[Rhinological aspects of endoscopic endonasal removal of hypophysial adenomas].

The authors analyse rhinological aspects of endoscopic endonasal transsphenoidal adenomectomy (EETA): a nasal operation, intra- and postoperative liquorrhea, liquorrhea-associated meningitis, postoperative nasal hemorrhage, local changes of nasal cavity anatomic structures; provide practical recommendations on management of the conditions many of which are life-threatening.

[Methods of the endoscopic endonasal transsphenoidal adenomectomy].

This paper provides the practical part of a procedure for endoscopic endonasal transsphenoidal resection of pituitary tumors. The authors have presently gained experience with about 400 endoscopic endonasal transsphenoidal operations. The advantages of endoscopic surgery include the wide vision field of an operative site under good illumination. The endoscopic intervention provides a possibility of extracting not only endo-, but also paracellular portions of a tumor under direct visual control, which can be rarely done during a standard microscopic transnasal operation. The paper gives recommendations on the equipment of an operating suite and anesthetic maintenance. It also describes surgical stages and postoperative management of patients.

[Comparative assessment of the results of different surgical treatments in patients with pituitary adenomas infiltrating the cavernous sinus]. / Sravnitel'naia otsenka rezul'tatov khirurgicheskogo lecheniia patsientov s adenomami gipofiza, infil'triruiushchimi kavernoznyi sinus, s primeneniem razlichnykh khirurgicheskikh metodik.

Benign pituitary tumors or adenomas are highly common, occasionally inclined to infiltrate the adjacent structures, the cavernous sinus in particular. Despite the fact that drug and radiation therapy are at present widely used treatments, surgical procedures remain highly topical. Different modifications of two basic surgical methods (transcranial intradural and transsphenoidal) that fail to completely remove a tumor from the cavernous sinus in most cases are mostly frequently used as before. Attempts to improve surgical procedures and introduction of current technologies have led to the emergence of an extradural method for tumor removal from the cavernous sinus and to the introduction of endoscopic monitoring during transsphenoidal operations. A strategy of two-stage removal of pituitary tumors has simultaneously been developed. The paper presents the results of surgical treatment of 297 patients with pituitary adenomas growing into the cavernous sinus, by using currently available procedures: transsphenoidal, transcranial intradural, and intra-extradural, and two-stage ones. The findings have confirmed that transsphenoidal removal of pituitary adenomas is the safest method. However, this method has a number of limitations in cases with tumor being grown into the cavernous sinus especially when there is a medial displacement of the intracavernous segment of the internal carotid artery. Moreover, secondary tumor nodes that may be removed by transcranial intradural access are a contraindication to its use. With this, attempts to remove a tumor from the cavernous sinus fail to ensure the desired completeness of removal from the cavernous sinus. The application of an intra-extradural access is the most adequate procedure for tumor removal from the cavernous sinus. The two-stage removal is the most adequate procedure in cases of simultaneously significant spread of a tumor intracranially and into the structures of the base of the skull.

[Successful transsphenoidal removal of sphenoidal sinus tumor in a patient with severe thrombocytopenia]. / Uspeshnoe transsfenoidal'noe udalenie opukholi pazukhi osnovnoi kosti u bol'nogo s tiazheloi trombotsitopeniei.

The paper describes a clinical case of successful transsphenoidal removal of sphenoidal sinus tumor in a patient with severe thrombocytopenia. It also discusses the problems of infusion-transfusion therapy policy in such patients during surgery.

[Surgery of the base of the skull]. / Khirurgiia osnovaniia cherepa.

To treat pathological processes, primarily tumors, in the base of the skull is one of the most intricate neurosurgical problems. In the past decade, interest in this problem has greatly increased due to the advent of new methods of diagnosis, up-to-date neurosurgical equipment and to a greater cooperation of physicians of related disciplines: ophthalmologists, otosurgeons, plastic surgeons. The authors present and summarize the experience accumulated by the researchers of the N. N. Burdenko Institute of Neurosurgery in the past 10 years in treating basal tumors. Based on a great deal of clinical findings, approaches are proposed in treating some groups of basal tumors, such and pituitary adenomas, craniopharyngiomas, meningiomas at various sites, trigeminal and acoustic neurinomas, and malignant neoplasms of the base of the skull. The conditions required for successful surgical treatment of the processes in the base of the skull are described in detail. One of them is a correct determination of a surgical approach.

[The results of neurosurgical treatment in Itsenko-Cushing's disease]. / Rezul'taty neirokhirurgicheskogo lecheniia bolezni Itsenko--Kushinga.

Fifty three consecutive patients with Cushing's disease were operated on in the Neurosurgical Institute from 1987 to 1995. In all cases the diagnosis was based on clinical and laboratory data, as well as radiographic images. Ten patients with false-negative CT scans had MRI confirming the presence of microadenomas less than 5 mm in size. The majority of patients (n = 51) were operated via transsphenoidal approach, transcranial route was utilized in 2 cases. Among the pathological findings, corticotropinomas were revealed in 49 cases, 4 patients were considered to have hyperplasia of the anterior pituitary without well demarcated adenoma. All patients were divided into 2 groups based on the history of previous treatment. Group 1 included 37 primary patients who had not been treated before admission. Group 2 included 16 patients treated surgically (e.g. neurosurgical operations, bilateral/unilateral adrenalectomy), or with irradiation therapy, including proton beam irradiation prior to admission. We came to conclusion that the following principles were essential in the management of Cushing's disease. 1. Properly interpreted clinical signs and symptoms along with biochemical data and radiographic imaging (including MRI) are extremely helpful in the preoperative evaluation of such patients. Our approach helped us reveal corticotropinomas with 98% accuracy. 2. Microsurgical removal was proved to be effective in up to 83% of patients, which was demonstrated by clinical and biochemical remission. 3. It should be emphasized that the results of treatment were significantly better in the first group versus the second one. In group 1, remission was reached in 91.1% of patients as compared to 62.5% in Group 2. 4. In primary patients, the trauma associated with surgical procedure is less and tumors demonstrate a less aggressive biological behavior.

[The staged use of transcranial and transphenoidal surgical approaches in treating hypophyseal adenomas]. / Poétapnoe primenenie transkranialnogo i transsfenoidal'nogo khirurgicheskikh dostupov v lechenii adenom gipofiza.

The study included 138 patients operated on for endo-extracellular pituitary adenomas which extend both intracranially and into the structures of the base of the skull. Operations via transcranial and transsphenoidal access to various tumor sites were performed in 38 patients (a main group), while 100 patients (a control group) underwent one of these operations. Two-stage operations, followed by removal of the suprasellar and basal regions of a tumor, are expedient for enhancing the efficiency of surgical treatment, reducing the incidence of complications associated with traumatic attempts at removing tumor parts hard-to-reach by transcranial or transsphenoidal approaches, as well as at reducing the number of relapses. At the first stage of surgical treatment it is advisable to make an intervention via transcranial access especially in cases of complex configuration of the suprasellar part of a tumor. The recommended interval between transcranial and transsphenoidal surgeries is 3-5 months. Two-stage surgical treatment does not lead to significant structural changes and to the increased number of complications, and to higher mortality rates as compared to one-stage surgery (transcranial or transsphenoidal surgeries alone).

[Surgery of pituitary microadenoma, complications and treatment]. / Khirurgiia mikroadenom gipofiza, oslozhneniia i ikh lechenie.

The authors analyze their observations of 118 patients with hypophyseal microadenomas in 1990-1992. Forty-four patients had prolactinomas, 35 somatotropinomas, 29 corticotropinomas, and 10 mixed tumors of the hypophysis. Operative interventions via a transseptal approach developed by the authors were carried out in all the patients. Complications of such operations are analyzed and methods of their treatment presented. The results lead the authors to a conclusion that selective microsurgery should be a method of choice in the treatment of hypophyseal microadenomas.

[The surgical treatment of dysembryogenetic tumors in the sella-sphenoid location by a transnasal-trans-sphenoid approach]. / Khirurgicheskoe lechenie dizémbriogeneticheskikh opukholei selliarno-sfenoidal'noi lokalizatsii transnazal'no-transsfenoidal'nym dostupom.

In 1979-1993, a total of 1,320 patients with tumors of various histological patterns were operated on by transnasal and transsphenoidal access. Among them, 57 patients had dysembryogenetic tumors: craniopharyngiomas (n = 37), chordomas (n = 10), angiofibromas (n = 6), Rathke's pouch cysts (n = 2), epidermoid cysts (n = 2). Eleven patients were operated on by a combined access (transcranial, then transnasal). The paper gives in detail the clinical aspects, X-ray diagnostic features of dysembryogenetic tumors of sellar-sphenoidal site, identifies their basic growth variants. It also describes the specific features of the access and operation techniques. Indications and contraindications for surgery have been developed. Tumors were totally and subtotally removed in 82.5% of patients. Visual improvements were observed in 74.4%. It is concluded that the transnasal and transsphenoidal access maybe used as the major method of surgical treatment and combined surgical treatment of dysembryogenetic tumors of sellar-sphenoidal site.

[Diagnosis and surgical treatment of microcorticotropinomas]. / Diagnostika i khirurgicheskoe lechenie mikrokortikotropinom.

Microsurgical selective removal of hypophyseal adenomas is more and more frequently used in the treatment of Itsenko-Cushing's disease of late. This permits complete cure of approximately 90% of the patients. Ten patients with this disease, induced by corticotropinoma, were observed. The hormonal methods, as well as computer-aided tomography and NMR tomography, were used to diagnose the condition. A high resolving power of these methods for the diagnosis of this disease is noteworthy. The authors describe the method for microadenoma detection during the operation and present the data of hormonal studies after selective adenomectomy. They emphasize that in cases when clinical data are supported by the hormonal and x-ray findings that confirm the presence of a microcorticotropinoma in Itsenko-Cushing's disease transsphenoidal adenomectomy must be the method of choice for the treatment of such patients.

[Obtaining and morphological characteristics of primary monolayer cell cultures of human somatotropinomas]. / Poluchenie i morfologicheskaia kharakteristika pervichnykh monosloinykh kletochnykh kul'tur somatotropinom cheloveka.

This paper describes the development of method of preparing cell suspension obtained from surgical material of patients with pituitary adenomas and acromegaly as well as the procedure of subsequent long-term cultivation in monolayers of the cells isolated. As judged by visual inspection and measurement of growth hormone and prolactin secretion, tumor pituitary cells kept viability and functional activity for at least 6 days of growing in vitro. Immunocytochemical visualization of somato- and lactotrophs of the same histological preparations permitted us to show that vast majority of cultured cells is represented by somatotrophs; however, a small portion of cell population is represented by lactotrophs and lactosomatotrophs. The peculiarities of cytoarchitectonics in two types of cell cultures of human somatotropinomas were studied.

[Regulation of hormone secretion in primary cell cultures of human somatotropinomas]. / Reguliatsiia gormonal'noi sekretsii v pervichnykh kletochnykh kul'turakh somatotropinom cheloveka.

The effects of somatostatin and thyroliberin (thyrotropin-releasing hormone; TRH) on growth hormone (GH) and prolactin (PRL) secretion were studied in short-term (0.5-3h) or long-term (21-24h) incubations using monolayer cell cultures of somatotropin obtained from surgical material of patients with acromegaly. High sensitivity of both GH and PRL release to inhibitory action of somatostatin (10(-11) M) was established. We could not reveal the unambiguous influence of TRH on somatotropic function in the in vivo and in vitro conditions, as compared to the action of this tripeptide on PRL secretion. The results obtained permit us to propose that cell cultures of pituitary adenomata represent adequate and convenient models for studying the pathogenesis of tumor processes in the pituitary gland and for the development of new procedures of pharmacotherapy.

[Transnasosphenoidal microsurgery of hypophyseal adenomas]. / Transnazosfenoidal'naia mikrokhirurgiia adenom gipofiza.

The results of surgical treatment of 550 patients through a transnasosphenoidal approach are analysed. The results of management of endosellar and endoextrasellar adenomas are discussed. Various groups of patients are set apart according to the hormonal activity of the tumor. The indications and contraindications for operations through a transnasosphenoidal approach are specified beforehand. The complications in transnasal operations are described and mortality is analysed.