OBJECTIVE The analyze the neuro-ophthalmic outcomes in patients with pineal and suprasellar germinoma after complex treatment. MATERIAL AND METHODS There were 125 patients (88 males, 37 females) with primary CNS germinoma for the period 2008-2017. All patients were divided into 3 groups depending on the tumor localization: pineal area - 62 patients, suprasellar neoplasm - 38 patients, bifocal germinoma - 25 patients. Treatment was performed in accordance with the «Germinoma-2008» protocol. Tumors were histologically patients (partial - 32 cases, subtotal - 16 cases). Surgery was followed by postoperative chemotherapy and stereotactic radiotherapy. The results were evaluated by neuro-ophthalmological examination at all stages of complex treatment. RESULTS Pineal germinoma resulted oculomotor and pupillary disorders (58 patients - 94%) and papilledema. The last one completely regressed under the treatment. Partial reduction of oculomotor and pupillary abnormalities occurred throughout chemotherapy (6 patients - 10%). More than half of patients (n=24, 63%) with suprasellar germinoma had visual impairment. Improvement of visual functions including severe visual disturbance was observed in 14 patients (58%). Predominantly, functional recovery occurred under chemotherapy (12 patients - 86%). Bifocal germinoma was followed by various combinations of oculomotor, pupillary and/or visual impairments. We observed regression of only mild visual disorders. Stereotactic radiotherapy did not ensure any changes in neuro-ophthalmic symptoms in all groups.

PURPOSE:To analyze neuro-ophthalmology symptoms in patients with germinomas located in pineal and suprasellar regions.MATERIAL AND METHODS:The study analyzed 133 patients with germinoma who were receiving treatment in Burdenko Neuro-surgical Institute from 2008 to 2017. Assessment of results was performed by neuro-ophthalmology examination, a computerized oculograph was used for the objectification of the severity of ocular-motor and pupillary disorders.RESULTS:Among the patients of the study, 65 had pineal germinoma, 42 - suprasellar germinoma and 26 - bifocal germinoma. Among patients with pineal germinomas, males prevailed, while more females had suprasellar germinomas. No statistical difference was found between gender and bifocal germinoma. Pineal germinomas were manifested predominantly by the development of the dorsal midbrain syndrome in the form of oculomotor and pupillary dysfunction (75%) and the development of papilledema (53%). Germinomas of suprasellar localization are most often presented by asymmetric chiasmatic syndrome (24%). Dorsal midbrain syndrome in patients with bifocal germinomas was detected in 76% cases, combination of oculomotor and pupillary dysfunction with visual impairments was found in 38% cases. Neuro-ophthalmological symptoms of germinoma of these regions manifest in the early stages of the disease and require ophthalmological examination during all stages of diagnosis and treatment.

The most common clinical manifestations of space-occupying lesions of the midbrain and pineal region are oculomotor and pupil disorders and ophthalmoscopic signs of intracranial hypertension.PURPOSE:To identify patterns of neuro-ophthalmic symptoms before and after surgical treatment in patients with space-occupying lesions of the midbrain and pineal region.MATERIAL AND METHODS:We analyzed neurological symptoms in 231 patients with space-occupying lesions of the midbrain and pineal region before and after surgical treatment. Malignant tumors were detected in 121 patients; benign tumors were present in 73 patients; 37 patients were diagnosed with pineal gland cysts. Patients with suspicion of germinoma underwent a tumor biopsy only; the other patients underwent tumor resection.RESULTS AND DISCUSSION:Before surgery, oculomotor and pupil disorders were detected in more than half of the (67%) patients; ophthalmoscopic signs of intracranial hypertension were present in 38% of the patients. Neuro-ophthalmic symptoms significantly more often occurred in patients with malignant tumors. Midbrain symptoms were significantly more pronounced in germ cell tumors than in other malignant neoplasms. In the early postoperative period after tumor resection, deterioration of oculomotor and pupillary functions occurred in 46% of cases; there were no changes in 51% of cases; improvement occurred in 3% of cases. After tumor biopsy, symptoms in all patients with germinomas remained at the preoperative level. Developed symptoms partially regressed in the long-term period, and finally, only 29% of patients had deterioration of oculomotor and pupillary functions compared to the preoperative level.

Stereotactic radiotherapy/radiosurgery (RT/ES) is an effective technique for treating craniopharyngiomas (CPs). However, enlargement of the cystic part of the tumor occurs in some cases after irradiation. The enlargement may be transient and not require treatment or be a true relapse requiring treatment.MATERIAL AND METHODS:In this study, we performed a retrospective analysis of 79 pediatric patients who underwent stereotactic RT or RS after resection of craniopharyngioma.RESULTS:Five-year relapse-free survival after complex treatment of CP was 86%. In the early period after irradiation, 3.5 months (2.7-9.4) on average, enlargement of the cystic component of the tumor was detected in 10 (12.7%) patients; in 9 (11.4%) of them, the enlargement was transient and did not require treatment; in one case, the patient underwent surgery due to reduced visual acuity. In 8 (10.1%) patients, an increase in the residual tumor (a solid component of the tumor in 2 cases and a cystic component of the tumor in 6 cases) occurred in the long-term period after irradiation - after 26.3 months (16.6-48.9) and did not decrease during follow-up in none of the cases, i.e. continued growth of the tumor was diagnosed. A statistical analysis revealed that differences in the terms of transient enlargement and true continued growth were statistically significant (p<0.01).CONCLUSION:Enlargement of a craniopharyngioma cyst in the early period (up to 1 year) after RT/RS is usually transient and does not require surgical treatment (except cases where worsening of neurological symptoms occurs, or occlusive hydrocephalus develops).

Aim of this study was to assess feasibility of videooculography in evaluation of oculomotor function and its dynamics in patients with mass lesions of pineal region, midbrain and pons. Computed videooculography was performed in 48 patients with tumors of pineal region and midbrain, 9 patients with pontine hematomas and 10 healthy volunteers. 25 patients with midbrain and pineal neoplasms were followed after tumor resection or open biopsy. We evaluated amplitude of eye movements in normal and impaired oculomotor function. 4 grades decreases of amplitude upwards, downwards, medially and laterally were emphasized. In early postoperative period statistically significant decrease of amplitude in patients with clinical deterioration was observed. Application of videooculography allows reliable quantitative assessment of oculomotor function, registration and storage of examination data and follow-up of oculomotor function for observation of tendencies in course of disease.

Surgical resection of deep-seated midline tumors often does not resolve obstruction of cerebrospinal fluid pathways and thus additional op-eration - ventricular shunting is required. To prevent postsurgical hydrocephalus we combine two different types of surgical interventions per-formed simultane-ously – tumor removal and intra-operative internal ventricular shunting.Patients and methods: Eighty-two patients with deep-seated midline brain tumors underwent 84 op-erations – tumor removal with simultaneous intraop-erative internal ventricular shunting in the Burdenko Neurosurgery Institute from June 2000 until October 2006. This series includes patients with malignant as well as benign tumors with an infiltrative growth pattern mainly of glial origin. Forty six tumors were located in pineal region, 18- in midbrain, 10- in thala-mus, 3- in thalamus and midbrain, 3- in the third ven-tricle, 4- other locations. We performed two types of intraoperative shunting – 1) third ventriculostomy by fenestration of the premamillary membrane of the third ventricle floor and Liliequist’s membrane – 53 operations, and 2) aqueductal stenting – 30 opera-tions. All operations were performed under micro-scope without endoscopic technique. Results: Subtotal and partial tumor removal was performed in the majority of patients - 45% and 20%, respectively, what was related to the diffuse pattern of tumor growth. There were no fatal outcome. Re-peated shunting due to inadequate function of stoma or stent was performed in 10 cases in the early post-surgical period (up to 30 days) and in 4 cases - in the follow-up period (median 21 month). Efficacy of intra-operative ventriculostomy and stenting comprised 75% and 97% respectively in the early period, and 89% in the follow-up period in each group. Diabetes insipidus, as a sequence of surgical manipulation in the diencephalic-hypothalamic region was revealed in 4 cases (7%), in 3 of them it was transient. Aque-ductal stenting did not aggravate eye movement dis-orders in comparison with the control group.Conclusion: Intraoperative ventriculostomy of the third ventricle and aqueductal stenting under di-rect visual control are considered effective methods of treatment of obstructive hydrocephalus in deep-seated midline brain tumors.