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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.

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.

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.

A new method for the removal of chiasma-sellar tumours is proposed consisting of endoscopic endonasal trans-sphenoidal surgery is described. A total of 400 operations were made with the use of this technique. Analysis of their results revealed merits and demerits of the endoscopic endonasal trans-sphenoidal approach. Practical aspects of the endoscopic procedure are discussed and recommendations on its introduction into routine clinical work proposed.

The article deals with endoscopic endonasal transsphenoidal surgery, which has gained great interest among the modem trends of neurosurgery. Application of extended endoscopic endonasal transsphenoidal approaches significantly advances capabilities of transsphenoidal surgery. Pituitary adenomas and some other sellar tumors which traditionally require transcranial procedure now can be removed via endonasal route. The article describes several types of extended endoscopic endonasal transsphenoidal approaches.

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.

This paper provides the practical part of a procedure for endoscopic endonasal transsphenoidal resection of pituitary tumors. The authors have presently gained experience with about 400 endoscopic endonasal transsphenoidal operations. The advantages of endoscopic surgery include the wide vision field of an operative site under good illumination. The endoscopic intervention provides a possibility of extracting not only endo-, but also paracellular portions of a tumor under direct visual control, which can be rarely done during a standard microscopic transnasal operation. The paper gives recommendations on the equipment of an operating suite and anesthetic maintenance. It also describes surgical stages and postoperative management of patients.

The authors analyse rhinological aspects of endoscopic endonasal transsphenoidal adenomectomy (EETA): a nasal operation, intra- and postoperative liquorrhea, liquorrhea-associated meningitis, postoperative nasal hemorrhage, local changes of nasal cavity anatomic structures; provide practical recommendations on management of the conditions many of which are life-threatening.