Objective ‒ to improve reconstructive and plastic methods of treatment of patients with malignant tumors that spread beyond the brain skull to ensure a decent quality of life.Materials and methods. The results of a comprehensive clinical examination and surgical treatment (with a reconstructive component) of 21 patients with scalp and skull tissue defects operated on in the extracerebral tumor clinic of Romodanov Institute of Neurosurgery of NAMS of Ukraine in the period from 2018 to 2021. There were 9 women and 12 men among the patients. The age of the patients is from 36 to 80 years old. All patients underwent clinical, neurological and instrumental examinations. The diagnosis was verified by the results of histopathomorphological examination. Statistical methods (discriminant analysis (MANOVA)) were used for data processing. Statistical significance was tested using the Pearson test (χ²).Results. The patients were divided into two groups. The main group (n=16) – operated on using adapted patented plastic techniques that take into account the optimal angle of direction of stress vectors in the tissue of skin-aponeurotic flaps in the postoperative period during stress relaxation. The comparison group was made up of 5 people operated on using traditional methods of mobilization and fixation of skin-aponeurotic flaps. Using the patient’s own tissues is the most reliable and effective method of cosmetic restoration of the head after radical treatment for locally advanced tumors. Active tactics (postoperative monitoring of the flap) make it possible to detect blood circulation disorders in the transplanted tissues at an early stage and to carry out a timely revision of the anastomoses. Performing simultaneous reconstructive operations is an integral part of complex treatment of patients with malignant tumors, expands the indications for performing gentle operations, allows to obtain «excellent» and «good» functional and aesthetic results in 85 % of cases. Simultaneous microsurgical reconstructive operations are possible in patients after complex treatment, although the frequency of thrombotic complications in this group was higher (12.5 %) than in the comparison group (7.5 %).Conclusions. The perspective of plastic-reconstructive replacement of defects for clinical application has been proven and the method has been improved using the latest technologies.Key words: malignant tumors; intracranial/extracranial spread; surgical treatment; reconstruction; quality of life.

A clinical case of locally advanced basal cell skin cancer with bone destruction is presented. Patient Ya., born in 1936, was under the supervision of doctors for basal cell skin cancer since 1982 (for 38 years). She was hospitalized in the department of extracerebral tumors of Romodanov Institute of Neurosurgery NAMS of Ukraine 09.27.2019. Multispiral computer and magnetic resonance imaging were performed.Considering the duration and spread of the tumor, the patient was offered an operation to remove the tumor within healthy tissue with resection of the auricle and parotidectomy. When receiving informed consent for surgical treatment, the patient put forward conditions regarding the scope of the operation: preservation of symmetry of the face, appearance of the face and integrity of the auricle. Surgery was performed, followed by symptomatic treatment. Reconstructive technologies for closing defects of the soft tissue of the facial skull were applied. She was operated on on October 4, 2019. The postoperative period was uneventful. Healing occurred by primary tension. The patient was discharged from the hospital in satisfactory condition on the 18th day (October 22, 2019). Postoperative distant gamma therapy was performed on the projection area of ​​the primary focus and the predominant anatomical routes of lymph drainage (total focus dose ‒ 45 Gy). Catamnesis postoperative ‒ 13 months. After 37 years, a relapse occurred with the tumor process involving all branches of the facial nerve, bones of the skull, metastasis to regional lymph nodes. The treatment was carried out at the Romodanov Institute of Neurosurgery NAMS of Ukraine. The patient did not consent to the extended scope of the surgical intervention, setting the condition of preserving the appearance. In this regard, the removal of affected tissues was carried out along the edge of the tumor invasion (without a reserve of healthy tissues) while preserving the trunk and branches of the facial nerve, i.e. in violation of the generally recognized principles of ablastics. The presented case of the course of the disease proves that timely radiation therapy at the first signs of a skin tumor contributes to a good clinical effect, which made it possible to achieve a long relapse-free period with a decent quality of life and full socialization. The progressive course of the disease (recurrence) justifies the feasibility of replacing large facial skull tissue defects after radical removal of parotid skin cancer with intracranial spread using the method of combining local plastic surgery and free skin flap transplantation, developed and implemented in the Department of Extracerebral Tumors.

Мета роботи — вдосконалити хірургічну тактику в хворих із менінгіомами навколоселярної локалізації (МНСЛ) та методики видалення цих пухлин. Матеріали та методи. Вивчено особливості хірургічного лікування 137 хворих із МНСЛ. Осіб чоловічої статі було 40 (29,2 %), жіночої статі — 97 (70,8 %). Середній вік становив (51,8 ± 0,9) року. Критерії відбору: менінгіоми горбка турецького сідла, малого крила основної кітки, переднього нахиленого відростка, медіальних відділів великого крила та латеральної стінки печеристої пазухи. При виборі доступу враховували розмір пухлини, локалізацію та співвідношення з оточуючими невральними структурами. Результати. Найближчі результати лікування МНСЛ були задовільними. Тотального видалення вдалося досягнути у 57 (41,6 %) хворих, субтотального — у 77 (56,2 %), парціального — у 3 (2,2 %). У 93 (67,9 %) пацієнтів з поширенням МНСЛ у канал зорового нерва виконано кісткову декомпресію зорового нерва. Функція зорового нерва поліпшилася у 38 (27,7 %) хворих. Тяжкість стану за шкалою Карновського 70 балів і нижче до операції зафіксовано у 27 (19,7 %) хворих, після операції — в 11 (8,0 %), 80 балів та вище — відповідно у 110 (80,3 %) та 126 (92,0 %). Висновки. Запорукою успішного хірургічного втручання при МНСЛ є вибір адекватного хірургічного доступу. На вибір доступу впливають топографія новоутворення, розміри та напрямок росту. При поширенні МНСЛ в канал зорового нерва необхідно провести кісткову декомпресію зорового нерва.

The aim of the work: improving surgical technique and reducing intraoperative blood loss by means of soft tissue electric welding (EW) and the use of cold-plasma coagulation during the curative operations for patients with extracerebral cystic meningiomas. Materials and Methods. At the Department of Extracerebral Tumors and Endoscopic Neurosurgery of A. Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine from 2012 to 2017 there were conducted surgical interventions for 54 patients (22 men aged from 20 to 79 years old and 32 women aged from 42 to 77 years old) with supratentorial cystic tumors, using the soft tissue EW generator (multifunctional and cross functional device EKVZ - 300 "PATONMED"). Results and Discussion. The HPC method has high tolerability, provides a high rate of wound epithelialization, is painless and shows a decrease in exudation. Studying of the terms of complete wound epithelization showed an accelerated recovery rate of the epithelium and decrease of the recurrence rate. With considering low cicatricial changes after the use of HPC it can be recommend as a method of CNS tumors surgery in order to prevent the secondary postoperative epileptic syndromes. Nowadays, together with the staff members of Paton Electric Welding Institute we are actively working on the development and imple­mentation into practice of a new method of contactless thermospray treatment of living tissues, which makes it possible to achieve stable hemostasis quickly and effectively if there is bleeding from vessels up to 3 mm in diameter, or from the parenchymatous organs, also it contributes to successful bloodless tissue dissection, thermoablation of tumors and metastases. Implementation of the technique of contactless thermospray treatment of living tissues proves its effectiveness in preventing wound infections and significant tissue damage, which makes it indispensable providing the surgical treatment in hospitals and in outpatient conditions. Conclusions. There is presented the data of our own researches of use the high-frequency technology of electric welding and cold-plasma coagulation during intracranial meningiomas removal. The application of surgical welding technologies allows us to shorten the duration of surgical procedure, to provide a stable hemostasis, to reduce the blood loss volume, to decrease the number of complications and to minimize the use of suture materials.

Objective – to determine the main of neuroimaging characteristics meningiomas among primary tumors of the lateral ventricles. Materials and methods. The work is based on the analysis of a retrospective and prospective multicentric study. 275 history of disease patients with primary lateral ventricular tumors, among which 52 cases of the lateral ventricles meningiomas (LVM). Patients with LVM since 1990 to 2016 were treated in 6 neurosurgical institutions in Ukraine at SI «Romodanov Neurosurgery Institute NAMS of Ukraine» (n = 25, including 1 patient who was further operated in ^iv Regional Clinical Emergency Hospital), ^iv Regional Clinical Emergency Hospital (n = 13), Clinical Hospital «Feofaniya» (n = 5), Regional Clinical Hospital in Dnipro (n = 6), Uzhgorod (n = 3), Rivne (n = 1). All patients with a tumor of the lateral ventricle underwent magnetic resonance imaging (MRI) and computed tomography (CT) in standard modes, which were performed with a contrast. In the period since 1990 to 2000 CT was intended for all patients as the main method of diagnosis of this pathology, in the period since 1993 to 2016 – MRI. MRI allows to measure the tumor in three projections, identify adjacent structures located in close proximity to the tumor, and also provides images in the axial, coronary and sagittal sections. Results. According to CT and MRI data LVM were predominantly clearly delineated borders. In the anterior horn, meningiomas were localized in 2 (3.85 %) cases (one on the right and one on the left), in the trigone – in 22 (42.31 %o) cases (10 on the right and 12 on the left), in the posterior horn – in 20 (38.46 %) cases (8 on the right and 12 on the left). Less commonly in our study, neoplasms that spread beyond the limits of one ventricular chamber were detected: occupying the trigone within the left lateral ventricle with distribution in the temporal horn – 1 (1.92 %) case, occupying the frontal horn and the body of lateral ventricle – 2 (3.85 %) cases, both on the left. Also in establishing the preoperative diagnosis a cases of multiple meningiomas with great diagnostic value: in the area of the posterior horn on both side – 3 (5.77 %) cases (in one of which meningiomatosis was observed in the structure of the neurofibromatosis II), in the region of the anterior and posterior horns – 1 (1.92 %) case (in this patient individual meningeomas were located in the III and IV ventricles), the tumor occupying all the left ventricle from the frontal to the occipital horn, and another meningiomas occupying the occipital horn contralateral on the right side – 1 (1.92 %) case. Conclusions. Neuroimaging is important for determining the localization, structure, distribution and configuration of lateral ventricular tumors, involvement of adjacent structures. Careful study of CT/MRI images, taking into account age and general condition of patients (presence of concomitant diseases – neurofibromatosis, tuberous sclerosis, oncopathology of internal organs), allows at the preoperative diagnoses Identifying the histological type of tumor within the ventricle. Determination of specific features of the LVM according to neuroimaging allows to choose the optimal surgical access for each case.

Objective — to improve surgical tactics in patients with around-sellar meningiomas (ASM) and removal of these tumors.Materials and methods. The features of surgical treatment of 137 patients with ASM were stu-died. Male population was 40 (29.2 %), female — 97 (70.8 %). The average age was (51.8 ± 0.9) years. Selection criteria: meningiomas of the Turkish sella, the small wing of the sphenoid bone and the anterior clinoidal process, the medial parts of the large wing of the sphenoid bone and the lateral wall of the cavernous sinus. When choosing an approach, the size of the tumor, the localization and the relationship with the surrounding neural structures were taken into account.Results. The results of the treatment of ASM were satisfactory. Total removal was achieved in 57 (41.6 %) patients, subtotal — in 77 (56.2 %), partial — in 3 (2,2 %). In 93 patients (67.9 %) with the spread of ASM in the optic canal, bone decompression was performed. The function of the optic nerve improved in 38 (27.7 %) patients. The Karnofsky score of 70 points and below before the operation was recorded in 27 (19.7 %) patients, after surgery — in 11 (8.0 %), 80 points and above — respectively 110 (80.3 %) and 126 (92.0 %).Conclusions. The key to a successful surgical intervention under ASM is the adequate surgical approach. The choice of approach is influenced by the topography of tumors, size and direction of growth. The spreading ASM to the optic nerve canаl requires the bone decompression of the optic nerve.

Objective – to optimizate of surgical treatment tactics in patients with around-sellar meningiomas involving optic canal. Materials and methods. The work is based on analysis of surgical treatment results of 93 (31 (33.3 %) men and 62 (66.7 %) women) patients with around-sellar meningiomas involving optic canal. The mean age was 54.6 ± 5.3 years. The tumor involve to the optic canal was recognized preoperatively according to MRI (39 cases, 41.9 %) and as an intraoperative finding (54 cases, 58.1 %). According to this the material was divided into two clinical subgroups: in the first group the early extradural decompression of optic nerve was performed, in the second – during or after tumor removal. Results. The totality of operation: total removal – 34 (36.6 %), subtotal – 19 (20.4 %), partial – 40 (33.0 %). The dynamics of optic nerve function in operated patients was: improvement – in 28 (30.1 %) cases, change for the worse – in 16 (17.2 %) cases, other patients – no changes. Quantity of patients with quality of life according to Karnovsky scale more than 80 points increase from 75 (80.6 %) before operation to 84 (90.3 %) after treatment. Conclusions. Surgical removal of around-sellar meningiomas is often complicated with tumor involving to the optic nerve canal. Bony decompression of optic nerve canal is a necessary and important stage of surgery, that provides optic nerve function preservation and totality of removal.

Мета роботи: поліпшити оперативну техніку і зменшити інтраопераційну крововтрату методом електрозварювання (ЕЗ) м’яких тканин і застосування холодно-плазмової коагуляції в ході виконання радикальних оперативних втручань у пацієнтів із ВКМ.Матеріали і методи. У відділенні позамозкових пухлин і ендоскопічної нейрохірургії ДУ “Інститут нейрохірургії імені акад. А. П. Ромоданова НАМН України” протягом 5 років (2012 – 2017 рр.) проведено 54 оперативні втручання при ВКМ різної локалізації з використанням генератора ЕЗ м’яких тканин, представленим багатофункціональним і універсальним апаратом ЕКВЗ- 300 “ПАТОНМЕД”. Всі пухлини були супратенторіальної локалізації.Результати досліджень та їх обговорення. Метод ГПК має хорошу переносимість, забезпечує високий темп епітелізації рани, відрізняється відсутністю болю і зменшенням ексудації. Вивчення термінів повної епітелізації рани показали прискорені темпи відновлення епітелію ТМО і зменшення числа рецидивів захворювання. Відсутність рубцевих змін після використання ГПК дозволяє рекомендувати застосування методу для лікування пухлин ЦНС з метою профілактики вторинного постопераційного епісиндрому.Нині спільно із співробітниками Інституту електрозварювання імені Є. О. Патона триває активна робота з розробки та впровадження в практику нової методики безконтактної термоструминної обробки живих тканин (БТОЖТ), що дозволяє швидко і ефективно досягти стійкого гемостазу при кровотечі з судин діаметром до 3-х мм, паренхіматозних органів, виконати безкровний розтин тканин, термоабляцію пухлин і метастазів.Застосування методики БТОЖТ доводить її ефективність у профілактиці гнійних ускладнень при значних ураженнях тканин, що робить її незамінною при наданні хірургічної допомоги в стаціонарах і в амбулаторних умовах.

Проаналізовані результати хірургічного лікування 54 хворих з приводу кістозних менінгіом (КМ) головного мозку (ГМ) різної локалізації. Пацієнти оперовані в однакових умовах, нейрохірургами однієї операційної бригади, з них 24 - з використанням новітніх технологій. Широке використання новітніх технологій в хірургії КМГМ дало можливість суттєво зменшити інвазивність хірургічного втручання і, як наслідок, достовірно зменшити тривалість операції, тяжкість інтраопераційної крововтрати.

Objective – to investigate the frequency of aseptic meningitis syndrome (AMS), to describe the peculiarities of diagnostics, clinical signs of AMS and its differential diagnostic criteria, as well as features of immune parameters for patients with cystic meningiomas with normal postoperation recovery and with AMS progression. Materials and methods. To describe the symptoms and determine the frequency of AMS there had been analyzed the medical records of 54 patients with cystic meningiomas of various localization and histological structure, being operated at Extracerebral Tumor Department of the SI Romodanov Neurosurgery Institute NAMS of Ukraine during 2012-2016. Immunity was estimated for 18 patients with brain tumors of different histostructures and postoperative AMS (meningiomas – in 13, gliomas of low degree anaplasia – in 2, gliomas of high degree anaplasia – in 3) in comparison with normal postoperative recovery for 7 patients with tumors of the brain without occuring of AMS (meningiomas – in 3, glioblastoma – in 1, metastasis of cancer – in 1). Studies were conducted in dynamics (weekly): at the 1st-7th, 8th-14th and 15th day or further after the surgery. The phenotype of peripheral blood lymphocytes (CD3+, CD4+, CD8+, CD4+/CD8+) was determined using monoclonal antibodies (IMK Plus, Becton Dickinson, USA) by means of flow cytometry (FASCalibur E2085), IgA, IgM and IgG, serum immunoglobulin level – by means of simple radial immunodiffusion in gel (Mancini method). The functional activity of neutrophils was estimated by the phagocytosis test according to phagocytic activity and phagocytic number, as well as by nitro blue tetrazolium reduction test. Ten patients with stable compression of the roots of lumbar spine were considered as the control group. Results. AMS occurred for 8 (14.81 %) patients. The clinical picture of AMS developed quickly on the 3rd-7th day after the operation. In the clinical blood count, leukocytosis was noted without significant fluctuations, high ESR. The analysis of the peripheral blood immunity parameters of patients with AMS showed no signs of infectious or autoimmune inflammation. The changes were indolent, atypical and short-term. The rates returned to normal ones within 3 weeks. In our opinion, the following laboratory indicators can show the risk of AMS developing in the preoperative period: a decrease in the number of lymphocytes and eosinophils, an increase in the number of monocytes of the peripheral blood. It is possible to assume, that a greater risk of AMS developing arises in special areas of localization (convextic-associated with the liquoronal pathways, the ventricles of the cerebrum and the posterior cranial fossa) and tumors of individual histological variants (anaplastic cystic meningiomas and glial tumors with cystic component, with necrosis and sarcolysis of the tumor itself). Conclusions. Eradication of cystic meningioma of the brain, the prevention of cystic fluid entering the cerebrospinal fluid, the rational use of glucocorticoids within 5-10 days after the operation can significantly reduce the frequency of ASM occurrence. When evidence of meningitis appear, it is mandatory to differentiate between it and bacterial meningitis and to extract cystic components from the cerebrospinal fluid and reduce the inflammatory response of the cerebral meninges by means of glucocorticoids.

The results of surgical treatment of 54 patients, suffering the brain cystic meningiomas of various localization, were analyzed. The patients were operated on in universal conditions by neurosurgeons of one operative team, of them 24 – using new technologies. Wide application of new technologies in surgery of the brain cystic meningiomas have permitted to reduce the surgical intervention invasiveness essentially, and, as a consequence, to reduce trustworthily the operation time essentially, as well as the intraoperative blood loss severity.

The issues on optimization of the restoration treatment of patients, suffering the brain meningioma, were discussed, basing on analysis of 498 observations. Tactics of the patients management in noncomplicated, complicated and severe course of postoperative period is adduced. The indices of survival and lethality, peculiarities of the infusion therapy were analyzed. The role of plasm-restituting preparations was demonstrated in complicated course of postoperative period. Rational complex approach to the restoration measures and intensive therapy conduction promotes the treatment efficacy raising, the patients fair quality of life securing in the brain meningioma in postoperative period.

On the base of 54 cases analysis the questions of renewing treatment optimization at patients with locally spread extrecerebral tumors were considered. The role of reconstructive and renewing operations was shown depending on tumor localization, size and growth characteristics and also radiotherapy and hormonal treatment in complex renewing treatment. The rational complex approach to renewing measures application is a factor of treatment efficiency increasing and satisfactory quality of life providing at patients with locally spread extracerebral tumors.

On the base of 54 cases analysis the questions of renewing treatment optimization at patients with locally spread extrecerebral tumors were considered. The role of reconstructive and renewing operations was shown depending on tumor localization, size and growth characteristics and also radiotherapy and hormonal treatment in complex renewing treatment. The rational complex approach to renewing measures application is a factor of treatment efficiency increasing and satisfactory quality of life providing at patients with locally spread extracerebral tumors.

Issues of the restoration treatment optimization of patients with locally spread extracerebral tumors (LSET) were discerned basing on analysis of 54 observations. The role of reconsructive-restoration operations, depending on the tumor localization, size and invasiveness was shown, as well as the role of radiation therapy in complex restorational treatment. Rational complex approach to conduction of rehabilitation measures constitute the factor, promoting the treatment efficacy raising and providing for satisfactory quality of life in patients with LSET.

We studied the levels of ER and PR and Ki-67 on the material of brain meningiomas of different hystostructure and localisation with the usage of immunohystochemical methods. It was shown, that level of PR and ER in bening meningiomas always higher than in maligna tumors, and apposite, the level of Ki-67 in benign tumors lower than in maligna. The offered index of hormone sensitivity of meningiomas can be used in the choice of method of hormone therapy of patients with hormone dependent meningiomas and as additional criteria of evaluation of meningiomas hormone sensitivity.

The contents of receptors of steroid hormones (estrogen and progesterone) in cerebral meningioma was studied up. Comparison between this hormones level and mostly significant clinico-morphological characteristics of meningioma was conducted. High frequency of estrogen and progesterone revealing in the tumor tissue permits to suggest the possibility of their application as a test of her hormonal sensitivity and is important for the disease course prognosis and an adequate methods of treatment choice as well.