Objective to develop an algorithm for the management of patients with VS in combination with HC (occlusive, open with increased pressure, normal pressure). Materials and methods. 76 patients with VS in combination with HC were treated at the subtentorial neurooncology department in 2017‒2023. All patients were examined by an ophthalmologist before surgery, in the early postoperative period and at repea­ted examinations after 3, 6 and 12 months. Standard preoperative procedures included CT scan, MRI brain examination with cont­rast, CT scan on the first day after sur­ge­ry, MRI with contrast in the early postoperative period – before discharge, and MRI with contrast in 3, 6 and 12 months. All patients were distributed in subgroups depending on the severity of symptoms of both hydrocephalus and VS, general somatic condition according to the ASA scale and age, and the most reasonable treatment tactics aimed at preserving the quality of life was used. Results. Depending on the type of HC and treatment algorithm patients were divided into 6 groups: I included 37 patients with VS and occlusive or open HC with increased pressure (OOHCIP) and papilledema. In these patients the 1st stage consisted of ventriculoperitoneal shunting (VPS), 2nd – VS removal; II – 6 patients with OOHCIP: 1st – VS removal, 2nd – VPS in whom HC not regressed; III – 13: 6 of whom OOHCIP and 7 with normotensive HC (NHC) – all VPS and observation in dynamics; IV – 9 with VS and NHC underwent VS removal and given the regression of HC VPS was not performed; V – 7 with VS and NHC in whom there was no HC regression after VS removal therefore the 2nd – VPS was carried out; VI – 4 with VS and vicarious HC underwent removal of VS and dynamic observation. Karnofsky scale increased more then 20 % was in groups I, III (OOHCIP), IV and V. Conclusions. For patients with OOHCIP and papilledema, the optimal tactic is 1st – VPS, 2nd –removal of VS. For elderly patients with VS in combination with normotensive or connective HC with increased pressure and concomitant pathology and predominance of HC symptoms it is recommended to conduct first step or only VPS under the follow up and VS removal in case of tumor/clinical signs progression.

Solitary occipital bone plasmacytoma at the level of the confluence of sinuses is a rare condition. We report a case of an unusual combination of occipital bone plasmacytoma, ocular motility abnormalities, and papilledema. To the best of our knowledge, no case has been reported in the literature on such a combination of nosology, location and clinical course.

Background: Even if current technologies are used in removal of a skull-base epidermoid cyst, the maintenance of function of the cranial nerves is still an important issue. Purpose: To assess changes in ophthalmological abnormalities after surgery for skull base epidermoid cysts. Material and Methods: We retrospectively reviewed the medical records of 21 patients who underwent surgery for epidermoid skull base cysts and had either ophthalmological abnormalities (abnormal visual, ocular motor functions and/or abnormal blood supply to the eye) or an involvement of the cranial nerves (CN; i.e., the ophthalmic, ocular motor, trigeminal, abducens and/or facial nerves). The surgical strategy was to aim for total tumor removal in order to prevent the development of postoperative meningitis and reduce the risk of tumor recurrence. Cranial nerve manipulations were performed under the highest available microscope magnification and with the use of endoscope imaging. In addition, intraoperative monitoring of the relevant cranial nerves was performed. All surgical procedures were video recorded. Long-term outcomes of surgery were determined either by outpatient examination or via a phone call using a standard checklist. Results: Total removal was achieved in 7 patients (33.3%), near total removal in 2 patients (9.5%), and subtotal removal in 12 patients (57.2%). Ocular motor functions were normal after surgery in 11 patients (52.4%). In addition, abnormalities in the early postoperative period were observed in 10 patients (47.6%), but the functions subsequently normalized in 3 patients and improved but not normalized in 7 patients. All the three patients with trigeminal neuralgia showed regression of pain syndrome. Conclusion: We determined the ophthalmological abnormalities that had been present before and after surgery, and the time required for function recovery. We found that endoscopic-assisted radical removal of the epidermoid cyst under the highest available microscope magnification with intraoperative cranial nerve monitoring was safe and effective for preserving cranial nerve functions in the late time points after surgery.

Актуальність. Процедури перкутанної ризотомії (ПР) в лікуванні класичної тригемінальної невралгії (КТН), за своєї достатньої ефективності, мають значний відсоток не-вдач та рецидивів болю. Вибір іншого втручання дуже складний, оскільки дані щодо лікування рецидивів КТН обмежені. Мета дослідження. Дослідити, чи впливають раніше проведені перкутанні втручання на ефективність та безпечність “золотого стандарту” лікування КТН – мікросудинної декомпресії (МСД). Матеріали та методи. Ретроспективний аналіз 28 послідовних випадків проведення МСД з приводу рецидиву КТН після ПР за період 2015–2016 рр. Категоризація даних та статистична обробка. Контрольна група 66 МСД у пацієнтів з КТН без будь-яких попередніх процедур. Використовувались шкали BNI для болю (BNI PS) та заніміння (BNI NS). Результати дослідження та їх обговорення. Інтраопераційні знахідки: атрофія та деколорація трійчастого нерва – в 9 випадках (32 %); щільні арахноїдальні злуки з деформацією корінця – в 13 випадках (46,7 %); “молочне” помутніння павутинної оболони – в 5 (17,8 %); в одному випадку конфлікт не виявлено (3,6 %). Середній після-операційний бал за шкалою BNI PS склав 2,21 і статистично не відрізнявся від контрольної групи – 1,95. Під час останнього контролю бал BNI PS був нижчим у групі виключно МСД (1,43 проти 2,43; P = 0,0006; 95 % ДІ 0,5918–1,9987). BNI NS та інші показники нейропатії були вищими в групі ПР (2,5 проти 1,3; P < 0,0001; 95 % ДІ 0,6697–1,6541). Серед них 100 % мали клінічно суттєву нейропатію та 57 % мали дизестезії, на відміну від 27 % та 7 % відповідно в групі виключно МСД . Поява або погіршення симптомів нейропатії спостерігались у 5 пацієнтів (17,9 %). Додаткові ризики розвитку нейропатичних проявів ймовірно обумовлені деструктивним характером перкутанних втручань. Висновки. Процедура МСД, як більш патогенетично обґрунтована, лишається втручанням вибору для пацієнтів із рецидивами КТН після раніше проведених ПР. Результати у цієї категорії пацієнтів гірші, ніж після пер-винної МСД. Перспективи подальших досліджень. Багатоцентрові дослідження з мультифакторним аналізом великих масивів даних. Конфлікт інтересів. Відсутній.

The results of treatment of 104 patients with large (30–40 mm) and giant (40 mm) vestibular schwannomas were analyzed. The primary tumors were seen in 89 patients, residual and reccurrence tumors – 15 cases. Stereotactic radiosurgery was used in 15 patients with subtotal and partial removal of tumor, and radiotherapy was done in one patient with repeated partial removal. Mortality rate was 2.88% (2 patients after primary surgery and one patient after reoperation). The main reasons of the death were disgemic disorders in the brainstem. Dysfunction of cranial nerves was increased after surgery. Following radiosurgery the tumor grouth control was achieved in 92% of patients. Surgery was done in 104 patients with large and giant vestibular schwannomas (100%), combined treatment – in 15 patients (14.4%). The total resection of tumors was possible in 18 patients (17.3%), subtotal – in 42 patients (40.4%), partial removal – in 44 patients (42.3%). Combined treatment may be employed as treatment strategies for incomplete removal of large, and giant vestibulas schwannomas for the preservation of facial nerve.

The data about anatomic-topographic peculiarities of petroclival sub- and supratentorial meningiomas were presented. There were operated on 24 patients, of them 5 have died. Three main topographoanatomic variants were delineated, depending on the tumor primary origin and topographic peculiarities present. The most frequent variant of the tumor localization was a lower one. Depending on the variant of the tumor localization present, the peculiarities of interrelationship between the tumor and nerves, vessels and the brain stem are determined.

Introduction. Today the role of viral contamination of brain tumors and possibility of antiviral therapy are studied widely.Materials and methods. Polymerase chain reaction was used to study the presence of оnсо- and herpes viruses in medulloblastomas and gliomas of the brain.Results. At research of 61 tumor samples contamination by different viruses was revealed in 47.5% cases, most often — in medulloblastomas (in 51%), less often — in glioblastomas (in 22%). More often virus of herpes VII type (in 16.3%) and polyomaviruses (in 10 %) were found. The shortest period before disease recurrence was observed in patients with medulloblastoma at contamination by polyomavirus SV-40.Conclusions. The role of viruses in oncogenesis initiation, their prognostic value and possibilities to use antiviral therapy for brain tumors treatment need further research.

Syndromes of neurovascular compression or hyperactive disorder (SHD) of cranial nerves at most patients are provocated by vascular compression of corresponding nerve’s root. But some authors deny vascular compression to be the main etiological factor of SHD of cranial nerves and reveal plural contacts of vessels with nerves without those syndromes development. On the base of intraoperative investigation of neuro-vascular relationships it was found out that in the zone of real vascular compression nerve’s root decolouration was observed that meant capillary perfusion infringement and disappeared after decompression; as closer to 90° the pulsation vector according to nerve’s root in the place of contact than probability of SHD occurrence is higher and symptoms of corresponding syndrome are more expressed.

22 cases of hyperactive dysfunction syndromes (HDS) of cranial nerves (20 — trigeminal neuralgia, 2 — hemifacial spasm) in combination with extracerebral tumors in posterior fossa (9 — meningioma, 6 — acoustic nerve tumor, 6 — cholesteatoma, 1 — angiolipoma) were observed. Clinical investigation, MRI and intraoperative microtopography of nerves, vessels and tumors relationships were conducted.A conclusion was made that single tumor compression of cranial nerve is not enough for HDS development. HDS of cranial nerves in case of tumor in posterior fossa develops when vascular compression exists.

An analysis of 7 cases of ponto-cerebellum corner structures revision after unsuccessful CN MVD for HDS in early terms with positive results of a repeat operation in 6 (85.7%) patients is presented; as well as 38 (11.5%) cases of HDS recurrence (out of 330 patients), 9 (2.7%) of whom were operated on in the terms from 6 months to 5 years with positive immediate result and subsequent partial recurrence in 2 (22,2%) cases under follow-up.In 19 (50%) out of 38 patients with HDS recurrence virologic and immunological tests were done, which necessitated the use of antivirus and immunocorrective therapy with a positive result in 15 (78.9%) patients, 4 (21.1%) — were operated on again later.Virologic and immunological investigations and therapy based on pathogenesis are validated in case of HDS. In case of unsuccessful MVD of CN or HDS recurrence ponto-cerebellum corner structures should be revised with the aim of repeat decompression or CN neurolysis.

The technique of microvascular decompression at trigeminal neuralgia caused by nerve’s flattening against the tentorium is described. The original method is used to make a space between the tentorium and tortuous artery — inserting a piece of non-scattered double teflon felt against artery and tentorium.

Micro-topographoanatomical features of extramedullar cranio-vertebral (CV) tumors were studied. The attention was paid to definition of extramedullar cranio-vertebral tumors micro-topographoanatomical variants.The necessity to account various types of intramedullar cranio-spinal tumors localization and their interactions with neurovascular structures in this area was proved at surgical interventions planning, that allowed to decrease considerably the postoperative complications probability.

The results of clinical and MRI investigation as to the peculiarities of posterior cranii fossa (PCF) parameters, appropriate for the small PCF and frequency of Chiari malformation in 220 patients with neurovascular compression syndrome (trigeminal and glossopharyngeal neuralgie, hemifacial spasm, Meniere’s syndrome, essential paroxysmal arterial hypertention) are presented. The surgical tactics in neurovascular compression syndrome combined with Chiari malformation are discussed. Decompression of craniocervical conduct simultaneously with microvascular decompression (MVD) surgery were performed in 7 patients. MVD was performed in 2 patients followed by PCF because of growing signs of tonsillar herniation. PCF decompression was performed in 2 patients before MVD. Only craniocervical conduct showed resolution of trigeminal neuralgia without MVD surgery in one case. Signs of cerebellar herniation have been resolved in all 12 patients after craniocervical conduct decompression, like signs of cranial nerves compression after MVD.

The results of clinical and MRI investigation as to the peculiarities of posterior cranii fossa (PCF) parameters, appropriate for the small PCF and frequency of Chiari malformation in 220 patients with neurovascular compression syndrome (trigeminal and glossopharyngeal neuralgie, hemifacial spasm, Meniere’s syndrome, essential paroxysmal arterial hypertention) are presented. The surgical tactics in neurovascular compression syndrome combined with Chiari malformation are discussed. Decompression of craniocervical conduct simultaneously with microvascular decompression (MVD) surgery were performed in 7 patients. MVD was performed in 2 patients followed by PCF because of growing signs of tonsillar herniation. PCF decompression was performed in 2 patients before MVD. Only craniocervical conduct showed resolution of trigeminal neuralgia without MVD surgery in one case. Signs of cerebellar herniation have been resolved in all 12 patients after craniocervical conduct decompression, like signs of cranial nerves compression after MVD.

Article is devoted to diagnostics and treatment features of craniovertebral junction (CVJ) extramedullar tumors. Alongside with a brief historical statement of a problem, the basic attention is given to modern methods of surgical treatment, in particular, to lateral approaches to area СVJ. The necessity of effective preoperative diagnostics and application of the expanded lateral approaches are proved, that essentially improves the nearest and follow-up surgical interventions results.