[Comparision of stress response severity during intravenous, inhalation and combined anesthesia (inhalation plus local) for pituitary transsphenoidal adenomectomy].

Transsphenoidal pituitary surgery is usually accompanied by severe hemodynamic stress response which is hardly treated with fentanyl. The main goal of the study is to compare anesthetic methods for endonasal endoscopic transsphenoidal pituitary adenomectomy and single out the most effective way of reducing or preventing the stress reaction. 65 patients underwent endonasal endoscopic transsphenoidal pituitary adenomectomy. In all the patients general an- esthesia was induced with propofol. Analgesia was provided by phetanyl boluses. The patients were divided into three groups. In the first group of patients TIVA with propofol-TCI was used. In the second group of patients anesthesia was maintained by N20 plus sevoflurane. The third group of patients received an additional bilateral endoscopic mucosal 2% lidocain 5 ml infiltration of the pterygopalatine nerve branches zone. Pipecuronium was used for neuromuscular blockade. The simultaneous HR, ABP and metabolism increase were qualified as stress response. In the first and second groups of patients the maximum stress response was recorded on the stage of mucosal coagulation and on the opening of the blades of bivalve nasal speculum. No major difference in stress response severity was noted in these groups. In the third group stress response was significantly lower. According of the results of the study bilateral endoscopic mucosal lidocaine infiltration of the pterygopalatine nerve branches zone for anesthetic management of endonasal endoscopic transsphenoidal pituitary adenomectomy can be recommended.

[Therapeutic management for iatrogenic injury of great arteries during transnasal surgery of tumors of the hypophysis].

Results of clinical examination and surgical treatment of 1022 patients with tumors of the hypophysis were analyzed. All the patients were operated upon by transsphenoidal endoscopic approach during the recent 10 years. Complications were observed in 76 (7.4%) patients. Most serious of them were: intraoperative mechanical injury of the right internal carotid artery and contact rupture of a large aneurysm of the internal carotid artery falsely diagnosed as craniopharyngioma. In both cases urgent intravascular interventions were necessary which resulted in relief of symptoms and recovery of the patients.

[Transsphenoidal surgery for large and giant pituitary adenomas by intraoperative video endomonitoring].

The paper analyzes the outcomes of surgical treatment of patients with pituitary adenomas on the basis of 614 performed transsphenoidal surgical appliances, of which there were 209 large and giant pituitary adenomas. The use of intraoperative video endomonitoring during these interventions could substantially reduced the number of complications, enhance the radicalism and selectivity of a surgical appliance. By using such advantages as endoscopy as powerful lighting, an endomicroscopic phenomenon, and a lateral view, at surgery we could precisely determine the borders of an adenoma, the site and sizes of non-removed tumors fragments. The lateral view of an endoscope permits removal of a tumor via the optimal access, prevention of traumatization of cerebral structures and the contents of cavernous sinuses. If there is intraoperative liquorrhea, the latter can be verified and eliminated. Thus, the accumulated experience allows the authors to recommend using intraoperative video endomonitoring during transsphenoidal surgery for pituitary adenomas.

[Video endoscopy in neurosurgery]. / Videoéndoskopiia v neirokhirurgii.

The authors present an analysis of their experiences with performing more than 330 video endoscopic operations on the autopsy material and in 172 patients. In 54 of these patients operations were performed for traumatic intracranial convex hematomas, in 21 for adenomas of the hypophysis, in 14--for arterial aneurysms, and 53 patients with discogenic radiculitis, spinal tumors, consequences of severe spinal traumas. In 25 patients the endoscopic videomonitoring was made during excision of the tumors, paratumorous cysts and abscesses of the brain, decompression of the optic nerve, plasty of the anterior cranial fossa fundus with closing the liquor fistulas. Intraoperative angioscopy in carotid endarterectomy was fulfilled in 5 patients. The video endoscopy was proved to result in less traumaticity of the radical surgery. It is a valuable and highly informative method giving optimum results in performing many microsurgical operations.