OBJECTIVE To analyze intracellular pH measurement with phosphorus-31 MR spectroscopy in glioblastoma cells and to compare these data with intracellular pH in healthy volunteers. MATERIAL AND METHODS There were 10 patients aged 41 - 67 years with supratentorial glioblastomas. Intracellular pH in glioblastoma cells was compared with pH in healthy persons. RESULTS We found a tendency to increased intracellular pH in glioblastoma cells in comparison with pH in intact brain tissue. CONCLUSION Intracellular pH in brain tissue can be used as a potential marker of early abnormalities which could not be detected by conventional MRI. Moreover, these data may be valuable to estimate the efficacy of chemotherapy. The study was supported by Russian Science Foundation (grant No. 18-15-00337).

The purpose of this study was an assessment of the proton 3D MR spectroscopy efficacy in diagnosis of primary glial brain tumors.Material and methods. Sixty three patients aged from 20 to 60 years with primary glial brain tumors of varying degrees of malignancy were examined. The ratios of main metabolites indices were evaluated with following comparison with the metabolites obtained in gray and white matter of the opposite hemisphere.The ratios of main metabolites: Cho/Cr, NAA/Cr, Cho/NAA showed significant (p <0.005) differences in the groups of patients with low and high grade gliomas.Results. The obtained data proved the efficacy of the proton 3D MR-spectroscopy in predicting of the glial brain tumors malignancy.

Introduction. Digital tensor tractography (DTT) is well-known and efficient method for white-matter tracts visualization. However, few publications show its effectiveness in cranial nerves tractography. The aim of the study is to develop and to implement the protocol for visualizing cranial nerve tracts. Materials and methods . DTT was implemented in 6 patients with vestibular schwannoma (VS) W. Koos 3-4 grade, preliminary coordinated by the study of 5 patients with trigeminal neuralgia. The tracts were “built” using 3D Slicer software. Results. In 5 of 6 cases, full correlation of pre- and intraoperative data was registered. In 1 case, the tracts were non-identifiable. Conclusion. Presented algorithm provides effective preoperative visualization of cranial nerves (V, VII). Obtained results allow to consider the method of DTT a promising technique for preoperative visualization of trigeminal and facial nerves in patients with posterior fossa lesions.

The possibility of segmenting three-dimensional objects by DICOM-series is well known and available both on specialized workstations and on personal computers. The technique, however, is relatively rarely used in clinical practice, and we believe that the benefits of preoperative preparation using segmented 3D models are underestimated. The article is devoted to our experience in using segmentation of anatomical structures based on CT and MRI for preoperative preparation for surgical operations performed in neurosurgical departments on patients with vascular pathology. The paper discusses the types and possibilities of segmentation, provides some examples describing the clinical use of the technique.

Evaluation of brain metabolism is an important part in examination of brain lesions. Phosphorus magnetic resonance spectroscopy opens up great opportunities for studying the energy metabolism and allows noninvasive examination of metabolic processes occurring both in healthy and in pathologic brain tissue by obtaining a spectrum of phosphorus-containing metabolites involved in the turnover of cell membrane phospholipids. The technique presented in this paper was used to conduct 31P MR spectroscopy and to estimate the ratio between the peaks of the main metabolites and intracellular pH of the healthy brain tissue of 23 volunteers in the age group under 30 years old in clinical settings. Based on the recorded stable phosphorus spectra of metabolites of the healthy brain tissue, the value of intracellular pH (6.963±0.044) and the ratio of the main PME/PDE peaks (1.17±0.20) were calculated. The database was created to subsequently analyze the metabolic changes in brain tissue spectra in norm and in pathology, as well as the intracellular pH variations that have diagnostic and prognostic value.

The purpose of this work was to present the advanced imaging tools using diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) for yielding structural and functional information about white matter (WM) pathways in the brain. A brief review of the basic principles underlying DTI and examples of clinical applications of DTI and DTT in neurosurgery forpatients with brain tumors is presented. Knowledge of DTT patterns, when a cerebral neoplasms involves the WM tracts, becomes critically important when neurosurgeons use DTI in evaluation of the topography of WM and tumor for planning tumor resection.

The dynamics of changes in the N-acetylaspartate/creatine ratio (NAA/Cr) in brain tissue in patients with multiple sclerosis (MS) were studied by proton multivoxel magnetic resonance spectroscopy (PMRS) to identify relationships between these parameters and the clinical status of patients to assess the potential for using this method in monitoring disease severity and the extent of the neurodegenerative process. The potential neuroprotective effect of treatment with an interferon β-1a formulation for intramuscular administration (IFNβ-1a, Avonex) in patients with remitting MS (rMS) was also studied. A total of 26 patients with rMS took part in the study. Investigations included history-taking, neurological examination with assessment on the EDSS, neuropsychological testing, and dynamic MRI studies using PMRS. A decrease in the NAA/Cr ratio was seen in patients with rMS as compared with healthy subjects. Analysis of the NAA/Cr ratio at one year demonstrated a significant reduction. A negative relationship was found between the NAA/Cr ratio in brain tissue and the levels of neurological and cognitive deficit. Analysis of intramuscular IFNβ-1a treatment of MS demonstrated a stabilizing neuroprotective effect through the one-year treatment period, which may be associated with the effects of this agent on the neurodegenerative process in MS.

THE AIM OF THE STUDY:Paper describes a study of language lateralization of patients with brain tumors, measured by preoperative functional magnetic resonance imaging (fMRI) and comparison results with tumor histology and profile of functional asymmetry.METHODS:During the study 21 patient underwent fMRI scan. 15 patients had a tumor in the left and 6 in the right hemisphere. Tumors were localized mainly in the frontal, temporal and fronto-temporal regions. Histological diagnosis in 8 cases was malignant Grade IV, in 13 cases--Grade I-III. fMRI study was perfomed on scanner "Signa Exite" with a field strength of 1.5 As speech test reciting the months of the year in reverse order was used. fMRI scan results were compared with the profile of functional asymmetry, which was received with the results of questionnaire Annette and dichotic listening test.RESULTS:Broca's area was found in 7 cases in the left hemisphere, 6 had a tumor Grade I-III. And one patient with glioblastoma had a tumor of the right hemisphere. Broca's area in the right hemisphere was found in 3 patients (2 patients with left sided tumor, and one with right-sided tumor). One patient with left-sided tumor had mild motor aphasia. Bilateral activation in both hemispheres of the brain was observed in 6 patients. All of them had tumor Grade II-III of the left hemisphere. Signs of left-handedness were revealed only in half of these patients. Broca's area was not found in 4 cases. All of them had large malignant tumors Grade IV. One patient couldn't handle program of the research.CONCLUSIONS:Results of fMRI scans, questionnaire Annette and dichotic listening test frequently were not the same, which is significant. Bilateral activation in speech-loads may be a reflection of brain plasticity in cases of long-growing tumors. Thus it's important to consider the full range of clinical data in studying the problem of the dominant hemisphere for language.

Trigeminal neuralgia (TN) is a disabling disease with severe impairment of quality of life and everyday activity of patients. Range of treatment modalities is wide and includes conservative therapy, surgical methods and stereotactic radiosurgery (SRS). SRS is a minimally invasive technique which provides good results and minimal rate of complications. High geometrical and clinical precision of frameless SRS using CyberKnife system allows its application in TN when high dose is delivered to a small volume. The given paper focuses on the first Russian experience of frameless SRS of TN using robotized system CyberKnife. Since April 2009 till June 2011 4 patients with TN were treated in department for radiation therapy of Burdenko Neurosurgical Institute using CyberKnife system. Mean age was 63 years. Mean and maximal target dose reached 70 and 90 Gy, respectively. Data of catamnestic clinical examination were available in all 4 patients. Follow-up period reached 8 months. Response to treatment was observed in all cases. In 2 (50%) patients full effect was reached while in the rest only partial effect was present. No complications were encountered. Effectiveness and safety of SRS using CyberKnife system is comparable with framed SRS.

Meningiomas are frequently diagnosed intracranial lesions which cannot be resected radically in the majority of cases. Traditional radiotherapeutical techniques allow control of tumor growth in such situations. CyberKnife system may be used for radiosurgery and in sight hypofractionation. During 27 months 231 patient with intracranial meningiomas of different localization was treated in department for radiation therapy of Burdenko Neurosurgical Institute using CyberKnife system (Accuray Inc., USA). Mean age was 53 years. 55% of patients underwent previous surgical treatment, and diagnosis of meningioma was histologically verified. In 231 patient 374 targets were irradiated. Mean volume of irradiation reached 15.8 cm3 (range - 0.73-108.5 cm3). In 89% of cases hypofractionated therapy was used, in 10.1% we performed radiosurgery. Catamnestic data were available in 80 patients. Mean follow-up period was 11.6 months (6-27 months). Control of tumor growth was established in 100% of cases with WHO grade I tumors, in 66.7% of WHO grade II tumors and 60% in WHO grade III tumors. Deterioration after radiation treatment was observed in 16% of cases of 75 with control of tumor growth. In 8 cases worsening was due to radiation-induced reactions verified by MRI studies. Radiosurgical and hypofractionated treatment of meningiomas using CyberKnife is actual and highly-effective technique. Further investigations are needed to determine optimal standards of hypofractionated radiotherapy of meningiomas.

79Тригеминальная невралгия (ТН) характеризу-ется короткими простреливающими односторон-ними болями, внезапно начинающимися и так же внезапно заканчивающимися, ограниченными зо-ной иннервации одной или более ветвей тройнич-ного нерва. Ежегодно регистрируется 4—5 новых случаев на 100 000 населения [9]. Обычно ТН воз-никает на шестом десятилетии жизни и чаще встре-чается у женщин (в соотношении 3:2) [25]. Заболе-вание диагностируется на основании критериев

UNLABELLED: The aim of this study was to assess the role of different modalities in early diagnosis of cerebral hyperperfusion syndrome (CHPS) following carotid endarterectomy, as well as to develop effective treatment protocol for abovementioned complication. MATERIAL AND METHODS: Study group consisted of 61 patient who underwent uni- or bilateral carotid endarterectomy (CEA). Diagnostic modalities included transcranial Doppler study (TCD), cerebral oximetry, perfusion CT scanning and neuropsychological evaluation. STUDY RESULTS: We demonstrated that both bilateral carotid stenosis and stroke were independent predictive factors for CHPS at early postoperative period. "Classical" two-fold increase of cerebral blood flow in ipsilateral CMA was seen in 15% patients only. According to our data, predictive TCD-value was 1.48 increase of CBF. The most informative tool for early CHPS diagnosis was perfusion CT scans: preoperative mean transit time asymmetry in temporal areas (in the group of patients with unilateral carotid stenosis) correlated with CHPS development. Effective medical treatment for CHPS was achieved with Ca2+ channel antagonists use, that enabled us to prevent evolution of "mild" clinical appearance of CHPS into status epilepticus or intracerebral hemorrhage. CONCLUSION: Modern diagnostic modalities that assess brain perfusion can (with certain rate of accuracy) predict CHPS development even preoperatively. Early therapy of this complication with Ca2+ antagonists can usually control it.

: The authors describe 2 cases of primary intraosseous cavernous hemangioma (PICH). PICH are extremely rare tumors that represent less than 1% of all tumors of the bone. Only 20% of them involve skull. In both cases clinical findings were presented by proptosis, oculomotor disorders and chronic daily headaches. Surgery is the most recommended method of treatment. The best surgical management is gross total resection within intact tissue. In both cases tumor was removed completely.