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Glioblastoma multiforme is characterized by persistent recurrent course despite surgical, radio- and chemotherapeutic treatment. The outcomes of superselective intra-arterial administration of bevacizumab with blood-brain barrier disruption in patients with recurrent glioblastoma have been published. The authors reported significant increase in overall survival (up to 2.5 years). We report treatment of recurrent glioblastoma in a young patient with progressive course of disease despite 4 previous neurosurgical interventions, radiotherapy and first-line chemotherapy. Superselective intra-arterial administration of bevacizumab with blood-brain barrier disruption made it possible to achieve clinical response and improve neurological status.

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Three clinical cases of simultaneous operations upon synchronous identification of brain tumor and kidney cancer are described. A metastatic lesion of the brain was detected in two of them, and a combination of a primary CNS tumor (glioblastoma) with kidney cancer was identified in one case.

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Brain metastases are known to have poor prognosis. In spite of using modern treatments such as microsurgical resection, radiotherapy, chemotherapy, survival of these patients remains low. Due to this fact we looked for novel methods of treatment that are able to increase the recurrence-free surgical and therefore overall survival of these patients. This paper analyzes new treatment methods used in brain tumors--fluorescent detection and photodynamic therapy with 5-aminolevulinic acid.

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Cerebral metastases are the most common brain tumors in adults and are characterized by poor prognosis. Despite application of modern methods of treatment (microsurgery, radiation therapy, chemotherapy) survival rates of these patients remain low. This fact triggers development of new therapeutic options which are able to increase recurrence-free period and consequently overall survival. The article contains review of literature dealing with photodynamic therapy which is a newly introduced technique for treatment of cerebral metastases.

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The paper presents 3 cases of radio-induced meningiomas in patients who underwent irradiation for retinoblastoma in infancy. Meningiomas of the middle cranial fossa were diagnosed in women aged 16, 34, and 47 years. Radiation therapy was in the complex treatment of retinoblastoma in all patients in infancy (4 months to 3 years). The latent period between the irradiation and diagnosis of meningioma was 15 to 44 years. The location of detected meningiomas (the wings of the basilar bone on the side of exenteration or enucleation) corresponded to the irradiation fields. Surgical treatment yielded good results. Histological study has indicated that meningiomas were fibroblastic in the former two cases and atypical meningioma was verified in the third case when the tumor infitratively spread. Our observations support the fact that there may be radio-induced meningiomas in the area exposed to irradiation.

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The study was a result of joint studies conducted by the Academician N. N. Burdenko Research Institute of Neurosurgery, Russian Academy of Medical Sciences, and the P. A. Herzen Moscow Cancer Research Institute, Ministry of Health of the Russian Federation, in 1996 to 2001. During this period, the joint team operated on 32 patients with malignant craniofacial tumors. Of them there were 18 males and 14 females whose age was 8 to 74 years. Most patients were aged 36 to 60 years. Epithelial tumors were predominant in the histological pattern of 18 (56%) patients. Squamous-cell (8 patients) and adenoid cystic (4 patients) carcinomas were prevalent among the epithelial tumors and rhabdomyosarcoma (4 patients) was prevalent among the mesenchymal tumors. Craniofacial block-resection was one of the stages of complex treatment in patients with malignant tumors of the base of the skull. Malignant craniofacial tumors are prone to local spread and rarely give rise to both regional and distal metastases. This is the basis for the concept that the patient may be cured via block removal of a tumor with a portion of its adjacent intact tissues in a combination with pre- and/or postoperative multidrug and radiation therapies. There were intraoperative and postoperative fatal cases. The signs of tumor remnants were absent, as evidenced by computed tomography and magnetic resonance imaging (MRI) performed in all cases. Further control MRIs were performed every 3 months during 2 years, then every 6 months, Complications as graft rejection were observed in 2 cases: on day 2 after surgery in one case and on day 6 in the other. They were not a cause of liquorrhea and meningitis due to the effectiveness of a pedicle periosteal graft that restricts the dura matter. Repeated microsurgical operations using other types of grafts. The patients were followed up for 3 to 5 years. During this period, 12 (37.5%) patients died of dissemination in the period of 1 month to 2 years; 1 (3.1%) patient died of the causes unassociated with the underlying pathological process. In 7 (21.8%) patients, the relapse-free was 5 years or more; of them there were 5 patients with epithelial tumors, 1 with a mesenchymal tumor, and 1 with a malignant chondroid tumor. In these patients, cosmetic corrective operations were made by plastic surgeons. Twelve patients, including 5 with epithelial tumors, 4 with mesenchymal tumors, and 3 with chondroid ones, were operated on for recurrences. Seven patients underwent lymphadenectomy due to the cervical lymph nodal metastases. Nineteen (59.4%) and 17 (53.1%) patients survived > or = 3 and > or = 5 years, respectively.

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Chondrosarcomas are malignant mesenchymal tumors of chondroid nature. Less than 5% of all chondrosarcomas are localized in the head and neck. The paper analyzes a case of extensive chondrosarcoma of the skill base, which involves the anterior and median cranial fossa, ethmoidal, sphenoidal, right maxillary sinuses, and intratemporal fossa. A basal approach that is a combination of two-flapped subfrontal and orbitozygomatous accesses was used to remove the tumor. In doing so, the tumor could be excised and extensive defects of the skull base could be effectively closed with the flaps of the periostium and musculus temporalis, yielding a good functional and cosmetic effect.

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The authors present the clinical and experimental substantiation of the method of local cooling of the cerebrospinal formations and the evaluation of its efficiency in various surgical interventions on the spinal column and the spinal cord. The method of performing local hypothermia of the spinal cord in 64 patients is described. Having compared three versions of local cooling, the authors recognize that the optimum method was that with the cooling element placed directly on the dura mater and with compulsory neurovegetative protection during the performances. The high efficiency of local hypothermia of the spinal cord was confirmed by rapid stabilization during the postoperative period of the values of central hemodynamics and the oxygen budget of the patients' organisms, while there was regression of the neurologic deficiency, prevention and arresting of the brain tissue edema and analgesia.

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