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In 1972 to 2000, a total of 102 patients aged 60 years or more underwent surgery for pituitary adenomas. They were 54 males and 48 females (mean age 63.5 years). Before surgery, all the patients had impaired vision (with asymmetry of visual loss in 61% of patients). 17% had ophthalmoplegia. Most adenomas (92%) were clinically and biochemically hormonally inactive. In all cases, pituitary adenomas had extrasellar extension: 63% of the adenomas were enclosed and 37% were invasive. A total of 111 interventions were made in 102 patients. Analyzing the outcomes indicates that transsphenoidal microsurgery is an effective and safe treatment in elderly patients with pituitary adenomas.

Operations were conducted on 83 patients for total (49) or subtotal (34) removal of craniopharyngioma. A dependence of the possibilities of effective radical operations for these tumors on the variant of their localization in the infundibulo-hypophyseal region was revealed. The use of microsurgical techniques made the operation more radical and improved its results. The features of the surgical techniques in endosuprasellar, suprasellar extraventricular and intraventricular craniopharyngiomas are described. After radical operation 26 patients died. The outcomes of radical operations were least favourable in intraventricular craniopharyngiomas. The provision of conditions excluding damage to medio-basal brain areas which are of greatest functional importance is or primary significance in radical operations.

Verified "embryonal" adenomas were studied in 24 patients. It is established that these tumors are characterized by considerable spreading beyond the sella turcica, frequent growth into the cavernous sinuses, and rich vascularization. Diencephalo-vascular symptoms predominate in the clinical picture. Neurosurgical diagnosis calls for a complex of auxiliary methods of examination. The possibilities for radical removal of pituitary "embryonal" adenomas are limited. Attempts to remove as much of the tumor as possible, however, are justified. This proves possible if the specific sequence of the main stages of the operation with the use of microsurgical techniques is observed.

Sixty-seven patients with craniopharyngioma were tested by total (41) or subtotal (26) resection of the tumor. The possibility for radical removal of a craniopharyngioma depends on the size of the tumor and the character of its growth and on the peculiarities of its relation with the abjoining structures, i.e. the sella turcica, third ventricle, optic chiasm, and the vessels of the cerebral base. The tendency to perform radical operations for endosuprasellar craniopharyngiomas may be undertaken if it is possible to achieve atraumatic separation of the capsule of the tumor from the structures forming its seat under the floor of the third ventricle. The results of radical interventions for suprasellar intraventricular craniopharyngiomas are less favourable due to the marked macro- and microstructural changes in the hypothalamic and thalamic parts of the brain.

Meningiomas of the third ventricle, especially those located in its anterior part, are a rare occurrence. Two patients with meningiomas of the third ventricle are described. In one of them the tumor was removed successfully. Pneumoencephalography and positive ventriculography are of decisive importance in the diagnosis of these tumors. Analysis of the data in the literature and the authors' personal observations shows that timely removal of these tumors with the use of rational approaches and microsurgical techniques may yield satisfactory results.

A group of hypophyseal adenomas with extensive extrasellar spread (179 patients) is distinguished and the main topographo-anatomical characteristics of the tumors are determined. The most important characteristics are a large size of the adenoma and growth in many directions with involvement of several structures of the skull and brain. Frequent (up to 70%) invasive growth is typical of such hypophyseal adenomas irrespective of the histological structure. Multiple anastomoses form between the vessels of the tumor and the vascular networks of all anatomical structures with which the tumor comes in contact. These tumors are always separated from the brain matter by the pia. mater. The invasive character of the growth of hypophyseal adenomas makes their radical removal less possible. Maximum effect of surgery may be expected in demarcated growth of the hypophyseal adenoma, including cases with its extensive extrasellar spread.

The article deals with the study of 288 verified cases with adenomas of the pituitary gland. Growth of the tumor into the cavernous sinus was revealed in 102 cases (35.4%). The possible routes of penetration of pituitary tumours into the cavernous sinus and the relationship of the new growths with the intracavernous structures are described in detail. The findings of purposeful radio-diagnostic examination revealing the characteristic combinations of the symptoms of intracavernous expansion of the tumor are of paramount importance in recognizing growth of pituitary adenomas into the cavernous sinuses. It is emphasized that the possibility of such growth must be borne in mind when the operation is planned.