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The dilemma of whether to apply surgical or drug treatment to prolactinomas has been ongoing for the past 30 years. The aim of this study is to compare the early postoperative values​​ of prolactin (PRL) in two groups of patients with prolactinomas: those who underwent primary surgical-treatment, and those who underwent surgery after a dopamine agonist (DA) therapy. We present the results of surgical treatment on a series of 161 patients with prolactinomas. Surgery was the primary treatment in 65 patients, while 96 patients had surgery following a long-term treatment with a DA. All surgically treated prolactinomas were operated in the standard transsphenoidal, microsurgical approach. The criteria for hyperprolactinemia remission was a PRL level under 25 ng/ml. Early normalization of PRL was achieved in 92% of those patients who underwent primary surgical-treatment, yet it was achieved in only 42% of patients who were operated on after receiving a long-term drug treatment with a DA. The highest prevalence of postoperative normalization of PRL was achieved in a group of patients with microadenomas who were primarily operated on (98%). The worst results in postoperative normalization of PRL were found in the group of patients with macroadenomas who received a long-term drug treatment with a DA first. These results show our surgical experience in treating prolactinomas. Using surgical treatment, the best clinical outcome was acieved with microprolactinomas and intrasellar, well-confined macroprolactinomas. Nevertheless, we stress the need of an individualized approach and recommend treatment in multidisciplinary centres for pituitary diseases.

Intraventricular neoplasms are uncommon central nervous system lesions that account for only 10% of all neoplasms and are unusual location of metastatic breast cancer. A 73-year-old woman with a medical history of breast carcinoma without any signs of metastatic lesions in the liver, lungs or bones and with an intraventricular tumorous lesion found on multislice computed tomography of the brain is presented. Surgery was indicated in order to confirm the diagnosis histologically and to gain local control of the metastasis. The patient was operated on using the neuronavigation guided transcortical approach. The tumor was removed using the Cavitron ultrasonic aspirator. Histopathologic examination revealed a metastatic breast carcinoma. Postoperative irradiation of the whole brain was performed., Intraventrikularni tumori predstavljaju svega 10% svih tumora središnjega živčanog sustava. Još je rjeđa intraventrikularna lokalizacija metastatskog karcinoma dojke. Prikazujemo slučaj 73-godišnje bolesnice s karcinomom dojke bez znakova metastaskih promjena u jetri, plućima ili kostima. Neuroradiološka obrada (MSCT, višeslojna kompjutorizirana tomografija) je pokazala intraventrikularnu tumorsku tvorbu. Radi potvrde histološke dijagnoze te lokalne kontrole rasta tumora indicirano je operacijsko liječenje. Bolesnica je operirana transkortikalnim pristupom uz pomoć neuronavigacijskog sustava. Tumor je uklonjen uz primjenu kavitronskog ultrazvučnog aspiratora. Patohistološka analiza je pokazala metastatski karcinom dojke. Poslijeoperacijski je provedeno ozračivanje cijelog mozga.

Sacral perineurial (Tarlov) cysts are rare lesions. Over a seven year period 4000 patients underwent surgery for lumbar disk herniation. In three patients neurological symptoms were caused by large sacral perineurial cysts. Methods of choice for diagnosis of Tarlov cysts are lumbosacral magnetic resonance imaging and computerized tomography myelography. The majority of Tarlov cysts are asymptomatic. In case of large (> or = 1.5 cm) and symptomatic perineurial cyst, as in three patients reported in this article, microsurgical treatment was successful. Although rare, perineurial (Tarlov) cysts must be taken into consideration when approaching to patient with low back and radicular pain. Authors review the medical literature, pathological and pathophysiological features and treatment options of sacral perineurial cysts.

Aim: To estimate the incidence of intracranial tumors in the adult population of the Varazdin County, Croatia, for the 1996-2004 period. - - - - - Methods: Setting: Varazdin County General Hospital and four university hospitals in Zagreb, the capital of Croatia. Study period: January 1, 1996 to December 31, 2004. Incident patients: county residents admitted for newly diagnosed intracranial tumors according to the WHO diagnostic criteria. Demographic data were extracted from the 2001 Croatian census. Incidence rates (IRs) per 100,000 person-years (p-y) and annual IRs (per 100,000 persons) were determined and compared as incidence rate ratios (IRRs) with 95% CI. - - - - - Results: For primary intracranial tumors (PITs), IR was 12.1/100,000 p-y (95% CI: 10.3-14.2), comparable in men and women. The highest incidence was recorded for glioblastoma (IR 4.8, 3.7-6.2) and meningioma (IR 3.1, 2.2-4.2). The incidence of PIT was somewhat greater than that of metastatic tumors (IRR 1.58, 95% CI: 1.22-2.05, P < 0.001). Metastatic tumors were more frequent in men than in women, especially metastatic lung tumors (IRR 6.08, 2.32-20.16, P < 0.001). IRs of all PIT taken together, neuroepithelial tumors cumulatively, nonepithelial tumors cumulatively, glioblastoma and meningioma were higher in the population aged >= 40 vs. population aged