Problems epidemiology, classification, diagnosis, and treatment of spinal tumors are considered. Data on morbidity and characteristics of different histological forms of benign and malignant vertebral tumors are presented. Features of spinal tumor diagnosis, classic radiological signs, and current noninvasive visualization and invasive (biopsy) techniques are discussed. Literature data on techniques and capabilities of surgical treatment are analyzed. Current trends in selection of surgical intervention radicality level depending on the type of spinal tumor using staging classifications by Ennеking, Weinstein–Boriani–Biagini and Tomita are described. Current indications for radical en bloc resection performed in a limited number of cases is considered. Minimally invasive spine surgery is discussed: from vertebroplasty, radiofrequency ablation and intervention removal of metastatic tumor to separation surgery for epidural compression. Apart from surgical treatment, neoadjuvant and adjuvant radiotherapy of vertebral tumors are analyzed: conventional, conformal, including stereotaxic, beam therapy and radiosurgery. Data on current trends in treatment selection depending on histological nature of the tumor, its radiosensitivity and probability of post-radiation malignant transformation are presented. Drug treatment, in particular chemotherapy, is an indispensable in treatment of secondary and some primary spinal tumors. Data on chemosensitivity of various tumors and tactics of combination and complex treatment are presented. Evidently, the current trend is to decrease the level of surgical invasiveness and selection of minimally invasive methods of surgical treatment. Moreover, it is concluded that considering the biological nature of hemopoietic tumors and some sarcomas, currently surgical treatment is not the main method of treatment of these malignant tumors.

ВНЕДРЕНИЕ РЕЗУЛЬТАТОВ СИМУЛЯЦИОННОГО ОБУЧЕНИЯ В ПРАКТИКУ ОКАЗАНИЯ НЕЙРОХИРУРГИЧЕСКОЙ ПОМОЩИ ПАЦИЕНТАМ СО СТЕНОЗИРУЮЩИМИ ПОРАЖЕНИЯМИ СОННЫХ АРТЕРИЙ

This study is devoted to the accuracy of the optic navigation system “Neuroplan”. To assess the complex error of the system, a plastic model of the skull with 8 radiocontrast target points was developed. Twelve neurosurgeons with different levels of training participated in the study. The design of the study provided for each doctor performance of registration in the “Neuroplan” system at various positions of the model with subsequent hit at the target points. To select the optimal method of registration for different patient positions on the operating table, the registration table for anatomical landmarks (from 3 to 7) and on the surface was used. The analysis of the obtained results showed a high accuracy of the optic navigation system “Neuroplan”: in the side position of the scull model the target error averaged 1.57 [1.11; 2.13] mm, in the face down position – 1.69 [1.26; 2.19] mm, which is comparable with the declared accuracy of foreign analogues. When the experiment was repeated, it was shown that the system has high retest reliability.

The study objective is to examine the anatomical characteristics of transnasal endoscopic and transorbital endoscopic approaches to perform medial orbitotomy and decompression of the optic nerve.Materials and methods. The study was based on the results of anatomical approaches on cadavers. The comparison was carried out according to the following anatomical-surgical parameters: 1) the area of interest in mm2 ; 2) the area of orbitotomy in mm2 ; 3) the area of the optic nerve decompression in mm2 ; 4) the length of periorbital incision in mm; 5) the depth of the wound in mm; 6) the horizontal angle of attack in degrees; 7) the vertical angle of attack in degrees. The measurements were carried out using the Russian optical navigation system “Neuroplan”.Results. It has been established that the area of orbitotomy is noticeably larger, and the depth of the operative wound is smaller with the transorbital approach. It was also revealed that there are no noticeable differences in the area of the optic nerve decompression between the transnasal endoscopic and transorbital endoscopic approaches. In addition, there is a tendency for large angles of attack in both horizontal and vertical planes with transorbital access, which is probably due to the smaller depth of the wound and the possibility of lateral traction of the eyeball. It was determined that as with transnasal, as with transorbital approaches, the length of the periorbital incision did not differ significantly.Conclusion. The study demonstrates the equivalent possibilities of both transnasal and transorbital endoscopic approaches in the implementation of the medial orbitotomy and decompression of the optic nerve in patients with endocrine ophthalmopathy. Some advantages, in particular, a large area of orbitotomy, as well as the preservation of the paranasal structures, make it possible to speak out in favor of choosing transorbital endoscopic approaches to the medial wall of the orbit and the optic nerve when performing surgical decompression in this group of patients. Further collection of clinical material is needed for final results.

Purpose of the study. Elaboration of a surgical technique to manage patients with metastatic lesions of the craniovertebral region.Patients and methods. The study included 7 patients with metastatic lesions of the craniovertebral region, who’ve been operated on for severe instability, pain syndrome, neurological deficit in the period from 01/01/2014 to 09/30/2022. To assess the neurological status and patients’ condition the Frankel and Karnofsky scales were used on the day of admission and discharge of the patients from the hospital. Pain intensity was assessed using a visual analog pain scale (VAS). To assess instability in the affected spinal motion segment the SINS scale was used. All patients underwent palliative surgical treatment in the amount of occipitospondylodesis with a biopsy of the neoplasm from the posterior approach.Results. The average age of patients was 60 [44; 66] years. All patients had a marked pain syndrome prior to the surgery. The average pain intensity according to the visual analog pain scale was 8 points. In the preoperative period, 6 (85 %) patients on the Frankel scale were assigned to group E, 1 (14 %) – to group C. In 6 (85 %) patients there was no dynamics in the neurological status following the surgery, however according to the Karnofsky scale there was an improvement up to 10 points due to the regression of the pain syndrome down to 1 point on the visual analog scale. Hemiparesis developed in 1 (14 %) patient due to malposition of the laminar hook in the postoperative period. The average duration of surgical interventions made up 337.5 [315; 345] min, the average intraoperative blood loss made up 300 [300; 800] ml. In 6 out of 7 patients (85 %) there was no neurological status dynamics after the surgery, and according to the Karnofsky scale an improvement up to 10 points was noted due to regression of the pain syndrome to an average value of 1 [1; 2] VAS score. Conclusion. The obtained results indicate the clinical application possibilities of minimally traumatic surgical technologies for the treatment of craniovertebral zone metastatic tumors.

Background. Epidural spinal cord compression (ESCC) is the most common neurological complication in metastatic spinal tumours.Materials and methods. The study included 87 spinal malignancy patients operated within 01.01.2014–30.09.2021. All patients had a type of palliative decompressive and stabilising surgery: standard posterior access (SPA, 55 patients), minimally invasive posterior access (MPA, 22 patients) or anterior access (AA, 10 patients).Results. The patient cohorts did not differ significantly by the duration of surgery, length of hospital stay, rates and types of postoperative complications. The AA cohort revealed a statistical difference by intraoperative blood loss. A Karnofsky performance status was statistically improved post- vs. pre-surgery (p < 0.05) at no significant change of Frankel neurological function status (p > 0.05). A Kaplan — Meier curve analysis showed no significant survival rate variation among the surgical techniques. Discussion. Our results suggest that posterior access interventions should be considered optimal. We report no statistical difference in the postoperative neurological and performance status dynamics between both cohorts, which encourages the MPA use in all patients with minimal epidural compression.Conclusion. Posterior access with cytoreductive tumour removal in anterior spinal cord compression is advantageous over anterior surgery. A posterior access surgery with minimal spinal canal decompression is recommended in all patients with grade 1 tumoural epidural compression.