The paper describes the classification and treatment options of craniopharyngiomas, benign epithelial tumors arising from the cell remains of the Rathke’s pouch. It presents a few types of surgical accesses during surgical treatment for this disease and gives examples of how to place an Ommaya reservoir. 

Piloid astrocytoma (PA) is a low-grade (WHO grade I) glial tumor that is more common in pediatric patients. According to the data of many authors, stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) promote long-term remission or delayed tumor progression in patients with inoperable tumors after incomplete removal of a tumor and with its recurrence. So it is urgent to determine the place and role of SRS and SRT in the combination treatment of patients with deeply located PA.

Subjects and methods. In the period April 2005 to May 2010, the Department of Radiology and Radiosurgery, Neurosurgery Research Institute, Russian Academy of Medical Sciences, treated 101 patients diagnosed as having intracranial PA. Of them there were 70 children (aged 17 years inclusive) and 31 adults; 51 men and 50 women. The median age was 15.1 years (9.8 years for children and 28.7 years for adults). Tumor was histologically pre-verified in 90 (89.2 %) patients (tumor ablation in 83 cases and biopsy in 7). The diagnosis of PA was made on the basis of clinical and X-ray data in 11 (10.8 %) patients. ART was used in most cases (n = 66 (66.3 %)). SRS was performed in 35 (34.7 %) patients.

Results. The median follow-up of the patients from the onset of disease was 52 months (range 2–228 months). Eighty-eight (87 %) patients could be followed up. On completion of the follow-up (December 2010), 87 (98.8%) of the 88 patients receiving SRT and SRS were alive. The median follow-up from the initiation of radiotherapy was 22.7 months (range 6–60 months). Tumors were enlarged in 20 (22.7 %) patients; those were due to cysts in 18. Eighteen patients were reoperated on. Histological specimens were examined and comparatively analyzed in 12 operated patients. The tumor changes accompanied by a reduction of the solid component and an increase of the cystic component were found to be a manifestation of tumor reactive-degenerative alterations as a consequence of radiation pathomorphi sm.

Conclusion. SRT and SRS are effective treatments in patients with primary or recurrent PA irrespective of the tumor site and must be performed early after non-radical tumor removal. At present (median follow-up 22.7 months), tumor growth is controlled in 98 % of the 

The authors analyze their experience in treating metastases in the chiasmal-sellar region (CSR), which has been gained at the Acad. N.N. Burdenko Neurosurgery Research Institute in 2000 to 2011 (a follow-up was made in 93 patients with metastatic skull base tumors, of them 19 (20.4 %) metastases were located in CSR), as well as the data available in the literature.

Chiasmal neoplasms are a rather common pathology that constitutes as high as 25 % of all cranial tumors. The paper gives the clinical picture of the disease, describes the diagnostic methods for chiasmal neoplasms, which are required to detect the pathology until its evident symptoms appear

The problem of lymphoproliferative lesions of the central nervous system (CNS) is urgent in both patients with immunodeficiency states and those without background systemic pathology in spite of the fact that the statistics vary greatly in these two categories. Despite a wide range of noninvasive diagnostic procedures, it is impossible to obtain a significant confirmation of primary lymphoproliferative CNS lesion in patients with no background systemic manifestations of the disease. Stereotactic biopsy, followed by combination chemo- and radiotherapy in accordance with the existing protocols, is a well-known procedure to treat suspected primary CNS lymphoma. This paper describes 4 cases of primary CNS and skull bone lymphomas in patients operated on for skull bone granuloma (in one case) or rapid progression of focal and global cerebral neurological deficit (in 3 cases). A postoperative histological analysis using the currently available methods revealed lymphoproliferative lesions; in this connection the patients continued treatment by oncologists. 

Chondroid skull base tumors are a rare and little studied pathology; many problems of their classification, diagnosis and treatment remain to be solved. This group of neoplasms is referred to as bone tumors arising from the cartilaginous tissue of the skull base bones, particularly from the bones formed during chondral osteogenesis. The paper details the clinical picture, X-ray and morphological diagnosis of chondroid tumors. Particular attention is given to surgery and radiotherapy for this category of tumors.

The main tasks of the study were to evaluate the efficiency of treatment and to estimate time to progression and survival rates in patients with recurrent glioblastomas receiving combination treatment with irinotecan and bevacizumab. Five (41.7 %) patients achieved partial regression; disease stabilization and progression were observed in 5 (41.7 %) and 2 (16.6 %) cases, respectively. The median time to disease progression was 5.5 months; 6-month and one-year survival rates were 66.6 and 25 %. The median overall survival was 9.0 months. Treatment tolerability was satisfactory. Thus, the preliminary results of our study show the high efficiency of a combination therapy regimen incorporating bevacizumab and irinotecan for patients with recurrent glioblastomas and they are comparable with the data available in the literature on investigations of the efficiency of this treatment regimen. This study is being continued. 

The paper considers the experience with capecitabine in 67 patients with brain metastatic lesion from breast cancer. The immediate efficacy of capecitabine and the results of therapy with the agent were analyzed in the groups of its use alone and in combination with radiotherapy both for therapeutic purposes and as an adjuvant regimen. In the chemoradiation therapy group, the objective effects in the brain were 73 %. The median time to progression was 12.27 months. In the monochemotherapy group, the objective effects were 30 %. The median time to progression was 4 months. The results of the investigation show that capecitabine has pronounced antitumor activity and moderate toxicity. Combination treatment is the method of choice. 

Since 2006, the N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, has been conducting an investigation of the efficiency of targeted therapy with gefitinib in patients with brain metastasis from non-small cell lung carcinoma (NSCLC). The evaluation of treatment efficiency in 9 patients with tumor EGFR mutation in NSCLC revealed that 1 (11.1 %) and 5 (55.6 %) patients achieved complete and partial regression, respectively; disease stabilization was observed in 3 (33.3 %). The median time to progression was 7 months; the patients did not achieve the median survival. The evaluation of treatment efficiency in a group of 6 patients without tumor EGFR mutation or its evidence showed complete and partial tumor regressions; disease stabilization was noted in 3 (50.0 %); disease progression was in 3 (50 %). The median time to progression was 2 months; the median survival was 5 months. Thus, the high efficiency of treatment with the EGFR inhibitor gefitinib in patients with brain metastases from NSCLS was achieved only in a group of patients with found ECFR mutations in exons 18–21 in the tumor. Determination of the status of ECFR in the tumor is the most important prognostic factor when using therapy with the EGFR tyrosine kinase inhibitor gefitinib in patients with brain metastases. The investigation is being continued. 

Under the present-day conditions, it is necessary to allow for rapid postoperative awakening in each neurosurgical patient, which is impossible under residual neuromuscular block. The paper gives the preliminary data of a prospective observational study of the frequency of residual neuromuscular block after single intraoperative administration of a moderate- or long-acting myorelaxant. When the myorelaxants are used once according to the standard procedure (in the absence of TOF monitoring and pharmacological elimination of the action of myorelaxants), the rate of residual myorelaxation in neurosurgical patients has been found to be unacceptably high and to hinder their rapid awakening and neurological assessment. The administration of pipecuronium gives rise to residual block in all cases. That of rocuronium makes it possible to reduce the rate of residual myorelaxation, but not to eliminate it completely. Residual block can be preserved 2–4.5 hours after single administration of rocuronium or pipecuronium. 

Tumor cells can differentiate into more mature forms in undifferentiated or poorly differentiated tumors, such as medulloblastomas with increased nodularity, as well as neuroblastomas. The authors describe 2 cases of neuroblastoma maturation into ganglioneuroblastoma 5 months after chemotherapy in a 2-year-old girl and 3 years after radiotherapy in a 16-year-old girl.

Hepatocellular carcinoma ranks 5th in prevalence and 3rd in cancer mortality worldwide. The prognosis of this disease is very poor: the 5-year survival rate was not more than 3–5%. Metastases generally occur in the lung, in the lymph nodes of the abdomen, chest, and neck, in the vertebrae, kidneys, and adrenals. The cases of brain metastasis from hepatocellular cancer are very rare. Overall, the prognosis is very poor for patients with brain metastases from hepatocellular carcinoma. Nevertheless, solitary brain metastases and good hepatic function are favorable survival criteria; thus, the treatment of this group of patients may lead to their better survival. The paper describes a clinical case of brain metastasis from hepatocellular carcinoma in a patient receiving the combination treatment involving neurosurgical treatment and targeted therapy.