Compared with transcranial and microscopic transsphenoidal surgery, endoscopic transsphenoidal surgery offers a wide exposure for cavernous sinus medial wall adenomas that enables removal of the adenoma from the medial cavernous sinus wall. Because of the necessity for multidisciplinary treatment to achieve satisfactory results, Gamma Knife surgery and medical therapy should be supplementary treatment options after endoscopic transsphenoidal surgery.

The endoscopic transsphenoidal approach has been reported in the literature as a useful tool to treat sellar and parasellar lesions. The endoscope permits a panoramic view instead of the narrow microscopic view, and it allows the inspection and removal of the lesions of sellar, parasellar, and suprasellar compartments by angled-lens endoscopes. On the basis of the experience gained with the use of the endoscope, we have performed extended endoscopic endonasal transsphenoidal approach in 13 of 200 (total endoscopic transphenoidal approaches since September 1997) patients for the last 5 years. Extended endoscopic transsphenoidal approach was performed for three patients with pituitary adenoma, two patients with craniopharyngioma, one patient with metastatic lesion, one patient with anaplastic germinoma, two patients with chordoma, one patient with chondrosarcoma, one plasmocytoma, and two patients with tuberculum sella meningioma. Total removal of the tumor was achieved in nine patients and subtotal removal was achieved in four patients. Extended approaches are essential for reaching the area from lamina cribrosa to the cranio-cervical junction. Endoscopic approach permits reaching the lesion without brain retraction and with minimal neurovascular manipulation. The main problems are related to the hemorrhage control of intracranial vessels and to the closure of the dural and bony defects, with subsequent increased risk of postoperative cerebrospinal fluid leak, tensive pneumocephalus, and/or meningitis.

Current literature reveals different opinions about the effectiveness of endoscopic third ventriculostomy in the treatment of hydrocephalus in children less than 2 years of age. Performing a retrospective evaluation of our own experience in this age group, we aimed to contribute to the growing data on the controversial issues related to this procedure in children. In a series of 97 endoscopic third ventriculostomy procedures, 25 were performed in children less than 2 years of age as an initial treatment for hydrocephalus. A retrospective analysis of our data revealed that the overall success rate of endoscopic third ventriculostomy in this age group was 56%. However, analysis of the results in subgroups with different etiologies of hydrocephalus showed that the success rate of the procedure was 83% in patients with defined anatomic obstruction, 66.6% in post-hemorrhagic hydrocephalus, 50% in infection related hydrocephalus and 41.6% in hydrocephalus accompanied by myelomeningocele. This article considers our data and the features of endoscopic third ventriculostomy procedure in this age group, with a detailed review of the literature. In our experience, the success of endoscopic third ventriculostomy is etiology related rather than age-dependent. We suggest that there are no grounds for denying children younger than 2 years this chance for a shunt-free life.

Hydrocephalus causes damage to periventricular white matter at least in part through chronic ischemia. Emphasizing the periventricular ischemia/hypoxia in hydrocephalus, various authors indicated the secondary biochemical impairment and oxidative damage in experimentally induced and congenital hydrocephalic rat brain. (-)-Epigallocatechin gallate (EGCG), the main constituent of green tea polyphenols, has been shown to be of some protective value in various models of neurological injury as a free oxygen radical scavenger. In the present study the effects of EGCG were examined on the periventricular oxidative damage in experimental childhood-onset hydrocephalus. Hydrocephalus was induced in 3 weeks-old rat pups by kaolin injection into the cisterna magna. A single daily dose of 50 mg/kg of EGCG injected into the peritoneum of the rats for 15 days significantly reduced periventricular white matter malondialdehyde levels when compared to non-treated hydrocephalic animals. Our results indicate that EGCG may have a protective effect against periventricular white matter oxidative damage in hydrocephalus induced infantile rats.

There is a correlation between DTI-derived FA values of the optic nerves and visual parameters. DTI assessments of the affected sides with FA and MD values may help to estimate the response of visual improvement to the surgical therapy in the early postoperative period.