[Treatment of anaplastic astrocytomas and glioblastomas in children by the use of temozolomide (TMZ)].
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Adolescent↗
Biomedical subjects
A G Melikian
Publications and source records attributed to A G Melikian.
[Use of neurotransplantation in the treatment of Parkinson's disease].
The outcomes of transplantation of the human embryonal mid-brain into the striatum of patients with Parkinson's disease are presented. For this, a procedure for obtaining, isolating, preparing the human embryonic midbrain, as well as a method for stereotactic administration of embryonal nerve tissue suspension having high dopaminergic neuron levels into the patients' striatum are specified. Patients underwent neurological examinations by the international protocol Core Assessment Program for Intracerebral Transplantation including monthly video recording within 3 months before and 3-24 months after surgery. Electrophysiological, neuropsychological, and immunological examinations were made at the same intervals. Most patients had positive dynamics: diminution of the severity of main disease symptoms, reduction in the efficiency of a single dose of DOPA-containing drugs, decrease in the magnitude of side effects of drug therapy.
Adult↗
CT-guided computer-assisted stereotactic resection of brain tumours.
A computer-assisted technique was developed for CT-guided stereotactic microsurgical resection of small intracerebral lesions. An original stereotactic retractor was developed to work with the Riechert-Mundinger's equipment for precise localisation, safe exposure and microsurgical removal of these tumours. A software-program was developed to work on an ordinary IBM-compatible PC/AT. It assisted the procedure from treatment planning till the end, including tumour excision, and provided computerized support for the removal of pathological tissues within the CT-defined boundaries of the lesion. 6 patients, harbouring supratentorial intracerebral lesions underwent surgery using this technique. 2 of them suffered from brain metastases, in 1 patient a cavernous angioma was removed, 2 patients had glial tumours, and in the last patient only radiation necrotic tissue was found to be the cause of ring-enhanced lesion, which had been suspected to be a recurrent glioma. Their largest dimensions varied between 18 and 30 mm and the age of the patients ranged from 15 to 52 years. In 2 cases the lesions were localised deeply in the region of basal ganglia and thalamus. In the remaining patients the tumours were rather superficial, infiltrating subcortical white-matter close to the central sulci. There was no mortality nor significant morbidity following the procedure, the Karnofsky Performance Status (KPS) cumulative scores being either unchanged (in 3), or improved (in 3 patients). Current state and modern concepts in image-guided open stereotactic methodology is discussed.
Adolescent↗
[Computerized system of dosimetric planning of interstitial multiposition stereotaxic irradiation in neutron therapy of brain tumors].
A computerized system PLUT-B intended for a dosimetric design of stereotaxic neutron brachytherapy of brain tumors, was developed. It is capable of simulating dose distribution in various parameters of irradiation, manipulating them, retaining the surgical aspects within the field of vision, and arriving at an acceptable dosimetric plan. The system permits visualization of a target with an applied dose field in the multiwindow mode, layer-by-layer vision in any direction, displaying a scheme of implantation, and drawing up of maps of isodose distributions. It is intended to be used by a physician, convenient in operation, the time at the design stage is 35-40 minutes.
Brachytherapy↗
[Endoscopic ventriculocisternostomy: methods and equipment].
The paper describes endoscopic ventriculocisternostomic techniques. It discusses the problems associated with the optimum configuration of equipment and tools, as well as with the basic principles of postoperative management of patients. Emphasis is laid on the engineering features and on the prevention of complications. The paper is based on 4-year experience gained in using this procedure at the Academician N. N. Burdenko Research Institute of Neurosurgery, Russian Academy of Medical Sciences, to treat over 60 patients with acquired occlusive hydrocephalus.
Cerebral Ventricles↗
[Endoscopic fenestration of median supratentorial cerebrospinal fluid cysts].
Mid-supratentorial liquor cysts are a relatively rare and generally congenital abnormality of the cerebral ventricles and subdural spaces. The data and views available in the literature on rational surgical policy is contradictory. The authors' experience in treating 16 patients was used to consider whether endoscopic techniques can be employed for invasive fenestration of the cysts. The goal of surgery was to remove the masses caused by cystic malformations and their local compression of the brain via fenestration of the walls of the cysts and via communication of their cavities with the ventricles and cisterns. There were solitary cysts in all cases (arachnoidal cysts of the interpedicular cistern and the third ventricle in 9; cysts of the ventricular septum in 4, ependicular cysts of the lateral ventricle in 2, and cysts of the celiac plexus of the third ventricle in other 2 cases, in 1 cases a liquor cyst was located in the midbrain thickness). The clinical picture was characterized by a combination of hypertensive, hydrocephalic and focal symptoms of damages to the hypothalamic and thalamic structures and the adjacent formations of the brain (pyramidal and extrapyramidal disorders, ataxia, chiasmal syndrome, metabolic and endocrine disorders, etc.). In 6 cases these symptoms were persistent despite preimplanted VP anastomosis. Rigid Storz endoscopes (Germany) with an external coat, 6 mm in diameter, and a Codman fibroendoscope (USA), 4 mm in diameter, were employed. Cystic ventriculostomy and cystic ventriculocisternostomies were made in 11 and 6 patients, respectively; one patient underwent endoscopic resection of the walls of an ependymal cyst. In one patient with signs of decreased liquor resorption, endoscopic fenestration was concurrently developed into a ventricle-peritoneal anastomosis. In other 4 anastomosis-dependent patients, the preimplanted mechanically consistent bypass system was left at its site. In 2 of these cases, cystic ventriculostomy was supplemented by ventricular septal fenestration and third-ventricular bottom perforation. Twelve patients were followed up for 6 to 36.5 months (mean 15 months). There has been no information about 6 patients since their discharge. In 12 (66.5%) surgery yielded expected results and the fenestration of cystic walls was followed by their retraction and a steady-state regression of local and/or hypertensive symptoms. In 5 (28%) patients, the complaints and clinical data remained unchanged despite although incomplete but objective cystic relaxation. This was most frequently noted in patients (n = 4) with arachnoidal cysts of the interpedicular cistern and the third ventricle who had endocrine disorders. In one case the operation was stopped due to bleeding. Totally, 5 patients were found to have complications (hemorrhage, ventriculitis). None patient died. Some aspects of indications for endoscopy and surgical techniques are considered. It is concluded that endoscopic internal bypass surgery in patients wit median cystic liquor malformations is the treatment of choice. When equipment is adjusted, fenestration of the membranous walls of these cysts by using an endoscope is reliable and safe. Such patients may be recommended endoscopic technology used as the method of choice.
Adolescent↗
[Use of the navigation system Stealth Station(TM) for removal of brain neoplasm].
The paper analyzes the authors' initial experience with the Stealth Station navigation system (Medtronic-Sofamor Danek, USA) during neurosurgery for intracranial tumors and outlines its techniques. Twenty eight patients with various brain tumors were operated on. Thirteen patients had tumors of the skull base (meningiomas, chordomas, paragangliomas, fibrous dysplasia). Twelve patients showed various intracerebral tumor-forming processes (gliomas, cavernous angiomas, and metastizing carcinomas). The navigation system ensured resection of these tumors. It was used in 2 other patients with gliomas and in 1 patient with cystic craniopharyngioma for their stereotactic puncture, biopsy, and drainage. The Stealth Station proved to be an effective tool for preoperative planning of cranial neurosurgical operations and their intraoperative guidance. Strict observance of the protocols of preoperative preparation ensures a high accuracy and facilitates search for and identification of anatomic guides. Only in 1 patient with surface glioma involving the central gyri, its resection was followed by hemiparesis that subsequently progressed. In the remaining 27 cases, the operation ran smoothly and caused no new neurological defect. The brain-shift phenomenon is the principal limitation of accuracy of the intraoperative system. This problem is less evident in skull-base surgery where the system was effectively used for critical structural location. Also, it can be safely employed for elimination of slight deep lesions to protect the brain and to minimize its injury via approach to a tumor through the brain parenchyma.
Brain Neoplasms↗
[Successful use of a cell saver in massive blood loss in pediatric neurosurgery (a case)].
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Blood Loss, Surgical↗
[Results of endoscopic ventriculostomy of the III ventricle in the treatment of occlusive hydrocephalus].
The paper presents data of a retrospective analysis of the outcomes of endoscopic ventriculostomy of the 3rd ventricle, obtained in a consecutive series of 120 patients aged 5 months to 58 years who had occlusive hydrocephalus and operated on at the Research Institute of Neurosurgery, Russian Academy of Medical Sciences, in 1995-2000. In most cases (n = 112), hydrocephalus was caused by a block at the level of the cerebral aqueduct. In more than 50% of the patients, different tumors were responsible for occlusion. In 96 (80%) cases, the operation led to the elimination of occlusion and to the regression of symptoms just after surgery. Complications were few and observed in 19 patients, ventriculitis (n = 7) and intracranial hemorrhages (n = 6) being most common. No death occurred. Seventy three patients were followed up for 1 month to 5 years (mean 1.5 years). Eliminated occlusion and steady-state remission were found in 64 (87.7%) cases. Improvement was strongly correlated with an increase in the reserve craniovertebral content capacity estimated by measuring the pulse amplitude of blood flow in the tentorial sinus in body position-changing tests. In 9 patients, the symptoms of hydrocephalus remained or recurred after short-term improvement. In 3 of them, this occurred with anatomically competent anastomoses between the 3rd ventricle and cisterns. In the other 6 cases, the obliteration and anatomic incompetence of ventriculostoma were responsible for a relapse. In 8 of the 9 patients, shunting had to be made subsequently in the period of 1 to 6 months. The paper also considers some biophysical aspects of cerebrospinal fluid circulation and discusses indications for endoscopy. It is concluded that endoscopic ventriculostomy of the 3rd ventricle is the method of choice in the treatment of patients with obstructive hydrocephalus.
Adolescent↗
[The CT-stereotaxic neutron brachytherapy of brain tumors with californium sources on the ANET-B apparatus].
A method for stereotaxic intratissue radiotherapy of brain tumors based on the findings of computed tomography is described. Radiosurgical implantation of sources with increased 252Cf content emitting mixed neutron + gamma-radiation was accomplished by means of an ANET-B apparatus by the afterloading method. Neutron irradiation is particularly effective in patients with malignant tumors possessing a large fraction of cells in a state of deep anoxia. Dosimetric planning was conducted by means of an original computer system. Devices and radiation-technical equipment for adaptation of the ANET-B apparatus for irradiation of neurosurgical patients are described. The indications for the use of this method and its place among the complex of measures for the treatment of patients with new growths of the brain are discussed. The first experience in using CT-stereotaxic neutron brachytherapy with californium sources on the ANET-B apparatus for the treatment of 6 patients with malignant glial tumors of the brain is dwelt on.
Adult↗
[Complications and failures of endoscopic ventriculostomy of the third ventricle].
The study was undertaken to elucidate the poor outcomes of endoscopic ventriculostomy of the third ventricle (EVTV), including complications and dysfunctions. A series of 249 consecutive EVTV (the mean age of 15 years in 247 patients) made at the Institute of Neurosurgery in 1995 to 2003 was analyzed. The causes of hydrocephalus were benign tumors in 95 (38%) patients, stenosis of the aqueduct of the cerebrum in 73 (29%), malignant tumors in 63 (25%), and other causes in 18 (7%) cases. Obstruction in the posterior cranial fossa was present in 12 (5%); prior to EVTV, 24 (10%) and 36 (15%) patients had undergone craniotomy and bypass surgery, respectively; 12 (5%) patients had sustained subarachnoidal or intraventricular hemorrhage, 21 (8%) had intracranial infections. The follow-up averaged 16 months. Its results showed that 40 complications occurred in 34 (14%) patients. Seven (3%) patients required unplanned operations; transient and persistent neurological deficits were present in 15 (6%) and 2 (1%), respectively; there were no surgery-related deaths. Meningitis occurred in 14 (6%) cases; its risk was higher in patients having a history of intracranial infections (p = 0.02); meningitis was absent in patients with benign tumors (p < 0.01). Intracranial hemorrhages occurred in 7 (3%) cases; 2 of them required surgical treatment. Moreover, there were 6 (2%) wound complications (4 cases of wound cerebrospinal fluid discharge); 5 (2%) EVTVs were prematurely discontinued; isolated neurological deficit occurred in 6 (2%), single seizures were observed in 2 (1%). There were early dysfunctions in 16 (6%) cases; their risk was associated with obstruction in the posterior cranial fossa (p = 0.04) and with the technical result of an operation (p < 0.01). Late dysfunctions occurred in 21 (8%) cases, on the average, after 12 months of EVTV; their risk was higher in patients with malignant tumors (p = 0.04). It is concluded that indications for EVTV should be substantiated by the good chance of having a steady-state surgical success, by an overall prognosis, and staffs experience. The history of intracranial infections requires careful preoperative studies. Obstruction at the level of the posterior intracranial fossa is a relative contraindication to EVTV due to a low chance of having a success. The high risk for late dysfunctions in patients with malignant tumors requires a more strict choice of indications in this group. If there is anastomotic dysfunction, EVTV may be a good alternative to shunt revision.
Adolescent↗
[Iatrogenic metastasis of pineal tumors].
Malignant pineal tumors (PT) tend to metastasize. In rare cases, this process is provoked by surgery. This paper describes four cases of iatrogenic metastasis of PT. Metastasis occurred: a) along the surgical approach path after tumor removal in 2 cases; b) along the biopsy cannula path; and c) along the ventriculoperitoneal catheter into the abdomen. The sources of metastases were pineoblastoma (n = 1), malignant teratoma (n = 1), germinoma (n = 1), and malignant germ-cell tumor of unknown genesis (n = 1). To prevent this complication due to high-grade PT, such as malignant germ-cell tumors and pineoblastomas, radiation of the whole brain, besides the sites of a tumor should be performed and, in some cases, in combination with chemotherapy.
Adolescent↗
[The CT-stereotaxic biopsy of brain tumors].
CT-stereotaxic biopsy is a modern method for the diagnosis of intracranial tumors. The histological diagnosis established by means of it makes it possible to choose the most rational tactics of treatment and determine more exactly the indications and contraindications for the operation. The examination was conducted on 219 patients with various brain tumors. Authentic histological information was obtained in 84% of cases, 4 patients died, a stable neurological defect developed in another 2 patients. Some methodical procedures for increasing the informativeness and reducing the risk of complications are discussed. An important component is rapid examination of part of the bioptic material by means of smears for intraoperative appraisal of its representativeness and correction of biopsy targets. Among 73 cases in which smears were examined only in 9 the findings were in disagreement with the data of the traditional histologic study, only in the degree of tumor differentiation in all of them. Stereotaxic biopsy is most expedient in situations in which the tactics and main method of treatment are determined to a greater degree by the histological structure rather than by the localization and the patient's general condition. Such cases account for one fourth of all cases of intracerebral tumors.
Adolescent↗
[CT-stereotaxic punctures, aspiration and drainage of deep space-occupying processes in the brain (cystic tumors, hematomas and abscesses)].
The article analyses the clinical material concerning 68 patients with various deeply-seated space-occupying processes of the brain (cystic tumors, multiple abscesses, intracerebral hematomas) which were subjected to stereotaxic aspiration on the basis of the findings of computed tomography (CT-stereotaxic punctures). A significant and immediate effect with rapid regression of local and general cerebral symptoms was recorded in 38 patients with cystic intracerebral tumors and craniopharyngiomas. All the patients tolerated the operation well and in none of them were complications encountered. The precision, reliability and safety of CT-stereotaxic punctures--is the basis for such operations as intra-tissue beta-therapy of craniopharyngiomas with radiocolloids, evacuation of intracerebral hematomas, and drainage of multiple brain abscesses. Being an obvious palliative surgical measure, CT-stereotaxic aspiration of deeply-seated cystic tumors is a method of choice in cases in which a direct operation is contraindicated and in patients who are in a grave condition.
Adolescent↗
[Electrosubcorticography and impedance in the computer tomographic biopsy of brain tumors].
During 15 stereotaxic biopsies of brain tumors along 26 trajectories of introduction of the bioptic cannula, the brain tissue impedance was measured many times together with the recording of an electrosubcorticogram from the same points. Electrophysiological examination yields mutually complementing and authentic information concerning the boundaries of the pathological process and the condition of the perifocal brain matter, which improves the results of stereotaxic biopsy by increasing its informativeness. The impedance contours on the whole reflect the changes of the brain matter X-ray density, but there may be a discrepancy between these data in some cases since impedance is a more dynamic characteristic.
Biopsy↗
[Thrombosis of the internal carotid artery in the neck as a result of a wound in the palatopharyngeal region and closed craniocerebral injury].
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Adolescent↗
[Stereotaxic computer tomography].
Methods for using computer tomography (CT) in stereotaxic calculations are discussed. A stereotaxic CT method elaborated at the Scientific Research Institute of Neurosurgery, AMS USSR which is intended for the Riechert-Mundinger stereotaxic apparatus is described; the method is used for calculating targets chosen according to CT. In combination with a high resolution (ND-8 000) CT-scanner, the method provides for the attainment of targets with a mean magnitude of error of no more than 1 mm in all directions. The calculations are made by means of computer tomograph service programs. The method is simple, reliable in application, and the patient is exposed to relatively small radiation. The method was used in operations for stereotaxic biopsy on patients with deeply located tumors of the brain and is recommended for application in the neurosurgical clinic, mainly in the diagnosis and treatment of patients with tumors of the brain.
Biopsy↗
[Correlation of the histological structure of gliomas with densitometry findings during computer tomography].
Local features of the histological structure of malignant glioma tissue are compared with the results of densitometry in computer tomography (CT) with a contrast amplifier. The material for histological examination was collected during stereotaxis biopsy conducted according to CT findings (9 patients) and in examination of the brain of 5 patients who had died without being subjected to operation. The method by means of which anatomical axial sections identical to a series of CT sections were obtained is described. The results in the form of mean values of the coefficients of absorption and the homogeneity of their distribution are shown in accordance with the density of areas with intact brain in each CT section. These data make it possible to detect details of the CT image which are not accessible to visual analysis in some cases and to appraise more objectively the boundaries and spread of the tumors. Besides, they may be used in choosing the targets for stereotaxis biopsy of brain tumors when it is conducted according to the findings of CT. They also increase the informativeness of biopsy.
Astrocytoma↗