[Experience with transcranial surgery of hypophyseal adenomas]. / Opyt transkranial'nykh operatsii pri adenomakh gipofiza.

The article generalizes experience in intracranial operations on 453 patients performed at the Institute of Neurosurgery, AMS, USSR in 1983-1987. The tumors had a pronounced extrasellar growth in most cases. The surgical approaches and the peculiarities of surgical techniques in removal of pituitary adenomas are described. The importance of microsurgical techniques which raise the radical character of the surgical interventions and improve their results is discussed.

[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.

[Catamnestic evaluation of the results of surgical and combined treatment of pituitary tumors]. / Katamnesticheskaia otsenka rezul'tatov khirurgicheskogo i kombinirovannogo lecheniia opukholei gipofiza.

The work deals with the study of the results of surgical and combined treatment of 455 patients with adenoma of the hypophysis who were operated on between 1971 and 1977. the catamnestic follow-up periods ranged from 2 to 7 years and more. Microsurgical techniques were used in operations on 146 patients, 309 patients underwent operation by the traditional method. Among 455 patients, 190 were treated by surgery alone, whereas 265 patients received combined treatment (surgical intervention and radiotherapy, mostly in the postoperative period). Study of the results of catamnestic investigation showed that with the use of microsurgical techniques the intervention was more radical and tumors with pronounced extrasellar growth could be removed. The current diagnostic and surgical means as well as combined therapy (surgery combined with radiotherapy) do not solve the problem of the prevention of recurrent tumors of the hypophysis. Recurrences were observed in 22.1% of cases after surgical intervention and in 11.1-15.18% of cases after combined treatment. Combined therapy produces poorer results from the standpoint of correction of the visual and hormonal disorders. The existence, of a considerable number of recurrences makes necessary exact identification of the histobiological and hormonal nature of the whole group of adenomas because the classification accepted today does not meet the essence of the clinical problems encountered in the treatment of these tumors. An exact classification of adenomas of the hypophysis according to their spread is necessary.

[Dynamics of diencephalic-hypothalamic disorders after the removal of basal meningiomas]. / Dinamika diéntsefal'no-gipotalamicheskikh narushenii posle udaleniia bazal'nykh meningiom.

Comprehensive dynamic examination of 27 patients after removal of basal meningiomas revealed some characteristic changes in the results of REG and EEG and in the neurological status. It was also found that the dynamics of the data studied differed with the course of the postoperative period. Some EEG and REG data of favourable prognostic importance were noted. The study of these data promotes objectivization of the course of the postoperative period and is thus also important in the choice of rational therapy in the postoperative period.

[Current problems in the surgical management of parasellar meningiomas]. / Aktuelle Probleme der chirurgischen Behandlung von parasellären Meningiomen.

In the period from 1967 to 1972, 302 patients suffering from basal parasellar meningiomas were operated on at the Burdenko Institute of Moscow. Further, an analysis of the results obtained in the surgical treatment of 43 patients is given who were operated on in the last two years by employing the microsurgical technique. The considerable advantages of the use of the operating microscope and the microtechnique are shown. The mortality rate was reduced to one half and the radicality increased from 50 to 80--85 per cent. All Tuberculum sellae meningiomas could be removed totally. Also in the presence of bad general conditions of the patients no contraindications were seen but the very last chances were used. Postoperative supervision consisted in measuring and checking the cerebrospinal pressure, intracerebral pressure, interstitial fluid pressure, local and regional blood flow, pCO2 and pO2, electrolyte balance, osmolarity and pH. In this way, low pressure conditions could frequently also be determined. The influence of an early diagnosis on the prognosis of the disease is specially pointed out.

[Current status of treatment of parasellar meningiomas]. / Zum gegenwärtigen Stand der Behandlung von parasellären Meingiomen.

For 302 patients presenting the respective indication in the years 1968 to 1972 the operation lethality amounted to 24.8%. Then the microtechnique including the operation microscope were introduced. Out of 47 cases of tuberculum sellae meningiomas one patient died; out of 42 patients suffering from median meningiomas of the wing of the sphenoid bone nine died. Lethality decreased by one half, radical surgery increased from 50 to 80 to 85%. A contraindication for surgery was not considered to be present even with a bad general condition. Post-operative control: cerebrospinal pressure, intracerebral pressure, pressure of the interstitial fluid, local and regional blood supply, pO2 and pCO2, electrolyte balance, pH, osmolality. This allowed also to record conditions of underpressure.

[Consciousness disorders in focal lesions of the right and left cerebral hemispheres]. / Rasstroistva soznaniia pri ochagovom porazhenii pravogo i levogo polusharii mozga

In the light of modern concepts of functional asymmetry in the human brain, the authors analyse paroxysmal conditions of changed consciousness which occurred in 160 patients with lesions of the hemispheres due to brain tumors (75 patients) and in epilepsy (85 patients). It is shown that certain forms of changed consciousness are characteristic of disorders of the right and left hemispheres in right-handedness. This clinical fact is taken as a basis for the assumption that in the formation of consciousness both hemispheres in different ways play a certain role and they provide different "formating" kinds of consciousness: the right hemisphere--a direct perception or a sensory perception of the environment and itself, the left--process of abstract perception based on speech, symbols, semantics.