Publications by authors named "I N Pronin"

168 Publications

Prediction of Intraoperative Fluorescence of Brain Gliomas: Correlation between Tumor Blood Flow and the Fluorescence.

J Clin Med 2021 May 28;10(11). Epub 2021 May 28.

N. N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, 125047 Moscow, Russia.

Introduction: The prediction of the fluorescent effect of 5-aminolevulinic acid (5-ALA) in patients with diffuse gliomas can improve the selection of patients. The degree of enhancement of gliomas has been reported to predict 5-ALA fluorescence, while, at the same time, rarer cases of fluorescence have been described in non-enhancing gliomas. Perfusion studies, in particular arterial spin labeling perfusion, have demonstrated high efficiency in determining the degree of malignancy of brain gliomas and may be better for predicting fluorescence than contrast enhancement. The aim of the study was to investigate the relationship between tumor blood flow, measured by ASL, and intraoperative fluorescent glow of gliomas of different grades.

Materials And Methods: Tumoral blood flow was assessed in 75 patients by pCASL (pseudo-continuous arterial spin labeling) within 1 week prior to surgery. In all cases of tumor removal, 5-ALA had been administered preoperatively. Maximum values of tumoral blood flow (TBF max) were measured, and normalized tumor blood flow (nTBF) was calculated.

Results: A total of 76% of patients had significant contrast enhancement, while 24% were non-enhancing. The histopathology revealed 17 WHO grade II gliomas, 12 WHO grade III gliomas and 46 glioblastomas. Overall, there was a relationship between the degree of intraoperative tumor fluorescence and ASL-TBF (R = 0.28, = 0.02 or the TBF; R = 0.34, = 0.003 for nTBF). Non-enhancing gliomas were fluorescent in 9/18 patients, with nTBF in fluorescent gliomas being 54.58 ± 32.34 mL/100 mg/s and in non-fluorescent gliomas being 52.99 ± 53.61 mL/100 g/s ( > 0.05). Enhancing gliomas were fluorescent in 53/57 patients, with nTBF being 170.17 ± 107.65 mL/100 g/s in fluorescent and 165.52 ± 141.71 in non-fluorescent gliomas ( > 0.05).

Conclusion: Tumoral blood flow levels measured by non-contrast ASL perfusion method predict the fluorescence by 5-ALA; however, the additional value beyond contrast enhancement is not clear. ASL is, however, useful in cases with contraindication to contrast.
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http://dx.doi.org/10.3390/jcm10112387DOI Listing
May 2021

[Intraosseous metastasis of K27-mutant glioma].

Arkh Patol 2021 ;83(3):40-44

Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia.

Glioma metastasis outside the central nervous system is a quite rare phenomenon. The disease in a young woman manifested itself as back pain and loss of vision in the left eye. Magnetic resonance imaging (MRI) revealed a tumor of the optic nerve; positron emission tomography showed multiple secondary bone changes. At the same time, MRI detected no signs of neoplasm in the midline brain structures (the brain stem and subcortical nuclei) and spinal cord. Two biopsies (superior iliac spine trephine biopsy and optic nerve tumor biopsy) were performed. There were similar histological tumors; the optic nerve tumor was found to have K27M mutation in the gene, whereas the metastatic tumor lacked this mutation (possibly due to the quality and quantity of DNA isolated from the tumor cells). The interesting features of this case are the simultaneous detection of primary and metastatic tumors before receiving any treatment and the absence of the K27M mutation in the gene in the metastasis.
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http://dx.doi.org/10.17116/patol20218303140DOI Listing
May 2021

[Combined cerebral revascularization for moyamoya disease].

Zh Vopr Neirokhir Im N N Burdenko 2021 ;85(2):47-59

Burdenko Neurosurgical Center, Moscow, Russia.

Introduction: Combined cerebral revascularization with direct and indirect components is recognized as the most appropriate method for treating patients with Moyamoya disease all over the world, however, large studies on its effectiveness in Russia have not yet been conducted.

The Aim Of The Study: Was to evaluate the results of combined cerebral revascularization in patients with Moyamoya disease with an analysis of the clinical state and perfusion and angiographic features of neoangiogenesis.

Material And Methods: For the period from 2013 to 2020 in N.N. Burdenko National Medical Research Center of Neurosurgery 79 combined revascularizations were performed in 55 patients with Moyamoya disease. The average age was 13.9±10.11 years. All patients were examined according to a single protocol, including a comprehensive assessment of the clinical symptoms, the state of the brain tissue, the cerebral vascular system, and cerebral blood flow. The results of surgical treatment were evaluated in the early postoperative and long-term periods. The average follow-up period was 14.66±13.17 months. In the postoperative period, the dynamics of neurological status and cerebral blood flow were assessed and the features of neoangiogenesis from various components of revascularization were studied.

Results: In the early postoperative period, in 77.2% of cases, a good treatment result was observed, with no negative dynamics of the neurological status. Ischemic stroke in the operated hemisphere developed in 4 cases (5.1%). In the follow-up period, an improvement in neurological symptoms was observed in 76.6%. Improvement of cerebral blood flow was noted in 92.4% of cases, direct anastomoses functioned in 94.3%, and signs of neovascularization in the area of indirect synangiosis were observed in 80.0%. At the same time, a complementary influence of direct and indirect components of revascularization was revealed in ensuring good general angiographic and perfusion results.

Conclusions: Combined revascularization is a highly effective method of surgical treatment of all patients with Moyamoya disease.
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http://dx.doi.org/10.17116/neiro20218502147DOI Listing
April 2021

[Stereotactic irradiation in the complex treatment of patients with intracranial pilocytic astrocytoma].

Zh Vopr Neirokhir Im N N Burdenko 2021 ;85(2):34-46

Burdenko Neurosurgical Center, Moscow, Russia.

Complex management of patients with intracranial pilocytic astrocytoma (PA) consists of surgical treatment, drug therapy (mainly in young children) and radiotherapy. For many years, radiotherapy (RT) has been a standard for residual tumors, recurrence or continued growth of PA. Currently, stereotactic radiosurgery and radiotherapy are preferred for PA, because these procedures are characterized by high conformity and selectivity, precise irradiation of tumor with minimal damage to surrounding intact tissues. Stereotaxic approach is very important since PAs are localized near functionally significant and radiosensitive brain structures in most cases. There is significant experience of single-center studies devoted to radiotherapy of patients with PA at the Department of Neuroradiosurgery of the Burdenko Neurosurgery Center. In this research, the authors analyzed the results of stereotactic irradiation of 430 patients with PA for the period from 2005 to 2018.
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http://dx.doi.org/10.17116/neiro20218502134DOI Listing
April 2021

[Phosphorus MR spectroscopy and 18F-FDG PET/CT in the study of energy metabolism of glial tumors].

Zh Vopr Neirokhir Im N N Burdenko 2021 ;85(2):26-33

Burdenko Neurosurgical Center, Moscow, Russia.

Objective: To study energy metabolism in glial tumors using dynamic MR spectroscopy and F-FDG PET/CT.

Material And Methods: The study included 19 patients (9 women and 10 men) with newly diagnosed supratentorial glial tumors WHO Grade I-IV (diffuse astrocytoma - 4 cases, oligodendroglioma - 4 cases, anaplastic astrocytoma - 5 cases, glioblastoma - 6 cases). All patients underwent examination and surgical treatment at the Burdenko Neurosurgery Center. Dynamic MR spectroscopy and F-FDG PET/CT were applied in each patient.

Results: We found multiple correlations between the ratio of bioorganic phosphate peaks and parameters of glucose uptake by tumor tissue. These relationships were more significant in patients with high-grade tumors: positive significant correlation between SUVtumor and PME/PCr ratio (R=0.75, =0.01), T/Nmix and βATP/Pi ratio (R=0.76, =0.02), SUVpeaktumor and aATP/Pi ratio (R=0.77, =0.008). Moreover, there were negative correlations between SUVtumor and PCr/bATP ratio (R= -0.66, =0.05), T/Nmix and PDE/bATP ratio (R= -0.83, =0.006), SUVpeaktumor and PDE/aATP ratio (R= -0.76, =0.009).

Conclusion: High-grade gliomas were characterized by higher glucose consumption, ATP release (intensification of energy metabolism) and faster cell membrane synthesis. These processes indicate enhanced proliferation of tumor cells (intensification of plastic metabolism).
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http://dx.doi.org/10.17116/neiro20218502126DOI Listing
April 2021