This study aimed to assess the feasibility of radiomic features derived from diffusion kurtosis imaging (DK MRI) in identifying microstructural brain damage in diffuse axonal injury (DAI) and predicting its outcome. We hypothesized that radiomic features, computed from parametric DK MRI maps, may differ between healthy individuals and those with trauma, and may be related to DAI outcomes. The study included 31 DAI patients and 12 healthy volunteers. A total of 342,300 radiomic features were calculated (2282 features for each combination of 10 parametric DK maps with 15 regions of interest). Our findings suggest that the set of radiomic features effectively distinguishes between healthy and damaged brain tissues, and can predict DAI outcome. A broad spectrum of radiomic parameters based on DK MRI data showed high diagnostic and prognostic potential in DAI, presenting advantages beyond the traditionally used average values for the regions of interest on parametric DK MRI maps.

Introduction . Preoperative fMRI often shows a reduced BOLD response in the areas located perifocal to brain tumors caused by pathological vasoreactivity as a result of neurovascular uncoupling. The aim of this study was an accurate identification of the eloquent cortical areas near brain tumors by measuring vasoreactivity using the breath holding test. Material and methods. 23 patients with brain tumors located near eloquent cortical areas underwent fMRI mapping of the language and / or motor cortical areas depending on the location of the tumor. Breath hold test was  also included, the design of which coincided with motor and language block paradigms. Results . A statistical dependency between motor, speech tasks and breath-hold BOLD-response was included into the BOLD analysis using coherence. fMRI activation maps generated by this method showed activation in the eloquent areas adjacent to brain tumors which were not detected by the standard analysis. This study shows that neurovascular uncoupling affects the accuracy of BOLD fMRI in brain tumors. Conclusion. The results of fMRI mapping can be partially improved by the incorporating vasoreactivity measurements into a standard analysis.

Neurosurgery of intracranial tumors, especially of glial origin, is a non-trivial task due to their infiltrative growth. In recent years, optical methods of intraoperative navigation have been actively used in neurosurgery. However, one of the most widely used approaches based on the selective accumulation of fluorescent contrast medium (5-ALA-induced protoporphyrin IX) by the tumor cannot be applied to a significant number of tumors due to its low accumulation. On the contrary, Raman spectroscopy, which allows analyzing the molecular composition of tissues while preserving all the advantages of the method of fluorescence spectroscopy, does not require the use of an exogenous dye and may become a method of choice when composing a system for intraoperative navigation or optical biopsy. This work presents the first results of using the principal component method to classify Raman spectra of human glioblastoma with intermediate processing of spectra to minimize possible errors from the fluorescence of both endogenous fluorophores and photosensitizers used in fluorescence navigation. As a result, differences were found in the principal component space, corresponding to tissue samples with microcystic components, extensive areas of necrosis, and foci of fresh hemorrhages. It is shown that this approach can serve as the basis for constructing a system for automatic intraoperative tissue classification based on the analysis of Raman spectra.

Oculomotor nerve neurinoma not associated with neurofibromatosis type II is an extremely rare pathology. According to the topography, cisternal, cisternocavernous, cavernous, orbitocavernous, and orbital tumor groups are distinguished. The clinical picture of the disease is characterized mainly by either oculomotor disorders or pyramidal symptoms, depending on the tumor localization. Neurinomas of the oculomotor nerve rarely occur without oculomotor disorders. However, in some patients with these tumors, the third nerve function remains intact. In this paper, we present clinical cases of two patients with oculomotor nerve neurinomas and analyze the relevant literature.

Intraoperative diagnosis of brain tumors remains a challenging problem of modern neurosurgery. A complete resection of tumor is the most important factor, determining an efficiency of its treatment, while an incomplete resection, caused by inaccurate detection of tumor margins, increases a probability of the tumor recurrence. The existing methods of the intraoperative neurodiagnosis of tumors are plagued with limited sensitivity and specificity; they remain laborious, time-consuming and/or rather expensive. Therefore, the development of novel methods for the intraoperative diagnosis of gliomas relying on modern instruments of medical imaging is a topical problem of medicine, physics, and engineering. In our research, we studied the ability of dual-modality imaging that combines such methods as optical coherence tomography (OCT) and terahertz (THz) pulsed spectroscopy, for intraoperative diagnosis of brain tumors with a strong emphasize on a human brain gliomas. We performed experimental studies of the frequency-dependent THz dielectric properties and OCT imaging of healthy (intact) and pathological brain tissues ex vivo in order to analyze the prospect for differentiation between tissue classes. The observed results highlight a potential of the considered instruments in the label-free intraoperative neurodiagnostics.

5-ALA intraoperative fluorescence is widely used in surgery of brain tumors for intraoperative demarcation of boundaries and more total resection because 5-ALA metabolites are not accumulated in the intact brain and vascular tissues. Given this fact, it was hypothesized that fluorescence of vessels in the immediate vicinity of a brain tumor may indicate their infiltration by tumor cells as a potential pathway for their dissemination and as a factor for continued tumor growth after surgery and adjuvant therapy.PURPOSE:Identification of fluorescent vessels located near cerebral gliomas, with a histological description of their structure, relationships with the tumor, and potential invasion of the walls by tumor cells.MATERIAL AND METHODS:A prospective cohort study included 14 patients with malignant supratentorial gliomas, aged 20 to 78 years. Five patients were operated on due to continued tumor growth. Two hours before surgery, all patients received 5-ALA orally. During surgery, a microscope (Carl Zeiss OPMI Pentero, Germany) with a fluorescent module (BLUE-400) was used. In all cases, molecular-genetic and immunohistochemical examinations of the tumor material were performed. During surgery, fluorescent vessels, after evaluating their functional significance, were also resected for histological examination.RESULTS:Glioblastoma and anaplastic astrocytoma were verified in 10 and 4 patients, respectively. In 4 out of 10 glioblastoma cases, vessels with homogeneous or fragmentary fluorescent walls were detected in the tumor bed after resection of most of the tumor; in patients with anaplastic astrocytomas, vascular fluorescence was not observed. In the four vascular samples with intraoperatively detected wall fluorescence, tumor invasion into the vascular layers was revealed in all cases. These patients underwent an immunohistochemical examination with monoclonal antibodies to the glial GFAP marker, which clearly identified areas of ingrowth of tumor cells into the vascular wall.CONCLUSION:5-ALA intraoperative fluorescence is a fundamentally new approach in the rapid diagnosis of tumor-infiltrated blood vessels. Invasion of tumor cells to intact vessels may be a mechanism of tumor progression and dissemination. Additional resection of fluorescent vessels may affect the radicalness of surgical treatment, but requires a mandatory assessment of their functional significance.

An increase in life expectancy affects the incidence rate of cancer. According to diverse sources, metastases in the spine are detected during autopsy in 30—90% of patients with a history of cancer. In Russian literature, there have been no in-depth studies of the quality of life in patients with various metastatic tumors of the spine who underwent surgical treatment, which determines the relevance of this study. Objective. The objective of the study was to demonstrate the need for implementing target setting in the combination treatment of patients with metastases in the spine as the main tool to identify the factors that adversely affect the patients’ quality of life. Material and Methods. The quality of life of 56 patients aged 16 to 81 years was assessed, including 26 males and 30 females. Of them, 26 patients underwent surgical treatment between 2002 and 2009, and 30 patients underwent surgical treatment between 2009 and 2014. Kidney cancer was a primary disease in 30.3% of patients, multiple myeloma was a primary disease in 23.1% of cases, and single cases of melanoma, thymoma, as well as metastases of tumors of the gastrointestinal tract, uterus, ovary, lung, prostate, pancreas, and the thyroid gland also occurred and amounted on the average to 3.5% (1.8 to 7.14%). The primary tumor site was not identified during cancer screening in 10.5% of cases. The quality of life of patients was studied using the EORTC QLQ-C30 scale. The patients were surveyed prior to the surgery and then 1, 3, 6 and 12 months after surgical treatment during 1 year or until death. Preoperative and postoperative contrast-enhanced spiral CT and MRI examinations were used to control the extent of decompression of neural structures. Results. On the basis of these findings, the authors identified the main factors affecting the quality of life of patients and formulated a range of treatment goals for patients with metastases in the spine. Conclusions. Surgical treatment has a positive effect on the quality of life in patients with metastases in the spine. However, it is not a key factor with regard to survival rate of these patients. Therefore, a decision on the possibility and necessity of surgical treatment should be taken both by the patient and oncologists of different specialties.

INTRODUCTIONSurgical treatment of spinal tumors is associated with a high risk of intraoperative complications, including injury to the spinal cord, its roots, and large vessels both during tumor resection and at the stabilization stage during implantation of pedicular or corporal screws. The use of intraoperative neuroimaging tools and a navigation system in surgical treatment of oncological diseases of the spine enables identifying the location and extension of a tumor lesion directly in the operating room, which provides control of the resection area and the possibility of the spine stabilization under disturbed anatomy conditions when bone density is altered by the osteolytic process or systemic changes. Also, the risk of injury to the major blood vessels is reduced.MATERIAL AND METHODSSurgical treatment of 156 patients with primary and metastatic tumors of the spine was performed at the Burdenko Neurosurgical Institute in the period from 2002 to December 2014. Twelve patients underwent diagnostic intervention (transcutaneous biopsy), and 35 patients underwent surgery using intraoperative CT and a navigation systems. The indication for biopsy using both CT and the navigation system was the presence of a spinal tumor not verified by a pathomorphological examination. An O-arm intraoperative computed tomography scanner and a Medtronic's StealthStation S7 Navigation System were used in all cases.CONCLUSIONThe use of both CT and the navigation system provides high quality treatment and significantly reduces radiation exposure to the medical personnel and patient. The possibility of intraoperative identification of the location and extension of a tumor in bone tissue facilitates adequate tumor resection within the intact surgical margin, with the surrounding vessels and neurological structures being under real-time control.

Many researchers consider degenerative diseases of the spine as a pandemic of the XXIst century. Herniated intervertebral discs of the lumbosacral spine occur in 61% of patients with degenerative spine diseases. Of these, 15% of patients have herniated discs at the LII-LIII level, 10% of patients at the LIII-LIV level, and 40% of patients at the LIV-LV and LV-SI levels. A high cost of conservative treatment of degenerative spine disease symptoms and its low efficacy in reducing the intensity and duration of pain necessitate the development of new methods of surgical treatment. In this paper, we analyze the literature data on minimally invasive spine surgery and demonstrate the main advantages of percutaneous endoscopic surgical techniques.

INTRODUCTIONEvery year the number of cancer patients increases due to increased life expectancy. According to various sources, metastases in the spine are found during autopsy in 30-90% of patients with a history of cancer. So far, there have been no full-scale studies of the quality of life of patients with various metastatic tumors of the spine who underwent surgical treatment in Russian literature. The main objective of this study was to demonstrate the need for implementing the comprehensive treatment of patients with metastases in the spine and target setting as the main tool to identify the factors that adversely affect the patients' quality of life.MATERIAL AND METHODSThe quality of life of 56 patients aged 16 to 81 years was assessed, including 26 males and 30 females. Twenty-six patients underwent surgical treatment between 2002 and 2009, and thirty patients underwent surgical treatment between 2009 and 2014. Kidney cancer was a primary disease in 30.3% of patients, multiple myeloma was a primary disease in 23.1% of cases, and the primary source of a tumor was not identified in cancer screening in 10.5% of cases. There were also isolated cases of melanoma, thymoma, metastases of tumors of the gastrointestinal tract, uterus, ovary, lung, prostate, pancreas, and the thyroid gland, which on the average amounted to 3.5% (1.8 to 7.14%). The quality of life of patients was studied using the EORTC QLQ C30 scale. The patients were surveyed prior to the surgery and then 1, 3, 6 and 12 months after surgical treatment during 1 year or until death. Preoperative and postoperative contrast-enhanced SCT and MRI examinations were used to control the extent of decompression of neural structures.RESULTSOn the basis of these findings, the authors identified the main factors affecting the quality of life of patients and formulated a range of treatment goals for patients with metastases in the spine.CONCLUSIONSurgical treatment has a positive effect on the quality of life of patients with metastases in the spine. However, it is not a key factor in the context of survival rate of these patients. Therefore, a decision on the possibility and necessity of surgical treatment should be taken in cooperation with the patient and oncologists of different specialties.