Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko最新文献

{"title":"[Analysis of a series of 14 clinical cases of neurosurgical treatment of hypophysitis].","authors":"L I Astafieva, D V Fomichev, I V Chernov, L V Shishkina, I S Klochkova, M G Pavlova, A C Arustamyan, O A Rastvorova, D A Starostenko, A N Shkarubo, M A Kutin, P L Kalinin","doi":"10.17116/neiro20258902139","DOIUrl":"10.17116/neiro20258902139","url":null,"abstract":"<p><p>Primary hypophysitis is a rare disease that is usually diagnosed retrospectively after surgery for suspected tumors of the sellar region (pituitary adenomas, craniopharyngiomas, etc.). The most common variant of the primary forms is lymphocytic hypophysitis, characterized by the presence of lymphocytes in the inflammatory infiltrate. Granulomatous hypophysitis is the second most common variant of the disease, the cause of which remains unknown.</p><p><strong>Objective: </strong>To study the frequency and nature of clinical manifestations, the features of MRI of the brain, as well as the results of neurosurgical treatment of patients with a confirmed histological diagnosis of hypophysitis.</p><p><strong>Material and methods: </strong>A retrospective analysis of the case reports of 14 patients with histologically confirmed diagnosis of lymphocytic (13 cases) and granulomatous (1 case) hypophysitis operated at the Burdenko Neurosurgical Center.</p><p><strong>Results: </strong>In none of the cases before the operation, according to the MRI data, the diagnosis of \"hypophysitis\" was made. Clinical symptoms were manifested by headaches in 12 patients, decreased acuity and/or visual field impairment in 9 patients, oculomotor impairments in 2 patients. Hypopituitarism was detected in 12 cases, and diabetes insipidus in 8 cases.</p><p><p>After surgery, 7 patients had a regression of headache and improved vision, in 5 cases there was no dynamics, in 1 case vision deteriorated. In all 8 patients with diabetes insipidus, it persisted after surgery. There were no new cases of diabetes insipidus. Panhypopituitarism was noted in all patients.</p><p><strong>Conclusion: </strong>Given the difficulty of diagnosing hypophysitis without morphological verification, as well as the rarity of these cases, prospective multicenter studies are needed to study the pathognomonic signs of hypophysitis and improve their neuroimaging methods.</p>","PeriodicalId":24032,"journal":{"name":"Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko","volume":"89 2","pages":"39-47"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Correction of the effect of direct oral and parenteral anticoagulants in hemorrhagic stroke].","authors":"A I Baranich, A A Sychev, I A Savin, V G Kudrina, A V Kozlov","doi":"10.17116/neiro202589011109","DOIUrl":"10.17116/neiro202589011109","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhagic stroke is associated with high risk of adverse outcome and follows intake of anticoagulants and antiplatelet agents in 25% of cases. The latest clinical guidelines of the Neurocritical Care Society for correction (reversal) of the effect of anticoagulants and antiplatelet agents in hemorrhagic stroke were published in 2016.</p><p><strong>Material and methods: </strong>In accordance with PRISMA recommendations, we reviewed the PubMed, eLibrary and UpToDate databases to a depth of 5 years and selected 48 articles.</p><p><strong>Results and discussion: </strong>Direct oral anticoagulants are currently common. To reverse their effect, one can use specific antidotes (idarucizumab is recommended for dabigatran, andexanet alfa (not yet registered In Russia) for factor Xa inhibitors (rivaroxaban, apixaban)) and combination of prothrombin complex concentrate and tranexamic acid. Protamine sulfate is antidote for unfractionated and low molecular weight heparins. Protamine sulfate completely inactivates unfractionated heparin, but it is less effective against low molecular weight heparin. It is characterized by high probability of anaphylactic reactions, especially after repeated administrations. The effectiveness of andexanet alpha and activated factor VII for reversing the effect of low molecular weight heparin is being studied. Fondaparinux sodium is used for heparin-induced thrombocytopenia. Protamine sulfate is ineffective for reversing the effect of fondaparinux. One can use prothrombin complex concentrate and andexanet alpha, but their effectiveness is unclear. Ciraparantag is being studied in clinical trials. Apparently, ciraparantag is highly effective as an antidote for various anticoagulants.</p><p><strong>Conclusion: </strong>Early hemostatic therapy and reversal of anticoagulant effects in patients with hemorrhagic stroke significantly reduce the risk of adverse outcomes. This problem is being studied. Regular literature review with creation of updated clinical guidelines is needed.</p>","PeriodicalId":24032,"journal":{"name":"Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko","volume":"89 1","pages":"109-115"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Mystery of the illness of the great painter I. Repin. By the 180th anniversary].","authors":"A V Gorozhanin, A G Fedyakov, V E Lovyagina","doi":"10.17116/neiro2025890116","DOIUrl":"10.17116/neiro2025890116","url":null,"abstract":"<p><p>There was the 180^th anniversary of Ilya Yefimovich Repin on August 5, 2024. He is the greatest Russian realist artist of the XIX century, a master of historical and genre painting, as well as outstanding portraitist. Repin's biography is unique. He was a professor and then academician of the Imperial Academy of Arts, teacher, author of memoirs and essays on fine art. After the age of 40, the artist developed a disease with impaired function of the right hand. Therefore, he retrained to write with his left hand. Accurate lifetime and post-mortem diagnosis was not established. The appearance of the artist's right hand represented by posthumous plaster cast indicates neuropathy of the right ulnar nerve.</p>","PeriodicalId":24032,"journal":{"name":"Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko","volume":"89 1","pages":"6-10"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[En plaque convexity hyperostotic meningioma: 69 cases from a singlecenter].","authors":"A V Kozlov, K V Efremov, M V Galkin, O K Kvan, M V Ryzhova, Yu A Strunina, O Yu Titov, S V Tanyashin","doi":"10.17116/neiro20258901120","DOIUrl":"10.17116/neiro20258901120","url":null,"abstract":"<p><strong>Background: </strong>To date, 16 cases of en plaque hyperostotic meningioma of the convexity have been described. There are no clinical guidelines for the treatment of such patients.</p><p><strong>Objective: </strong>To study the factors influencing the results of surgical treatment of en plaque convexity hyperostotic meningioma, to formulate the appropriate decision-making algorithm.</p><p><strong>Material and methods: </strong>A retrospective total group of 69 patients with en plaque convexity hyperostotic meningioma who underwent surgery at Burdenko Neurosurgical Center between 2014 and 2023. We analyzed clinical manifestations, tactics and results of surgery and radiotherapy using statistical methods.</p><p><strong>Results and discussion: </strong>Total resection of small local non-infiltrative hyperostotic meningioma not involving the superior sagittal sinus did not cause neurological deterioration. In case of spread infiltrative hyperostotic meningiomas, the best results (including regression of intracranial hypertension in all cases) were obtained after non-radical surgeries (resection of hyperostosis without wide excision of the dura or even without dura opening). Extent of resection of involved dura and intracranial tumor did not affect relapse-free survival. Additional morbidity at discharge from the clinic was 35%, after ≥6 months - 16%. The most common (27.5%) complication was pseudomeningocele. Redo surgery rate for pseudomeningocele - 7%, hematomas - 7%, wound infection - 6%. There were no mortality in the series. Radiotherapy increased relapse-free survival without statistical confirmation.</p><p><strong>Conclusion: </strong>Total resection provides optimal results in patients with small convexity hyperostotic meningioma and no brain invasion. Resection of hyperostosis and expansive cranioplasty are preferable for large and giant convexity hyperostotic meningioma involving venous sinuses and / or the brain.</p>","PeriodicalId":24032,"journal":{"name":"Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko","volume":"89 1","pages":"20-29"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Augmented reality as a method of neuronavigation in microsurgical treatment of cerebrovascular diseases: description of the method and clinical experience].","authors":"A N Konovalov, D N Okishev, Yu V Pilipenko, Sh Sh Eliava, A A Artemiev, V M Ivanov, A Yu Smirnov, S V Strelkov","doi":"10.17116/neiro20258901137","DOIUrl":"10.17116/neiro20258901137","url":null,"abstract":"<p><p>Augmented reality (AR) is a promising area in microsurgical treatment of cerebrovascular pathologies that can significantly facilitate preoperative planning and intraoperative understanding of anatomy.</p><p><strong>Objective: </strong>To describe AR-assisted neuronavigation in microsurgical treatment of intracranial aneurysms, arteriovenous malformations and cavernomas; to evaluate accuracy and applicability of AR-assisted neuronavigation.</p><p><strong>Material and methods: </strong>The study involved 22 patients with cerebral aneurysms, arteriovenous and cavernous malformations. Microsoft Hololens 2 HMD glasses and «Medgital» software for AR navigation were used. Accuracy of registration (TRE and FRE) and time for preoperative preparation were evaluated.</p><p><strong>Results. mean: </strong>TRE when using QR code was 0.6±0.2 cm, when combining through craniometric points - 1.4±0.6 cm. Time for preoperative image processing was 24.7±5.1 minutes, application setup in the operating theatre - 1.6±0.2 minutes. Combination using QR code provided higher accuracy of registration compared to craniometric points. AR-assisted navigation improved visualization and planning of surgeries for aneurysms, arteriovenous malformations, microvascular anastomoses and cavernous angiomas.</p><p><strong>Conclusion: </strong>AR-assisted navigation is an innovative method with specific advantages that can potentially improve microsurgical treatment of cerebrovascular diseases. Further research is needed to confirm these findings and develop AR technology in neurosurgery.</p>","PeriodicalId":24032,"journal":{"name":"Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko","volume":"89 1","pages":"37-45"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Continuous monitoring of somatosensory evoked potentials following spinothalamic tract stimulation in brainstem and spinal cord surgery: case report and literature review].","authors":"K N Lapteva, A V Gavryushin","doi":"10.17116/neiro20258901194","DOIUrl":"10.17116/neiro20258901194","url":null,"abstract":"<p><strong>Background: </strong>The primary objective of neurosurgical intervention for central nervous system tumors is a balance between optimal tumor resection and minimal postoperative neurological impairment. Intraoperative neurophysiological monitoring is essential in safeguarding somatosensory tracts during surgery. Virtually the only tool for continuous monitoring of sensory pathways is registration of peripheral somatosensory evoked potentials (SSEPs). However, this method has some limitations.</p><p><strong>Objective: </strong>To increase the quality of intraoperative SSEP monitoring in surgical treatment of brainstem and spinal cord tumors.</p><p><strong>Material and methods: </strong>To ensure continuous monitoring of sensory pathway function in brainstem and spinal cord surgery, we modified the method for monitoring of SSEPs. Unlike standard technique, we placed two-contact electrode for stimulation either in the area of the bottom of the fourth ventricle or on posterior surface of the spinal cord along the midline. This allows us to stimulate pontine tegmentum or posterior columns of spinal cord.</p><p><strong>Results: </strong>We demonstrated the feasibility of this method in 2 cases.</p><p><strong>Conclusion: </strong>The advantage of this method is possible brainstem or spinal cord stimulation reducing the chain of somatosensory tract that is valuable to neutralize the effect of anesthesia on significance of neurophysiological data.</p>","PeriodicalId":24032,"journal":{"name":"Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko","volume":"89 1","pages":"94-102"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Neuroimaging predictors of favorable outcomes after shunting procedures in patients with Hakim-Adams syndrome: a pilot prospective randomized trial].","authors":"A V Stanishevskiy, G V Gavrilov, B G Adleyba, M N Radkov, D V Svistov, I D Sukhinov","doi":"10.17116/neiro20258901168","DOIUrl":"10.17116/neiro20258901168","url":null,"abstract":"<p><p>Higher effectiveness of cerebrospinal fluid shunting procedures is still an unresolved issue in the treatment of idiopathic normal pressure hydrocephalus. Thus, over 15% of patients do not experience symptom regression in postoperative period. In recent years, several MRI predictors have been actively investigated to forecast the outcomes of cerebrospinal fluid shunting procedures. We have previously introduced a prognostic model for comprehensive evaluation of MRI data facilitating identification of patients likely to benefit from surgical intervention.</p><p><strong>Objective: </strong>To evaluate diagnostic properties of MRI data comprehensive assessment model compared to traditional invasive diagnostic method (spinal tap test) in prospective randomized trial.</p><p><strong>Material and methods: </strong>MRI data and postoperative outcomes in patients diagnosed with idiopathic normal pressure hydrocephalus who underwent ventriculoperitoneal shunting between September 2022 and April 2024 were analyzed in prospective randomized study. In the study group, surgical decisions were based on MRI data, while the control group followed an algorithm incorporating invasive diagnostic method (spinal tap-test). Ventriculoperitoneal shunting with constant-pressure valve implantation was performed in all patients selected for surgery.</p><p><strong>Results: </strong>The study included 54 patients (25 ones in the study group and 29 ones in the control group). Surgery was performed in 21 and 20 patients, respectively. We found no advantages of invasive diagnostic methods over comprehensive assessment of MRI data in predicting the effectiveness of surgical treatment.</p><p><strong>Conclusion: </strong>Comprehensive assessment of MRI findings allows for avoiding invasive diagnostic procedures in decision-making on cerebrospinal fluid shunting surgery in some patients with idiopathic normal pressure hydrocephalus.</p>","PeriodicalId":24032,"journal":{"name":"Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko","volume":"89 1","pages":"68-74"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Surgical treatment of intramedullary spinal cord tumors: a systematic review].","authors":"N A Konovalov, R A Onoprienko, S V Kaprovoy, E S Brinyuk, B A Zakirov, Yu M Poluektov, S V Ivanov, M O Kudymets, N O Ilyinsky","doi":"10.17116/neiro202589011103","DOIUrl":"10.17116/neiro202589011103","url":null,"abstract":"<p><strong>Background: </strong>Intramedullary spinal cord tumors are a rare group of central nervous system tumors with special treatment approaches. The main problems are related to optimal time of surgery, invasiveness and recurrence of tumor.</p><p><strong>Objective: </strong>To review available literature data on the treatment of intramedullary spinal cord tumors, to summarize the main achievements and changes in treatment strategy over the past 5 years.</p><p><strong>Material and methods: </strong>We reviewed Russian- and English-language literature on the treatment of intramedullary spinal cord tumors over the past five years. The studies were selected in accordance with PRISMA recommendations.</p><p><strong>Results: </strong>We analyzed literature data in the PubMed, eLibrary, Cochrane and Medline databases over the last 5 years. The studies were selected taking into account the relevance and quality of researches.</p><p><strong>Conclusion: </strong>Large-scale studies are rare due to rarity of intramedullary spinal cord tumors. The main changes in surgery for intramedullary spinal cord tumors in recent years have occurred due to changes in surgical tactics (emphasis on functional status rather total resection), improvement of equipment for adjustment of surgical approach (MRI, intraoperative monitoring, intraoperative ultrasound), more accurate and effective adjuvant therapy contributing to preoperative shrinkage of tumor and preservation of functionally important areas.</p>","PeriodicalId":24032,"journal":{"name":"Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko","volume":"89 1","pages":"103-108"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comparative analysis of combined treatment methods for patients with single brain lesions].","authors":"M Yu Ostapenko, V A Lukshin, D Yu Usachev, A V Golanov, E R Vetlova, A A Durgaryan, N G Kobyakov","doi":"10.17116/neiro20248804113","DOIUrl":"10.17116/neiro20248804113","url":null,"abstract":"<p><p>Primary brain metastases are common in oncology. Preoperative stereotactic radiosurgery followed by surgical resection is a perspective approach.</p><p><strong>Objective: </strong>To evaluate own experience of preoperative radiosurgery followed by surgical resection (RS+S) of metastasis regarding local control, leptomeningeal progression, surgical and radiation-induced complications; to compare treatment outcomes with surgical resection and subsequent radiotherapy (S+SRT).</p><p><strong>Material and methods. a: </strong>Retrospective study included 66 patients with solitary brain metastasis. Two groups of patients were distinguished: group 1 (<i>n</i>=34) - postoperative irradiation, group 2 (<i>n</i>=32) - preoperative irradiation. The median age was 49.5 years (range 36-75).</p><p><strong>Results: </strong>Local 3-, 6- and 12-month control among patients with postoperative irradiation was 88.2%, 79.4% and 42.9%, in the group of preoperative irradiation - 100%, 93.3% and 66.7%, respectively (<i>p</i>=0.021). Leptomeningeal progression developed in 11 patients (8 and 3 ones, respectively). The one-year survival rate was 73.5% and 84.4%, respectively (<i>p</i>=0.33). Long-term surgical and radiation-induced complications occurred in 12 (18.2%) patients.</p><p><strong>Conclusion: </strong>Preoperative radiosurgery with subsequent resection provides higher local control and lower incidence of leptomeningeal progression in patients with single brain metastases.</p>","PeriodicalId":24032,"journal":{"name":"Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko","volume":"88 4","pages":"13-21"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Choice of fractionation regimen for Grade IV gliomas depending on rapid early progression].","authors":"A S Chuguev, T M Kobyletskaya, V A Gerasimov, A A Belikova, A D Kaprin, P V Datsenko","doi":"10.17116/neiro20248805123","DOIUrl":"https://doi.org/10.17116/neiro20248805123","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effect of two fractionation regimens on survival in patients with Grade IV gliomas depending on rapid early progression (REP).</p><p><strong>Material and methods: </strong>Fractionation with prescribed doses of 2 and 3 Gy was alternately used in 140 patients with morphologically confirmed Grade IV glioma using a pairwise modeling strategy.</p><p><strong>Results: </strong>REP was diagnosed in 60 (42.9%) out of 140 patients with Grade IV gliomas and 55 (45.5%) out of 121 patients with glioblastomas. Fatal outcome was observed in 111 (79.3%) patients, 99 (70.7%) ones died from progression of glioma. In case of no REP, the median overall survival as of December 2023 was 32.20 (95% CI 25.7-38.7) months, with REP - only 16.03 (95% CI 13.5-18.6) months (<i>p</i><0.0001). Median survival was slightly lower in patients with glioblastoma - 28.2 and 16.5 months, respectively (<i>p</i><0.0001).</p><p><p>In patients with Grade IV gliomas and no REP, 3 Gy (<i>n</i>=40) fractionation regimen was followed by median overall survival 44.98 (95% Cl 15.3-74.6) months, 2 Gy (<i>n</i>=40) - 20.99 (95% CI 9.2-32.7) months (<i>p</i>=0.027). In case of glioblastoma, differences between fractionation regimes lose significance - medians 33.7 and 19.7 months, respectively (<i>p</i>=0.081). According to multivariate analysis, 3 Gy fractionation regimen is more effective than standard radiotherapy (<i>p</i>=0.009) in patients without REP, while significance of isoeffective doses <59.5Gy≥ is slightly lower (<i>p</i>=0.020). Radiotherapy on the background of temozolomide is equally important (<i>p</i>=0.007).</p><p><p>In patients with grade 4 gliomas and REP, 3 Gy (<i>n</i>=30) fractionation regimen was followed by median overall survival 17.18 (95% CI 14.2-20.2) months, 2 Gy (<i>n</i>=30) - 12.88 (95% CI 5.4-20.3) months (<i>p</i>=0.849). In case of glioblastoma, Cox model classification matrix looks as follows: fractionation variant (<i>p</i>=0.423), isoeffective dose <59.5Gy≥ (<i>p</i><0.0001), temozolomide during radiotherapy (<i>p</i>=0.701), functional status (<i>p</i>=0.485).</p><p><strong>Conclusion: </strong>In patients with Grade IV gliomas and no REP, 3 Gy fractionation regimen has significant advantages over standard radiotherapy regarding overall survival. In case of more aggressive course of tumor (REP), higher single dose does not improve treatment outcomes. Isoeffective dose ≥59.5Gy is of great importance.</p>","PeriodicalId":24032,"journal":{"name":"Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko","volume":"88 5","pages":"23-29"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}