From October 2001 to the end of November 2002 in Department of Neurosurgery, Silesian University School of Medicine in Katowice 70 explorations of the sella turcica were executed using the endoscopic method. In 63 cases the operation was done because of pituitary gland adenomas. In one case the diagnosis was craniopharyngioma, in 1 chordoma of the clivus, in one glioma of the optic nerve, in 1 the reason for an operation was an empty sella syndrome and in 3 cases the pathological diagnosis was an amorphous masses. Patients were operated using the 4-mm diameter endoscope with 0- and 30-degree angled lenses, using the method according to Jho and Carrau with our own modifications. In all cases of adenomas the total removal of the tumour was obtained in 71.4 %. Permanent diabetes insipidus occurred in 4.3 % of all operated patients. In our series of patients we did not observe any postoperative CSF leak or rhinological complications. One patient died, corresponding to 1.4 % of all cases. We the recommend transsphenoidal transnasal endoscopic approach for use in the cases of sellar region pathology because of the advantages of the method for surgeon and for comfort of the patient.

The endoscopic method is a safe, hardly invasive and efficient surgical technique in the treatment of recurrent and residual pituitary adenomas. Advantages which add to its attractiveness are also reduction of the procedure duration, very good visualisation of the operative field, absence of serious complications, less pain experienced after the surgery.

The results confirm that TCD is a useful method in the management of children after head injury.

We investigated the putative benefits of simultaneous teleradiotherapy and anti-epidermal growth factor receptor (EGFR) 125I monoclonal antibody (MAb) 425 radioimmunotherapy, when applied after neurosurgery in high-grade gliomas, over teleradiotherapy alone. In comparison to previous studies which have reported good results with this type of radioimmunotherapy, we advanced the adjuvant radioimmunotherapy step, that is, gave it during, not after, teleradiotherapy. The randomized prospective study examined two groups: simultaneous postoperative teleradiotherapy and radioimmunotherapy (TRT + RIT; eight patients) versus teleradiotherapy alone (TRT; 10 patients). Patients who after primary operation of grade III (6 cases) or IV glioma (12 cases), showed no or less than 2 mL of remnant tumor on post-operative magnetic resonance (MR) study and were not treated postoperatively by chemotherapy were enrolled and randomized. Anti-EGFR 125IMAb 425 RIT was started during week 4 of radiotherapy, not later than 8 weeks after neurosurgery, and was repeated three times at 1-week intervals. Total activity given was 5026 + 739 MBq/patient. The tolerance of TRT was good. No immediate side effects of concomitant anti-EGRF 125I RIT were observed. Observation showed a median total survival (as evaluated from the primary neurosurgical treatment) of 14 months (range 3.5-28 months). There was no improvement in disease-free or total survival in the group of patients treated by TRT + RIT after neurosurgery. In addition, an immunohistochemical analysis of EGFR expression in gliomas was performed in a group of 100 cases and was distinctly positive in 50% grade IV gliomas and 68% grade III gliomas. We conclude that simultaneous radiotherapy and radioimmunotherapy with anti-EGFR 125I-MAb 425 is not beneficial over radiotherapy alone in adjuvant treatment of high-grade gliomas after neurosurgery. We also recommend individual confirmation of EGFR expression in further anti-EGFR radioimmunotherapy trials.

We suggest that the very good outcome (100% very good results in patients operated on early) obtained and the high risk of rebleeding in children with cerebral aneurysm allow the recommendation of early surgery in children with ruptured cerebral aneurysms.