[Reproductive disorders and preservation of fertility in males with benign and malignant brain tumors]. / Narusheniia reproduktivnoi funktsii i vozmozhnosti sokhraneniia fertil'nosti muzhchin s dobrokachestvennymi i zlokachestvennymi opukholiami golovnogo mozga.

Brain tumors rank third in the incidence rate among cancer nosologies. However, improvement of neurosurgical treatment methods and the use of modern regimens of chemotherapy and radiotherapy have increased survival of patients with benign and malignant brain tumors. A significant proportion of patients with brain tumors are young people in the reproductive age who are interested in maintaining their fertility. Surgical removal of tumors, mainly in the hypothalamo-pituitary area as well as the use of chemotherapy and radiotherapy for malignant brain tumors of any localization may be complicated by hypogonadism and infertility. At present, a simple and reliable method of preserving male fertility is sperm cryopreservation. Neurosurgeons as well as oncologists and radiologists should inform patients with brain tumors about a potential risk of hypogonadism and infertility after treatment and about opportunities of sperm cryopreservation, which increases the chances of having future genetic progeny.

Restoration of fertility in a woman with giant prolactinoma in response to cabergoline treatment.

SUMMARY: A 32-year-old woman presented with primary amenorrhoea, prolactin (PRL) level of 154 150 mIU/L and was diagnosed with a giant pituitary adenoma measuring maximum 6.2 cm. Cabergoline (CAB) treatment at a dose of 0.5 mg/week was prescribed to the patient. The treatment decreased the tumour size after 3 months (MRI scans of the brain) and brought back to normal the level of the PRL (345 mIU/L) after 6 months of CAB treatment. After 7 months of CAB treatment, menarche was achieved, and after 12 months, the patient became pregnant. She discontinued taking CAB at 4-week gestation. The pregnancy resulted in a missed miscarriage at 6-7 weeks; an abortion was conducted by the vacuum aspiration method. The MRI scans of the brain did not show any tumour enlargement. After 18 months from the start of the treatment the patient got pregnant for the second time. At 25-week gestation an MRI scan of the brain was conducted which did not show any increase in the tumour size. At 38 weeks the patient delivered a healthy full-term girl via C-section. The patient chose not to breastfeed and resumed CAB therapy after the delivery. During the treatment, the PRL level returned to the normal range and the menstrual cycle was restored. After 3 years the patient got pregnant for the third time. The patient did not receive CAB during the pregnancies; the examination did not show any tumour enlargement. Further MRI scans did not show any tumour growth. CAB therapy was effective in normalization of the PRL level, tumour shrinkage, menarche and pregnancy-induction which led to the birth of healthy children in a woman with primary amenorrhoea and a giant prolactinoma invading the skull base bones. LEARNING POINTS: Giant prolactinomas are very rarely found in women. Cabergoline therapy can be effective in the normalization of the PRL level, tumour shrinkage, menarche induction in a woman with primary amenorrhoea, and giant prolactinoma. Cabergoline therapy can be effective in pregnancy induction which leads to the birth of children in a woman with giant prolactinoma. Cabergoline discontinuation did not trigger tumour enlargement during pregnancy.

[Preoperative and postoperative endocrine disorders associated with pituitary stalk injuries caused by suprasellar growing tumors]. / Éndokrinnye rasstroistva do i posle operatsii pri razlichnykh porazheniiakh steblia gipofiza supraselliarno rastushchimi opukholiami.

The pituitary stalk (PS) is a relatively thin bundle connecting the hypophyseal stalk to the pituitary gland; it consists of both axons of the hypothalamic nuclei (terminating in the neurohypophysis) and the system of portal vessels. Compression of the PS by a space-occupying lesion or its transection (forced or intended) during surgery may lead to the development of endocrine disorders: hypopituitarism, diabetes insipidus, and hyperprolactinemia. The modern literature lacks studies evaluating the severity of endocrine disorders depending on the PS condition before and after surgery. PURPOSE: The study purpose was to investigate endocrine disorders in patients with sellar region (SR) tumors and the PS that was compressed before surgery and preserved or transected during a neurosurgical intervention. MATERIAL AND METHODS: The study included 139 patients with various SR tumors. In 82 patients, a preoperatively compressed PS was preserved (41 patients with hormonal inactive adenoma (HIA) and 41 patients with suprasellar meningioma); in 57 patients, the PS was transected during surgery (46 patients with pituitary stalk craniopharyngioma and 11 patients with hormonally inactive endosuprasellar pituitary adenoma). The hormonal status (PRL, TSH, LH, FSH, fT4, cortisol, testosterone, or estradiol) was examined in all patients both before and after surgery. RESULTS: Hyperprolactinemia was preoperatively detected in 37% of patients with tumors compressing the PS. Elimination of PS compression (tumor resection) led to normalization of the PRL level in most patients and was not accompanied by aggravation of hypopituitarism symptoms. Transection of the PS caused panhypopituitarism in 100% of patients and diabetes insipidus in 93% of cases. After transection of the PS, hyperprolactinemia did not develop in 59% of patients with craniopharyngiomas (CPs) and 82% of patients with HIA. CONCLUSIONS: Given the difference in symptoms associated with compression and surgical transection of the PS, we believe that these two concepts should be clearly distinguished. The PS compression syndrome includes primarily hyperprolactinemia (37% of cases); elimination of PS compression leads to normalization of the PRL level in most patients and is not accompanied by aggravation of hypopituitarism symptoms. The PS transection syndrome in patients with CP and HIA led to the development of panhypopituitarism in all patients and permanent diabetes insipidus in most of them. The causes of the absence of hyperprolactinemia in many patients with PS transection require further research. The surgeon planning intraoperative PS transection to increase the radicality of surgery should be well informed about the consequences of this procedure for the patient's endocrine status.

[Clinical and functional characteristics of giant pituitary adenomas in the population of patients in the Moscow region]. / Klinicheskie i funktsional'nye kharakteristiki gigantskikh adenom gipofiza v populiatsii patsientov Moskovskoi oblasti.

Benign pituitary tumors are the most common sellar neoplasms. Lesions larger than 39 mm in the maximum dimension are called giant. They are rare, and, therefore, there are few data on the clinical and morphological features of giant pituitary tumors with different hormonal activity. AIM: The aim of this study was to identify the clinical and functional features of giant pituitary tumors with different hormonal activity. MATERIAL AND METHODS: We analyzed data of clinical, laboratory, and instrumental examinations of 351 patients diagnosed with pituitary macroadenomas at the Moscow Regional Research Clinical Institute in the period between 2008 and 2017: there were 144 hormonally inactive pituitary adenomas and 207 hormonally active pituitary adenomas (65 prolactinomas and 142 somatotropinomas). RESULTS AND DISCUSSION: Among 351 patients with pituitary macroadenomas, there were 32 (9.1%) giant adenoma cases: 18 (12.5%) 144 patients with hormonally inactive pituitary adenomas and 14 (6.8%) 207 patients with hormonally active pituitary adenomas 6 (3.9%) 65 prolactinomas and 6 (2.9%) 142 somatotropinomas. The volume of giant adenomas was somewhat larger among somatotropinomas 48 926 [35 067; 97 650] mm3 and prolactinomas 36 872 [15 281; 75 102] mm3 compared to that of hormonally inactive pituitary adenomas 26 933 [21 910; 42 895] mm3. Tumors had predominant suprasellar and posterosellar growth (31 (97.8%) and 29 (90.6%) cases, respectively). The most common first patient complaints were visual impairments (59.4%) and headache and/or dizziness (43.8%). Correspondingly, due to these complaints, 16 (50%) patients first consulted an ophthalmologist. Hypopituitarism detected before any treatment was present in 16 (50%) patients. CONCLUSION: In most cases, visual impairments and headaches/dizziness were the first manifestations of giant pituitary adenomas; therefore, ophthalmologists and neurologists should always refer patients with these complaints to MRI. Patients with identified giant pituitary tumors should be referred to an endocrinologist for exclusion of hypopituitarism and, if necessary, timely prescription of hormonal therapy.

[Indications for surgical treatment of prolactin-secreting pituitary adenomas]. / Pokazaniia k khirurgicheskomu lecheniiu prolaktin-sekretiruiushchikh adenom gipofiza.

Prolactinomas account for about 40% of all pituitary adenomas. The main treatment for prolactinomas is undoubtedly therapy with dopamine agonists (DAs). However, prolonged conservative treatment (for many years or even throughout life) that is necessary for permanent control of the disease makes some patients refuse pharmacological treatment for various reasons. In addition, not all prolactinomas respond to DAs therapy. Sometimes, the patient is not able to continue treatment because of the severity of side effects. Along with tumor resistance to therapy and patient intolerance of DAs, complications (liquorrhea, hemorrhage in the tumor) may occur during conservative treatment. In these cases, surgery is necessary. The paper analyzes the modern literature on various treatment options for prolactin-secreting pituitary adenomas and defines the indications for surgical treatment.

[A rare case of diencephalic cachexia in an adult female with cranio-pharyngioma]. / Redkii sluchai razvitiia diéntsefal'noi kakheksii u vzrosloi zhenshchiny s kraniofaringiomoi.

Diencephalic cachexia (DС) is progressive weight loss despite a normal caloric intake and a satisfactory state of health, which is caused by hypothalamic lesions. This is a rare (about 100 cases were reported) and potentially fatal disorder of unknown pathogenesis. At present, there is no effective pharmacological therapy for the disorder. Cachexia may regress only if the tumor reduces in size, therefore the timely diagnosis and treatment are of vital importance for the patient. DС is typical of early childhood, and only a few cases have been reported in adults. We present a rare case of DС in a 24-year-old female with papillary craniopharyngioma.

[The efficacy of desmopressin in the treatment of central diabetes insipidus after resection of chiasmo-sellar region tumors]. / Éffektivnost' lecheniia tsentral'nogo nesakharnogo diabeta preparatom vazomirin posle udaleniia opukholei khiazmal'no-selliarnoi oblasti.

Central diabetes insipidus (CDI) is a neuroendocrine disease, the pathogenesis of which is associated with abnormal secretion of the antidiuretic hormone. One of the specific causes of CDI is neurosurgical resection of chiasmatic-sellar region tumors. AIM: to study the efficacy and safety of desmopressin in CDI patients after resection of chiasmatic-sellar region (CSR) tumors. MATERIAL AND METHODS: Examination and treatment of patients were performed at a hospital for 7-14 days after surgery and then were continued after discharge. During treatment, the following tests were performed: a daily fluid intake and excretion volume, serum levels of sodium, potassium, and glucose twice a day, morning urine specific gravity, and Zimnitsky's test. RESULTS: Twenty-three patients with CSR tumors (11 craniopharyngiomas, 10 pituitary adenomas, 1 skull base chordoma, and 1 CSR meningioma) and CDI after neurosurgical treatment received desmopressin. On treatment, a thirst decrease, a reduced rate of diuresis, a reduced amount of excreted urine, and normalization of the sodium level were observed in all patients. In 12 patients (with pituitary adenoma, skull base chordoma, and meningioma) with transient CDI, desmopressin therapy was discontinued upon regression of symptoms 7-30 days after surgery. Eleven patients with permanent CDI continued to receive the drug at a dose of 1 to 4 doses per day. All patients well tolerated the drug without significant adverse effects. CONCLUSION: Therapy with desmopressin in the form of a nasal spray (vazomirin) in patients with transient and permanent CDI after resection CSR tumors of various histological nature (craniopharyngiomas, pituitary adenomas, meningiomas, and chordomas) was effective and safe in the early postoperative and long-term postoperative periods.

[Modern diagnosis and postoperative monitoring of acromegaly patients at a neurosurgical clinic]. / Sovremennaya diagnostika i posleoperatsionnyi monitoring patsientov s akromegaliei v usloviyakh neirokhirurgicheskoi kliniki.

Acromegaly is a severe disease associated with chronic overproduction of the growth hormone (GH) and insulin-like growth factor-1 (IGF-1), which is caused in most cases by pituitary adenoma. The main causes of mortality in acromegaly are cardiovascular diseases, respiratory diseases, and cancers. At present, the most effective treatment for acromegaly is surgical pituitary adenomectomy. Complete resection of pituitary tumors leads to the normalization of GH and IGF-1 levels, regression of symptoms, and a reduction in the risk of death. The article discusses the current criteria for diagnosis and remission of acromegaly after surgical adenomectomy as well as postoperative monitoring issues aligned with the recent guidelines of the Russian and international endocrinology associations.

[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 rate of hyponatremia in neurosurgical patients (comparison between the data from the Burdenko Neurosurgical Instutite and the literature) and recommendations for the diagnosis and treatment].

UNLABELLED: Hyponatremia is a relatively frequent and serious complication in patients with various neurosurgical pathologies. OBJECTIVE: This study is aimed at assessing the incidence of hyponatremia in neurosurgical patients depending on the pathology. MATERIAL AND METHODS: This paper presents a retrospective analysis 39 479 cases of patients operated on at the Burdenko Neurosurgical Institute from 2008 to 2014. RESULTS: A total of 785 hyponatremic patients with Na level lower than 130 mmol/l (2% of all operated patients) were identified. Mortality in patients with hyponatremia was 14.3%, which is tenfold higher compared to the rest of population of patients without hyponatremia who were operated on during the same period. In adults, hyponatremia most frequently occurred after resection of craniopharyngiomas (11%) and as a result of acute cerebrovascular accident (22%). In children, it occurred after resection of craniopharyngiomas (10%), astrocytomas (7%), ependymomas (24%), and germ cell tumors (10.5%). CONCLUSION: This study, which was mainly statistical one, was not aimed at detailed investigation of hyponatremia in different groups of neurosurgical patients. We only tried to draw the attention of various experts to those categories of patients, where focused and in-depth developments are more than important. Obviously, already gained international experience should be taken into account for this PURPOSE: Therefore, this article presents the literature data on the etiology and pathogenesis of hyponatremia. We describe the details of the various classifications of hyponatremia, its clinical symptoms, diagnosis, and treatments, primarily based on the recommendations of the last European consensus of various specialists (2014).

[Clinical and morphological characteristics, diagnostic criteria, and outcomes of surgical treatment of TSH-secreting pituitary adenomas]. / Kliniko-morfologicheskie kharakteristiki, diagnosticheskie kriterii i rezul'taty khirurgicheskogo lecheniya TTG-sekretiruyushchikh adenom gipofiza.

Thyrotropinomas (TSH-secreting tumors) are a rare type of pituitary adenomas, which account for about 0.5-2.0% of all pituitary tumors. The criterion of thyrotropinoma is visualization of the tumor in the presence of a normal or elevated level of the thyroid-stimulating hormone (TSH) in the blood and elevated concentrations of free T4 (fT4) and free T3 (fT3). OBJECTIVE: To study the clinical, diagnostic, and morphological characteristics and treatment outcomes of TSH-secreting pituitary tumors. MATERIAL AND METHODS: The study included 21 patients aged from 15 to 67 years with pituitary adenoma and a normal or elevated blood TSH level combined with elevated fT4 and fT3 levels who were operated on at the Neurosurgical Institute in the period between 2002 and 2015. Before surgery, in the early postoperative period, and 6 months after surgery, the patients were tested for levels of TSH, fT4, fT3, prolactin, cortisol, the luteinizing hormone (LH), the follicle-stimulating hormone (FSH), estradiol/testosterone, and the insulin-like growth factor (IGF-1). The thyroid status was evaluated using the following reference values: TSH, 0.4-4.0 mIU/L; fT4, 11.5-22.7 pmol/L; fT3, 3.5-6.5 pmol/L. An immunohistochemical study of material was performed with antibodies to TSH, PRL, GH, ACTH, LH, FSH, and Ki-67 (MiB-1 clone); in 13 cases, we used tests with antibodies to somatostatin receptors type 2 and 5 and to D2 subtype dopamine receptors. RESULTS: Thyrotropinomas were detected in patients aged from 15 to 67 years (median, 39 years), with an equal rate in males (48%) and females (52%). Before admission to the Neurosurgical Institute, 11 (52%) patients were erroneously diagnosed with primary hyperthyroidism; based on the diagnosis, 7 of these patients underwent surgery on the thyroid gland and/or received thyrostatics (4 cases). Hyperthyroidism symptoms were observed in 16 (76%) patients. The blood level of TSH was 2.47-38.4 mIU/L (median, 6.56); fT4, 22.8-54.8 nmol/L (median, 36); fT3, 4.24-12.9 pmol/L (median, 9.66). Tumors had the endosellar localization in 4 (19%) cases and the endo-extrasellar localization in 17 (91%) cases. Total tumor resection was performed in 7 (33%) patients. All these tumors had the endosellar and endo-suprasellar localization. No total resection was performed in patients with infiltrative growth of adenoma (invading the skull base structures). An immunohistochemical study of tumor resection specimens detected only TSH expression in 3 (14%) cases; 18 (86%) tumors were plurihormonal and secreted TSH and GH and/or PRL. Of 13 tumors, expression of the type 2 dopamine receptor was detected in 9 (69%) cases; expression of somatostatin receptors type 5 and type 2 was found in 6 (46%) and 2 (15%) cases, respectively. CONCLUSION: The criterion for total tumor resection was a postoperative decrease in the TSH level to 0.1 mIU/L or less. Total resection was performed in 33% of patients with tumors of only the endosellar and endo-suprasellar localization. In most cases, tumors were plurihormonal and secreted TSH and GH and/or PRL.

[Thyrotropin-producing adenomas and thyrotropic hyperplasia (clinical case reports and the review of the literature)]. / Tireotropinomy i tireotrofnaia giperplaziia (opisanie klinicheskikh sluchaev i obzor literatury).

An increased blood level of the thyroid stimulating hormone (TSH) is usually associated with primary hypothyroidism (PHT) but can also be observed in such rare cases as TSH-secreting pituitary tumor. The article describes four clinical cases of elevated TSH blood levels: 1) TSH-secreting pituitary adenoma with hyperthyroidism; 2) TSH-secreting adenoma with hypothyroidism; 3) hormonally inactive pituitary adenoma combined with primary hypothyroidism; 4) reversible thyrotropic hyperplasia. These clinical situations substantiate the importance of considering different diagnoses in a patient with a pituitary gland tumor associated with an increased TSH blood level.

[Transsphenoidal surgery of craniopharyngioma: form palliative surgery to radical removal].

The paper presents basic principles of transsphenoidal craniopharyngioma surgery. Stages of methodology development. Steps of methodology development of such operations in the Institute are described--from palliative interventions to the high-tech modern radical surgery with the use of anterior extended approach. Additional stereotactic irradiation provides reliable control of the disease for a long period. The article mainly describes operative technique and contains preliminary analysis of the surgical results showing effectiveness and safety of endoscopic removal of craniopharyngioma.

[Endoscopic endonasal anterior extended transsphenoidal approach in craniopharyngioma surgery].

The paper describes results of treatment of 56 patients with suprasellar craniopharyngioma (stem, intra-extraventricular) who were operated in Burdenko Neurosurgical Institute using endoscopic endonasal anterior extended transsphenoidal approach. Assessed dynamics of major clinical syndromes (neuro-ophthalmological symptoms, neurological and hormonal status), radicality of surgery, incidence and nature of postoperative complications, postoperative mortality. A comparative analysis of the results obtained in previous studies of our Institute, as well as with those of foreign authors is performed. Obtained data show that endoscopic endonasal anterior extended transsphenoidal approach in craniopharyngioma surgery is an efficient and non-traumatic technique, capable of providing a radical removal of the tumor along with a high quality of life after surgery, and relatively low rates of postoperative complications and mortality.

[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.

[Hormonally inactivated pituitary adenoma: morphological, immunohistochemical and electron-microscopic characteristic].

Morphology of hormonally inactivated pituitary adenoma can be different types of tumors. Morphological immunohistochemical and electron-microscopic researches of 23 hormonally inactivated pituitary adenomas has been carried out. We shown that more frequent morphological substrate was gonadotropinoma or "zero-cells" adenoma. According to our results, gonadotropinomas, "zero-cells" adenomas and oncocytomas have similar features and can be put into the same group of tumor Pathomorphologist has to differentiate this group of tumors from others "silent" pituitary adenomas because they have different prognosis for a disease. A research of somatostatin and dopamine receptors expression would be new area for differential diagnosis of these types of adenomas.

[Experience of skull base defect reconstruction using local pedicled grafts in endoscopic transsphenoidal surgery].

Since endoscopic technique was introduced in transsphenoidal surgery, the midline skull base from olfactory fossa to craniocervical junction has become available through transnasal corridor. One of the most challenging aspects in these types of surgery is watertight closure of skull base defect and prevention of postoperative CSF leaks. Various materials and sealants are applied in different clinics. Recently mucoperiosteal flap from nasal septum was introduced as "gold standard" for multilayer skull base reconstruction. We present our algorithm for selection of skull base reconstruction technique in endoscopic endonasal surgery. We demonstrate our experience of using of pedicled autografts (middle turbinate and mucoperiosteal flap). Surgical technique of grafting is described in details. Clinical results in 41 surgically treated patients are presented. First results of using of pedicled autografts demonstrated high effectiveness of this technique with acceptable rates of nasal complications in comparison to standard methods.

[Complications of treatment of prolactinoma by dopamine agonists].

Treatment of prolactin-secreting pituitary adenomas by dopamine agonists is highly effective and currently is used as basic treatment in most cases, however, literature sources practically do not contain data about possible complications of this therapy. We described a total of 11 cases of deterioration due to primary treatment of macroprolactinomas by cabergoline in the series of 176 patients. The first group included patients with enlargement of the tumor producing deterioration of the symptoms (onset of visual disorders and/or cephalgia). This occurred in 3 (1.7%) cases due to intratumoral hemorrhage or cystic transformation, and in 1 (0.6%) case as a result of growth of cabergoline-resistant tumor. The second group was made up of 6 (3.4%) cases of nasal CSF leak which developed within 3 to 6 weeks after start of treatment. All patients with CSF leak had adenomas with high sensitivity to the drug which produced rapid and significant shrinking of the tumor. The third group was presented by the single case (0.6%) of visual deterioration due to development of empty sella syndrome with dislocation of chiasm and optic nerves into sellar cavity.

[Comparative analysis of surgical and medical treatment of macroprolactinoma of different localization].

The authors performed comparative analysis of results of primary surgical and medical treatment of 306 patients with macroprolactinoma. The series included 178 male and 128 female patients. The tumor was endosellar in 48 cases, endosuprasellar in 94, invaded skull base in 164. The paper demonstrates that according to dynamics of visual function, neurological and hypopituitary symptoms, and probability of prolactin level normalization, treatment with cabergoline has significant advantages in comparison to surgery. Only surgical treatment of endosellar prolactinomas can compete with conservative treatment. After these operations no postoperative complications were observed, normalization of prolactin level was present in 67% of cases, and these results did not differ from results of medical treatment (71%). In case of extrasellar grown of macroprolactinoma, especially invading skull base, primary medical therapy is preferred.