(Polenov Research Neurosurgical Institute, Saint Petersburg, Russia)
There was considerable increase of a number of neurooncologic patients during the last decade. Despite a developed network of diagnostic centers, equipped with CT and MRI, a problem of diagnosis of cerebral tumors is still urgent. It concerns not only early diagnosis. Rapid development of microsurgery and technical equipment, used during operations, led to a considerable change of approaches, tactics and technique of removal of many CNS neoplasms. Today a great number of extracerebral neoplasms with the most complicated localization, which were considered to be inoperable earlier, can be removed successfully with minimum postoperative mortality (not more than 8%). Thus, surgery of extracerebral benign tumors has come to a point, where results of surgical treatment should be estimated on the basis of a patient's life quality after an operation. Successful treatment of gliomas, especially malignant ones, and malignant tumors of a base of cerebral and visceral cranium is known to be an unsolved problem. Complex treatment (surgery, chemo- and radiotherapy, local hyperthermia, immunotherapy, genetic therapy and other methods) is not reassuring. Attempts to use chemotherapeutic drugs under conditions of a guided break through the blood-brain barrier are doomed to failure most likely, as they do not solve a biological problem of peculiarities of a tumor growth. However, there is ground for supposition, that a new generation of apparatus for radiotherapy, ensuring, for example, changes of a collimator profile in transposition of a radiator head, can allow to get precise "concentration" of a radiosurgical effect on a tumor and a perifocal area. Thus, it is quite possible, that absolutely new positive results of radiosurgical treatment of malignant tumors will be obtained in the nearest future. Prospects of surgery of cerebral tumors are connected with holographic technique, which provides possibility of layer-by-layer three-dimensional observation of practically all anatomic structures of the brain of a patient just on an operating table; besides, one will be able to see them from various angles. A new generation of navigation systems with no rigid connection with sources of infrared irradiation, a new design of operating microscopes, not only projecting contours of a pathologic formation, but also possessing an unlimited depth of focus, are of great interest. Original technologies of application of a surgical microscope and endoscope, supporting each other, polyfunctional microsurgical instruments, destructors of tumor tissue, micromonodissectors, and other equipment will allow to achieve absolutely new qualitative results of treatment of cerebral tumors.