[The reflection of compensation processes in the structure of the EEG spatial-temporal relationships in patients with disordered brain regulatory mechanisms]. / Otrazhenie protsessov kompensatsii v strukture prostranstvenno-vremennýkh otnoshenii EEG bol'nykh pri narushenii reguliatornykh mekhanizmov mozga.

Studies of intercentral relations of electrical activity in the cerebral cortex of the patients with hypophysis tumours under the conditions of chronic (before operation) and acute (after tumour ablation, early post-operative period) influence of the focus on the regulatory brain systems allowed to reveal definite changes of spectral-coherent EEG characteristics, reflecting the functional state of the cerebral adaptive-compensatory apparatus. It has been shown that reciprocal character of changes of various forms of the brain electrical activity and their intercentral relations is one of manifestations of development of the processes of cerebral compensation. At the same time, global fall of the EEG intercentral relations indicating the disintegration of the cerebral functional connections, reflects a loss of CNS compensatory mechanisms. The revealed EEG-characteristics at the present time are applied in Burdenko Institute of Neurosurgery for diagnostic-prognostic estimation of the brain functional state in patients during pre- and post-operative period.

[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.

[Paragangliomas of the chiasma and sellar area]. / Paragangliomy khiazmal'no-selliarnoi oblasti.

The article describes five cases of rare cerebral tumors, paragangliomas of the chiasma-sellar area. Their clinical course characteristically begins with the appearance of endocrine disorders manifested by progressive hypophyseal insufficiency. Analysis of the clinical and X-ray signs of paragangliomas of the chiasma-sellar region show these to be similar to adenomas of the hypophysis. A specific feature of paragangliomas of the chiasma-sellar area is their rich vascularization, which is demonstrated by angiography and verified in all cases during operation. The rich vascularization of paragangliomas of the chiasma-sellar area calls for their rapid and complete removal so as to reduce the loss of blood and provide reliable hemostasis.

[Disorders of viscero-autonomic and neurohumoral regulation in tumors of sellar-diencephalic localization]. / Narusheniia vistserovegetativnoi i neirogumoral'noi reguliatsii pri opukholiakh selliarno-diéntsefal'noi lokalizatsii.

Twenty-nine patients with varying degrees of hypothalamic lesion were studied for disorders of viscero-vegetative and neurohumoral regulation. Three types of impairments were identified: intact under-compensated, reduced, and perverted. The type of disorders was found to correlate with the degree of the impact of the pathologic process on the hypothalamic structures. It is emphasized that preoperative examination of the central hemodynamics and biogenic amines allows the prediction of their impairment in the postoperative period.

[Pituitary tumors extending into the nose, their topography, diagnosis and principles of treatment]. / Opukholi gipofiza, prorastaiushchie v nos, ikh topografiia, diagnostika, printispy lecheniia.

Tumors of the hypophysis grow into the nose in 5.5% of cases. In 33 of 40 patients the new growth was very large and spread both into the cranial and the nasal cavity; less frequently (in 7 cases) the tumor was only infrasellar, growing into the nasal cavity. The initial signs of the growth of a hypophyseal tumor into the cavity of the nose are detected by purposeful anterior rhinoscopy of the deep anteroposterior parts of the nose and cytological examination of the aspirate from the tumor in the nose. X-ray examination and computer tomography usually reveal growth of the tumor into the nasal cavity only in the later stages of development. According to the size of the intranasal part of the tumor, the authors distinguish small (in 30 patients), of moderate size (1 case), and large (9 cases) tumors. Each group was marked by characteristic rhinoscopic and X-ray features. The choice of the method of treatment was guided by the ratio of the size of the intracranial and intranasal parts of the tumor, the extent of destruction of the base of the skull, and by other factors. Transnasal-transsphenoidal removal is recommended for a tumor growing only into the sphenoidal sinus and the nasal cavity. A tumor growing for the most part intracranially was removed from the cavity of the skull. Intracranial and endonasal rhinological removal is recommended in cases of a large tumor located in the nasal cavity and intracranially.

[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.

[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.

[Electroencephalographic reflection of arterial spasm following surgery for saccular cerebral aneurysms].

The purpose of the investigation was to study the electrophysiological manifestations of arterial spasm developing following surgical interventions for cerebral arterial aneurysms. Repeated EEG-recording was undertaken for this purpose in 40 patients with aneurysms of different localization. The EEG data were compared with the results of a neurological examination and angiography performed pre- and postoperatively. It was found that with an uneventful postoperative course no focal changes develop in the bioelectrical activity, and EEG returns to the initial (preoperative) state or to the normal pattern as soon as by the 15th-20th day. In the presence of postoperative arterial spasm, verified clinically and angiographically, the latter is reflected in EEG tracings as peculiar focal changes in the biopotentials. These changes have a nature of a periodically occurring delta-activity recorded predominantly in the zone of ischaemia. Along with a regress of the spasm its EEG manifestations were found to decrease as well. The focal EEG changes observed in postoperative spasm differ from the localization of those EGG changes that are caused by other factors (haematoma, cicatrical processes, etc.).