Today one can watch a qualitative leap in diagnosis of pituitary adenomas (MRI with paramagnetics as contrast substances, spiral CT, radioimmunologic evaluation of serum hormones), which makes it possible to diagnose tumors at the stage of microadenomas.
Besides, there have appeared new methods of treatment, permitting to improve its results to a great extent. They include sparing endoscopic transsphenoidal surgical approaches and conservative therapy with prolactin, dopamine agonists, somatotropin and somatostatin analogues.
However, a problem of diagnosis and treatment of pituitary adenomas has been solved almost completely only in large specialized centers. Introduction of endoscopic methods and development of transsphenoidal surgery allows to use modern technologies in the overwhelming majority of neurosurgical hospitals. Unfortunately, a number of fundamental works in this field, which can fill in the gaps in knowledge of practicing neurosurgeons, is not very large and information on the subject under discussion is uncoordinated and often contradictory. More than 20 years has passed since publication of the last home monograph (Pituitary and Chiasmal-Sellar Tumors edited by B.A. Samotokin and V.A. Khilko). This period was characterized by great changes both in strategy and tactics of pituitary adenoma treatment, appearance of new surgical accesses, technologies and drugs. Thus, the monograph Pituitary Adenomas: A Clinical Picture, Diagnosis and Treatment, edited by Prof. B.A. Kadyshev, is extremely important and long-awaited.
The first part of the book describes peculiarities of neuroanatomy and microsurgical anatomy of the chiasmal-sellar area. The authors consider anatomy of all structures of this area and versions of their blood supply in detail. The material is well illustrated. Modern data on neuroendocrinal relationships in the above area are presented. Pathogenesis of pituitary adenomas is discussed.
The monograph informs about the latest views on participation of the hypothalamohypophysial complex in the endocrine system regulation. Detailed analysis of pre- and postoperative endocrinal disorders, watched in pituitary adenomas, is an obvious merit of the monograph.
The second and third parts of the book are devoted to diagnosis and clinical symptoms of both hormone-producing pituitary adenomas and inactive neoplasms. Description of clinical syndromes, algorithms of diagnosis and differential diagnosis is brief, but informative. The material, presented in a very convenient form, is easy for reading and inderstanding. It is undoubtedly of great interest for neurosurgeons and endocrinologists.
Information on methods of radiological (CT, MRI, MR-angiography, etc.), ophthalmologic and endorcinal examination with using special tests is concrete and rather profound.
The next chapters consider indications and contraindications for surgical treatment and drug therapy. Besides, they describe peculiarities of different approaches and potentialities of conservative treatment. A great amount of clinical data is used by the authors to demonstrate motives of choosing this or that approach to the chiasmal-sellar region. It is accompanied by discussion of nuances and preferences on the basis of specific clinical cases. Results of surgical treatment, observed at different periods of time, are compared. Efficacy of up-to-date endoscopic and microscopic transsphenoidal accesses is analyzed. The authors dwell on a modern view, concerning preference of endoscopic approaches, which are equally radical, but more effective and less invasive.
Description of each clinical case is followed by its comparison with clinical and rentgenologic changes, observed in other patients with pituitary adenomas. In the authorsĺ opinion, it will help to select a proper diagnostic algorithm and treatment regimens.
The part, describing anesthesia peculiarities, dependent on a type of surgical treatment or watched under conditions of controlled intracranial hypertension in neuroendocrinal cases, will be of great help for neuroanesthesiologists.
The analysis of conservative treatment potentialities in hormone-producing pituitary adenomas is carried out in such a way, that it cannot but arise a genuine interest of practicing physicians in general and endocrinologists and neurosurgeons in particular. One of the indisputable advantages of the book is that its authors do not concentrate on one and, may be, greatly prospective method of treatment, but analyze the whole spectrum of available modalities with discussing their merits and demerits.
The analysis of radiotherapy, demanding a well-grounded individual approach, and its results in cases with pituitary adenomas is accurate, profound and competent.
It should be noted, that the monograph is based on the material, having been accumulated during several years. The book is characterized by skilful presentation of modern scientific and practical achievements in the field of neurosurgery, neuroendocrinology and adjacent disciplines. One should pay attention to a concrete and practical character of definitions and conclusions. The monograph is well illustrated and contains a lot of references. It will be extremely useful for neurosurgeons, endocrinologists, ophthalmologists, anesthesiologists, neurologists and radiologists. As for specialists, engaged in treatment of pituitary adenomas, there is no doubt, that this monograph will be their reference book for many years.