O ne need go no further than this 1288-page book, Diagnostic Neuroradiology, to realize that high-quality neuroradiology is practiced in major medical centers throughout the world. The authors, Drs Valery Kornienko and Igor Pronin, both from the Neuroimaging Department of the Burdenko Neurosurgical Institute in Moscow, in collaboration with 9 of their colleagues from the same department, have written a heavily and beautifully illustrated (1905 separate figures, many with multiple parts) text. The emphasis here is on showing multiple classic and clinically germane cases while still retaining a proper amount of narrative material.

Cerebral vasospasm (CVS) was described in patients after trans-sphenoidal pituitary surgery due to intra-operative trauma of arteries or blood clots around the arteries of Willis' circle. We consider that in the two presented cases the main cause of CVS in early postoperative period was meningitis. Two patients with pituitary adenomas were operated with trans-sphenoidal approach. CVS developed in early postoperative period. Meningitis was revealed in both cases. CVS regressed only after successful treatment of meningitis. In the first case empiric antibiotic therapy was ineffective and CVS remained until Klebsiella pneumonia was detected in CSF and specific therapy was performed. In the second case empiric therapy was effective and CVS vasospasm regressed in 12 days. These cases show that meningitis can be a leading cause of CVS in early postoperative period in trans-sphenoidal pituitary surgery. Adequate treatment of meningitis shortens duration of CVS in these patients.

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Endoscopic endonasal transsphenoidal resection of PAs invading the CS is a more efficient and safer surgical technique compared to microsurgical techniques (transsphenoidal and extra-intradural approach). The lateral extended transsphenoidal endoscopic approach enables resection of PAs with massive invasion into the CS (Grade III and Grade IV, Knosp scale) and has less postoperative complications compared to the extra-intradural approach (p<0.05).

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