[The transoral approach in neurosurgical practice]. / Transoral'nyi dostup v neirokhirurgicheskoi praktike.

Operations were performed on 25 patients by the transoral approach. All of the pathological processes were localized epidurally in the clival, craniocervical or upper cervical regions. These were tumors, developmental anomalies, inflammatory processes, and odontoid fracture with compression of the brain stem, cranial nerves, spinal cord or spinal radices. The advantages of the transoral operation are obvious in decompressing the neural structures from the direction of the exerted pressure. Surgery led to improvement in the 25 primarily operated patients and there was no operative mortality. Among 7 reoperations an emergency and tenable transoral reoperation (C2-4 twice recurrent chordoma) undertaken to relieve respiratory arrest, however, was only a transitory success.

[Surgical treatment of pituitary apoplexy]. / A hypophysis apoplexia sebészi kezeléséröl.

Hypophysis apoplexy is a clinical syndrome characterized by the sudden development of headache, visual disturbance, associated with nausea, vomiting, signs of meningeal irritation and ophthalmoplegia. The symptoms are caused by the hemorrhage of a hypophyseal adenoma. This leads to the swelling of the tumor and compression of the perisellar structures. The authors processed the clinical and pathological characteristics of 28 cases occurring among the patient material of the National Institute of Neurosurgery of the past 10 years. According to the experiences the most important factor of a successful treatment of hypophyseal apoplexy is an early diagnosis and quick admittance to an institute of neurosurgery of satisfactory conditions. Thereafter a steroid hormone therapy of large doses and decompression operation performed by transnasal-transsphenoidal approach leads in the majority of cases to recovery.

Peptides of the otosclerotic perilymph examined by analytical isotachophoresis.

Perilymphs of normal and otosclerotic origin were separated chromatographically on a Sephadex G-25 microcolumn. Peptide composition of the perilymphs was compared by capillary analytical isotachophoresis in the molecular mass range 0.3-5 kD. Otosclerotic perilymph samples contain a heterogeneous, UV-absorbing peptide subfraction which is not detected in the normal perilymph. Normal and otosclerotic perilymph, furthermore, contain four common subfractions detected in twice the normal concentration in the otosclerotic perilymph. These ITP subfractions are degraded during acid hydrolysis (6 M HCI). On the contrary, otosclerosis is a deficient state compared with the normal, as the number of peptides or oligoglycopeptides is twice as high in normal as in otosclerotic perilymph, beside the otosclerosis specific peptides.

[Transsphenoidal approach in pituitary adenomas with suprasellar growth]. / Transsfenoidal'nyi dostup pri adenomakh gipofiza s supraselliarnym rostom.

Experience in surgery through a transsphenoidal approach in 154 patients with suprasellar adenomas of the hypophysis complicated by disorders of vision is discussed. Positive changes of vision after the operation occurred in most cases. At the Budapest Scientific Research Institute of Neurosurgery the transsphenoidal approach to adenomas of the hypophysis is used in most cases, and only 10% of patients are operated on transcranially when there are tumors with parasellar growth. The authors persist in their opinion that the transsphenoidal approach is simpler in techniques and causes less injury as a result of which it can be used even in elderly patients and in those whose general condition is grave.

Transoral surgery for craniocervical space-occupying processes.

Although the number of reports concerning the transoral approach to anteriorly placed lesions of the craniocervical junction are increasing, the development of this technique is still in its early stages. The indications and surgical methods vary widely, and there is much room for discussion of the technical details. Eight cases operated on via transoral surgery during the last 4 years are presented in support of the transoral approach to tumors in the craniocervical region.

[Prolactin-producing hypophyseal adenomas]. / Prolaktin produzierende Adenome der Hypophyse.

It is a report about the diagnostic and the therapy of 10 women with a hyperprolactinemia caused by microadenomas of the hypophysis. The diagnose was made by reason of clinical symptomatology and hormonal and neuroradiological investigations. In six cases the tumor was removed by transsphenoidal route. One women does not give her consent to the microsurgical operation. In three patients the operation seemed not to be indicated absolutely. We gave them a longlasting therapy with bromocriptine. After operation galactorrhea decreased and we found ovulatory cycles in any case. It was concluded, that the results may be better, if the patients are dealt with bromocriptine for a long time, so abolishing the still existing complaints.

Morphological investigations of mixed pituitary adenomas.

Thirteen pituitary adenomas were investigated by light and electron microscopy and in tissue culture. In all adenomas the production of growth hormone and prolactin was proved by endocrine symptoms of the patients and by laboratory tests. Histopathological findings were compared with culture characteristics. In 3 cases the adenoma consisted of three kinds of cell population, in 7 cases of two kinds, and in other 3 cases of one kind. In cases where 3 kinds of cell population were found, beside the granulated cells star-shaped forms without secretion granules could be observed. They probably corresponded to follicular cells. In three cases one single cell population was found. In these cases two different hormones might have been produced by one type of cell. These cells could be considered stem-like cellular elements or differentiated committed cells.

Trans-sphenoidal surgery for suprasellar pituitary adenomas.

The introduction of the trans-sphenoidal approach has not only made intrasellar tumours removable, but has proved also to be a safe method for ablation of suprasellar tumour extension. Experiences with 154 suprasellar pituitary adenomas in a series of 278 trans-sphenoidal operations are presented. Results are compared to those in the literature, suggesting that this technique is possible also for higher risk elderly patients.

Transoral surgery for basilar impression.

A patient with basilar impression presented with a progressive myelopathy due to odontoid invagination. It was thought that a posterior decompression would be hazardous; therefore, the inferior clivus, odontoid process, and anterior arch of the atlas were removed transorally. We have found that, even with symptoms of long duration, marked improvement can be expected when the operation is targeted to the actual abnormality. In such cases, analysis of craniocervical tomograms will show the direction of medullary compression and thus indicate the correct surgical approach.

Myasthenia gravis: the effect of Tensilon on the caloric nystagmus response. Photoelectronystagmographic study.

The nystagmus response evoked by thermic vestibular stimulation on 25 patients with myasthenia gravis and on 10 control persons was investigated using the photoelectronystagmographic method before and after administration of Tensilon. On the basis of 19 nystagmograms (capable of being evaluated) it was found that the test is of diagnostic value when combined with abstinence from drugs, furthermore, it may indicate under- or overtreatment of patients taking drugs. Excluding the drug-resistant, "burned out" cases, a certain correlation may be observed between the magnitude of the reaction evoked by Tensilon and the severity of the clinical condition independent from the existence of ocular symptoms. The advantage of the test, apart from being numerically measurable, is that it can be repeated because of its non-invasive nature causing no physical burden to the patient. Its disadvantage is that it cannot be applied in cases with a pre-existent difference in vestibular tonus - 20% in the material tested.