[Rare case of vitreoretinal lymphoma].

Primary intraocular lymphoma (PIOL) is a primary central nervous system lymphoma subtype. The article presents a case of bilateral vitreoretinal lymphoma in a functionally monocular 68-year-old woman, whose ocular manifestations developed prior to multiple primary lymphoma of the brain, thus, impeding the diagnosis. Stereotactic radiotherapy enabled stabilization of the process and did not affect visual functions.

[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.

[Initial experience of treatment of primary intraocular lymphomas associated with primary CNS lymphomas].

Methods of diagnostics of primary intraocular lymphomas associated with primary CNS lymphomas are described. This article demonstrates the value of neurophtalmological assessment before surgery in patients with intracranial space occupying lesions. Three cases with bilateral primary intraocular lymphomas are presented. Authors analyzed initial results of intraocular lymphomas treatment with intravitreal methotrexate injections.

[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.

[Changes in visual and oculomotor impairments after endoscopic endonasal transsphenoidal removal of pituitary adenomas].

Changes in visual functions were analyzed in 427 patients with pituitary adenomas after endoscopic endonasal transsphenoidal tumor removal. The analysis indicated that not only the specific features of tumor growth and size and the baseline function, but also the efficacy of surgery and a patient's age affect postoperative changes in visual impairments. Endoscopic endonasal transsphenoidal adenomectomy was found to result in no clinical improvement as compared with the earlier used procedures of microscopic transnasal removal with and without an endoscope additionally used at some surgical stages.

[Selection of management tactics in treatment of giant prolactin-secreting pituitary adenomas].

Surgical treatment of giant pituitary adenomas is one of the most complicated problems of modern neurosurgery. Before introduction of dopamine agonists surgery was the dominating therapy. Advances in modern pharmacology allowed to approach the alternative way of management of giant prolactinomas (GP). The paper focuses on comparative analysis of results of surgical and conservative treatment of 57 patients with GP. 34 of them were operated and 23 received cabergolin as primary therapy. Assessment of neurological status, visual functions, hypopituitary disorders and prolactin level was performed. Dynamics of evaluated symptoms resulting from tumor shrinking showed that primary conservative treatment of GP is more preferable than surgical.

[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.

[Rare observation of giant pituitary adenoma spreading into posterior cranial fossa].

A case observation of unusual course of pituitary adenoma is presented. In 47-year old male patient with endo-supra-laterosellar pituitary adenoma and active acromegaly 2 different tumors were discovered intraoperatively during surgery for recurrence of the primary tumor. The first tumor was pituitary adenoma with nuclear polymorphism and the second was meningotheliomatous meningioma with solitary mitoses. After surgery the patient received radiation therapy. After 5 years the patient developed visual deterioration and clinical signs of tumor of left cerebellopontine angle. After removal of posterior fossa lesion, pituitary adenoma was verified.

[Malignant lymphoma of the central nervous system and eye].

Intraocular lymphoma was encountered in 11.4% of the 79 examined patients with malignant lymphoma of the central nervous system. In most cases it had occurred long on an average of 26 months before the development of neurological manifestations and the diagnosis of cerebral lymphoma. Biomicroscopy showed intraocular lymphoma to manifest itself as corneal endothelial precipitation of translucent corpuscles, opacity of the vitreous body, and its posterior detachment. Isolated intraocular lymphoma has been misinterpreted as uveitis of unclear etiology. In this connection, resistance to steroidal and antibacterial therapy should be an indication for diagnostic vitrectomy, followed by an immunohistochemical study of a biopsy specimen. The intraarterial administration of methotrexate, by breaking the blood-brain barrier, caused regression of cerebral lymphoma, but did not result in that of intraocular lymphoma, on this basis the authors consider the intravitreal injection of the agent to be indicated.

[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.

[Chiasmatic cavernoma].

Hemorrhage into the structures of the anterior visual pathway, apoplexy of the chiasma or optic nerves, is a rare pathology that can be caused by different pathological processes among which cavernous angioma and arteriovenous malformation are more frequently mentioned. The cause of chiasmatic apoplexy may be also hemorrhage into the tumor--chiasmatic glioma of blood penetration into the chiasma in pituitary apoplexy. The authors describe a rare case of chiasmatic apoplexy whose cause was chiasmatic cavernoma. In addition to acute visual disorders suggesting the involvement of the left optic nerve, chiasma, and left visual pathway, 23-year-old patient had endocrine disorders as polyuria, polydipsia, which first suggests craniopharyngioma and glioma of the chiasma. A capsule and hematomic clots were removed from the thickened left optic nerve and left chiasmatic half during surgery. Only did a morphological study involving immunohistochemical analysis permit identification of the process as hemorrhage from cavernous micromalformation with the formation of hematoma.

[Use of automatic static perimetry for the diagnosis of visual analyzer lesion in neurosurgical patients]. / Primenenie avtomaticheskoi staticheskoi perimetrii dlia diagnostiki povrezhdeniia zritel'nogo analizatora u bol'nykh s neirokhirurgicheskoi patologiei.

Emphasis is laid on how important to use clinical perimetry in the diagnosis of visual disturbances that are common in neurosurgical pathology. The authors compare kinetic perimetry with automatic static one. They consider the advantages of computerized perimetry used in patients with chiasmocellular diseases in visual analyzerlesion in the cerebral hemispheres, in congestive optic disks, anterior optic ischemic neuropathy, and visual dysfunctions.

[Neuro-ophthalmological symptoms in patients with para-clinoid aneurysms]. / Neirooftal'mologicheskaia simptomatika u bol'nykh s paraklinoidnymi anevrizmami.

Neuroophthalmological symptoms in patients with large and giant paraclinoid aneurysms is presented, based on analysis of case histories, examination of visual functions, and evaluation of ophthalmoscopic picture. Variants of paraclinoid aneurysm location with respect to optic tract structures and the visual function are discussed. Methods of modulating the peripheral and central neurons of the optic tract are described.

[Amaurosis after surgical gauze fixation of walls of a giant fusiform internal carotid aneurysm]. / Odnostornnii amavroz posle ukrepleniia khirurgicheskoi marlei stenok gigantskoi fuziformnoi anevrizmy vnutrennei sonnoi arterii.

A 42-year-old male patient was operated on for a giant fusiform aneurysm of the right internal carotid artery. Extracranial-intracranial bypass was first performed. Despite suction decompression, the aneurysm could not be clipped for its fusiform neck, and it was coated with surgical gauze. Before surgery, his bilateral visual acuity was 1.0; there was a complete left homonymic hemianopia, the fundus oculi was normal. On postoperative day 1, the visual functions were unchanged. Then there was a visual loss in the right eye that progressed to blindness 2 weeks after surgery. The authors consider variants of the pathogenesis of blindness: 1) development of foreign-body granuloma and surgical gauze-induced optochiasmal arachnoiditis; or 2) thrombosis of the aneurysm and thickening of its wall with compression of the right optic nerve. One-year follow-up revealed that the visual acuity of the right eye recovered (1.0), but the right optic disk became pale, the left optic disk was normal. A complete left homonymous hemianopia was unchanged. Spontaneous recovery of visual acuity makes the second hypothesis of the pathogenesis of blindness more preferable.

[Intravascular blood aspiration in large and giant parawedge aneurysm surgery]. / Metodika vnutrisosudistoi aspiratsii krovi v khirurgii krupnykh i gigantskikh paraklinoidnykh anevrizm.

The efficiency of a procedure of intravascular blood aspiration (IVBA) in patients with large and giant parawedge aneurysms of the internal carotid. The study was based on the analysis of clinical data and outcomes of surgical treatment in 20 patients with the aneurysms. The paper presents different procedures for IVBA, a complex of methods for preoperative examination of patients and intraoperative prediction of possible ischemic complications and defines indications for the IVBA procedure. Complete and partial aneurysm exclusion was achieved in 15 (75%) and 2 (10%) patients; the neck and walls of aneurysm were strengthened with surgical gauze in 2 (10%) patients. Incompetent clipping was observed in one case. There was recovery in 17 (85%), improvement in 2 (10%), 1 (5%) patients. No deaths occurred. The IVBA procedure for aneurysm is indicated for large and giant thin-walled non-thrombotic aneurysms of the parawedge carotid segment. It permit effective proximal monitoring of carotid blood flow and creates favourable conditions for preparing and excluding aneurysm, and, if necessary, forming a carotid lumen. Intraoperative monitoring of brain function is highly important and obligatory for early prediction and prevention of ischemic complications. Under intraoperative monitoring of brain function, fractional IVBA makes it effective even if collateral circulation is inadequate.