A primary abscess in the region of the Sella turcica is a rare neurosurgical pathology especially in the pediatric population. This pathology has no specific symptoms and may have an atypical presentation. It has no specific radiological features making diagnosis very difficult. In this article, we report on a 13-year-old girl with a confirmed primary pituitary abscess. Clinical and instrumental investigations as well as hormonal profile indicated a lesion of the Rathkes pouch- like a craniopharyngioma and to a lesser extent, a pituitary adenoma. In this case, laboratory and Magnetic resonance studies did not show any features of systemic or local acute inflammatory response respectively. The child underwent a surgery, during which the diagnosis was made — primary abscess of the pituitary gland.

This article provides an up-to-date literature review on the role of pathological changes in the extracranial, trunk segments of the vertebral arteries (VA) in the development of chronic and progressive vertebrobasilar insufficiency (VBI). Improving methodology of differentiated reconstructive interventions for VA stenosis based on specifically determined vascular territory with application of microsurgery instruments and minimally invasive technologies has made it possible to determine that all other conditions that could lead to the formation of VBI should be excluded in patients with this clinical picture during the planning of arterial reconstruction, and possible outflow pathways and reactivity of the arteries of the vertebrobasilar territory should be determined.

Vertebrobasilar insufficiency (VBI) is one of the most common forms of cerebrovascular pathology. The progression of the VBI, especially in the context of inadequate therapy, often leads to the formation of a persistent neurological deficits within the framework of dyscirculatory encephalopathy and the consequences of a stroke in the vertebrobasilar system. This study demonstrate the importance of objective methods of patient investigation to optimize the choice of the most effective methods of surgical treatment for VBI in cases of ineffective medical treatment. We have shown that the optimization of the diagnostic algorithm contributes to the correct individualized determination of types of surgical treatment for patients with VBI. It was found that, in addition to traditional diagnostic methods, the use of radiographic methods (ultrasound Doppler, multispiral computed tomography with contrast enhancement) is invaluable for choosing the tactics of surgical treatment. We propose a significant outcome indicator like the blood flow reactivity index to determine the postoperative improvement of blood flow in the vertebral arteries. In addition, the need to perform cerebral angiography and consultations with related specialists to exclude pathologies with a similar clinical picture is emphasized.