guided by navigation for motor cortex tumors under general anesthesia. Methods This was a prospective study that included 47 patients with tumors in the precentral gyrus. All surgeries were performed with neuronavigation and cortical mapping, with direct electrical stimulation of the motor cortex. We evaluated the prognostic evolution of patients with pre- and postoperative Karnofsky Performance Scale using the Eastern Cooperative Oncology Group scale. Results Complete resection was verified in all 18 cases of metastasis, 13 patients with glioblastoma multiforme, and 5 patients with low-grade gliomas. An analysis of the motor deficits revealed that 11 patients experienced worsening of the deficit on the first day after surgery. Only four patients developed new deficits in the immediate postoperative period, and these improved after 3 weeks. After 3 months, only two patients had deficits that were worse those experienced prior to surgery; both patients had glioblastoma multiforme. Conclusion In our series, motor deficits prior to surgery were the most important factors associated with persistent postoperative deficits. Small craniotomy with navigation associated with intraoperative brain mapping allowed a safe resection and motor preservation in patients with motor cortex brain tumor.

How Intraoperative Tools and Techniques Have Changed the Approach to Brain Tumor Surgery.

Surgical treatment of brain tumors remains an integral part of a comprehensive treatment plan. Here, we review technological advances that have enhanced what surgeons are capable of doing within and outside the traditional operating room. Extent of surgical resection has improved with the use of MRI and fluorescent dyes intraoperatively. Neurological injury during brain tumor surgery has decreased with appropriate use of neurophysiological monitoring. New operative scopes have enhanced ability of surgeons to visualize tissues during dissection. Laser interstitial therapy and radiation treatment have made possible the treatment of previously considered non-operable brain tumors in addition to replacing or serving as adjunct to surgical treatment of brain tumors. Surgery remains an important pillar in treatment of most brain tumors. Ongoing technological advances have augmented extent of what is possible in this realm.

REHABILITATION OF PATIENTS IN CHRONIC CRITICAL STATES DUE TO BRAIN DAMAGE IN CONDITIONS OF RESUSCITATION AND INTENSIVE CARE UNITS: THE EXPERIENCE OF THE FEDERAL RESEARCH AND CLINICAL CENTER

The article presents the experience of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology for the organization of medical care for patients in long-term (chronic) critical conditions due to the craniocerebral trauma, stroke, and surgical treatment of brain tumors who needs to be provided the functioning of vital organs against the background of prolonged impairment of consciousness, including methods of excommunication from the apparatus of artificial ventilation, medical correction of the level of consciousness, adequate general symptomatic treatment, nutritional-metabolic therapy and early rehabilitation by multidisciplinary medical teams.