[Endoscopic transsphenoidal resection of pituitary adenomas invading the cavernous sinus]. / Endoskopicheskoe transsfenoidal'noe udalenie adenom gipofiza, vrastayushchikh v kavernoznyi sinus.

INTRODUCTION: Pituitary adenomas are benign growths that invade the cavernous sinus (CS) in 10-15% of cases. There are different types of microsurgical and endoscopic approaches enabling resection of tumors from the CS cavity that is a relatively small and hard to reach anatomical structure comprising eloquent neurovascular structures. MATERIAL AND METHODS: A study group included 97 patients with pituitary adenomas (PAs) invading the CS. PAs were resected using an endoscopic technique: adenomas were resected from the CS cavity through a standard endoscopic endonasal transsphenoidal approach in 62 cases; a lateral extended transsphenoidal endoscopic approach was used in 35 cases. A control group included patients with PAs spreading into the laterosellar region who were operated on using microsurgical extra-intradural (n=14) and transsphenoidal (n=149) approaches. In the study group, the degree of PA invasion into the CS cavity was determined using the Knosp scale. RESULTS: In the study group, total tumor resection was achieved in 49 (50.5%) cases, subtotal resection in 39 (40.2%) cases, and partial resection in 9 (9.3%) patients. In the case of visual disorders (n=70), vision improvement was achieved in 41.4% of cases. Vision deterioration was detected in 11.4% of cases; no vision changes were in 47.1% of cases. Patients (27.8%) who had not had visual impairments before surgery had no negative changes in vision in the postoperative period. The development/augmentation of oculomotor disorders in the study group occurred in 14 (14.4%) cases. In the study group, hormonal remission of the disease in patients with hormone-active PAs was in 26.7% of cases (n=12). There were no cases of nasal liquorrhea, meningitis, and death in the study group. CONCLUSION: Endoscopic endonasal transsphenoidal resection of PAs invading the CS is a more efficient and safer surgical technique compared to microsurgical techniques (transsphenoidal and extra-intradural approach). The lateral extended transsphenoidal endoscopic approach enables resection of PAs with massive invasion into the CS (Grade III and Grade IV, Knosp scale) and has less postoperative complications compared to the extra-intradural approach (p<0.05).

[The effectiveness of using HyperHAES hypertonic isooncotic plasma solution to achieve stable intracranial hypotension in endoscopic endonasal transsphenoidal adenomectomy as an alternative to the invasive external lumbar drainage].

The structure of surgery of pituitary adenomas has been fundamentally changed over the past decade. The transnasal transsphenoidal approach is currently used to resect more than 95% of adenomas. The wide use of endoscopy has changed the need for perioperative control of intracranial pressure. While controlled intracranial hypertension was previously used during microscopically controlled transnasal surgery to bring the suprasellar capsule and tumor remnants to the field of vision, endoscopically controlled tumor resection implies that controlled intracranial hypotension is required to achieve complete spreading of the suprasellar capsule. External lumbar drains inserted at least for the entire surgery duration are conventionally used to control intracranial pressure. We present the results of the study proving the effectiveness and safety of the HyperHAES hypertonic isooncotic plasma substitute in achieving stable intracranial hypotension according to a large body of clinical data. Our findings give grounds for claiming that the use of the HyperHAES hypertonic isooncotic plasma substitute during the standard adenomectomy allows one to abandon the use of invasive external lumbar drainage, while the surgery quality and risks remain at the same level.

ADAPTIVE MECHANISMS OF THE IMMUNE SYSTEM IN CHILDREN IN FAR NORTH.

This article is devoted to the probleme of modern Pediatrics pathology of the immune system in children with complicated viral infections. The aim of this study was to investigate the immune and cytokine status in children with complicated acute respiratory viral infections. The study included 100 children are often ill respiratory virus infections (more than 8 times per year) from age 0 to 7 years, and 30 children with upper respiratory tract infection; no more than 1 time per year-the control group. The standards of indicators developed by the staff of Immunological laboratory Diagnostic center of the Ministry of health of Republic Sakha (Yakutia ) together with the Institute of health of the Republic Sakha (Yakutia). Statistical calculations made on the basis of applied programs "SAS"and "SPSS"In the analysis of contingency tables (estimates of the correlation of the characteristic and evaluation of significance of differences between groups) used the criterion of 2 (Pearson and likelihood ratio and Fisher's exact test. Comparison of mean values was performed univariate analysis of variance using T-student criterion for assessing the equality of mean F-Fisher test to assess equality of variance. Extreme climatic conditions ofthe far North have an impact on immunological mechanisms. In the analysis of changes ofthe immune status revealed the greatest decline in T-cell level and components of complement in children with complications of viral respiratory infections. In children with complicated respiratory viral infections reduced cellular immunity (CD3+, CD41, CD81, CD+, CD 22+). In children with complicated respiratory viral infections decrease levels ofcytokines (IFN-y FN0-d), indicating about the risk of the formation of complications of respiratory viral infections. As a result of drug therapy of broncho-vaxom marked improvement in immune status and the absence of recurrence of respiratory viral infections within the next 3 months after therapy.

[Damage to the cavernous segment of internal carotid artery in transsphenoidal endoscopic removal of pituitary adenomas (report of 4 cases)].

Endoscopic endonasal transsphenoidal approach (EETA) is an effective and relatively safe to remove pituitary adenomas and other sellar region tumors. One of the most serious complications of transsphenoidal surgery is damage to the cavernous segment of the internal carotid artery, which by different authors occurs at 0 to 3.8%. In the period from 2005 to March 2013 in Burdenko neurosurgical institute 3,000 patients with pituitary adenomas were operated by standard endoscopic transsphenoidal approach. Damage to the internal carotid artery (ICA) occurred in 4 patients, which amounted to 0.13%. To all patients with damage of the ICA angiography was performed in which identified one case of occlusion of the ICA and three cases of false aneurysm formation. Three patients underwent endovascular treatment. Damage to the internal carotid artery may be associated with the wrong orientation in the surgical wound, or excessively aggressive manipulations in the cavernous sinus. Damage to the cavernous segment of the ICA during transsphenoidal surgery is a rare but potentially fatal complication. Extremely important is the correct localization of the middle line and ICA using navigation systems and Doppler ultrasound.

[Endoscopic endonasal surgery of pituitary adenomas (experience of 1700 operations)].

The current paper analyses results of endoscopic endonasal surgical treatment of 1700 patients with pituitary adenomas in Burdenko Neurosurgical Institute during recent 7 years. We assessed the following parameters: dynamics of basic syndromes (neuroophthalmological, neurological and endocrinological symptoms), degree of resection, frequency and types of postoperative complications, postoperative mortality, recurrence rate etc. The obtained data were compared with results of microsurgical transnasal operations which were formerly performed in our department, as well as with results of leading endoscopic neurosurgeons of the world. In majority of parameters our results are on the same level as the data of most prominent endoscopic neurosurgeons of the world and are significantly better that in the group of patients operated using a microscope.

[Surgical treatment for giant pituitary adenomas: the state of visual functions].

Giant pituitary adenomas (more than 60 mm) are a most difficult group of tumors of the pituitary. Surgery is practically the only treatment, visual functions being most vulnerable. The study showed that the procedures for removal of tumors through transsphenoidal approach (improved vision or no negative changes was noted in 78.2% of the patients) or made in 2 steps (a good result was obtained in 64.7%) presented the least risk. The most complete removal of a supracellular tumor portion irrespective of a chosen approach yields a better result than non-radical operations despite its potentially high traumaticity of visual nerves and optic chiasms.

[Clinical presentation, diagnostics and results of primary conservative treatment of large and giant prolactin-secreting pituitary adenomas].

A prospective study of 55 patients with large and giant prolactin-secreting pituitary tumors receiving dopamine agonists as primary treatment was performed. Statistically significant data were obtained indicating decrease of prolactin level, improvement of vision, normalization of sexual function and shrinking of the tumor. Effectiveness and safety of dopamine agonists in patients with large and giant prolactinomas are proved. Also we discovered possibility of nasal CSF leak during conservative treatment.

[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.