During last 4 years leading endocrine societies of the world published clinical recommendations on diag nostics and treatment of medullary thyroid cancer. The article covers most aspects of following patients with this pathology.

Thyroid surgery is most frequent interventions on endocrine organs. Whereas laryngeal nerves which inner vate the muscles of larynx are passing nearby the thyroid and central compartment therefore the risk of their injury and functional integrity is extremely important. First of all it is recurrent laryngeal nerve which in 0.5–2.7% has not “recurrent” path and depart vagus at cricoid cartilage level. Secondary it is external branch of superior laryngeal nerve with innervates cricothyroid muscle. Routine use of intraoperative neuromonitoring significantly decrease laryngeal nerves temporary palsy (paresis) rate however significant reduction of perma nent palsy frequency was not demonstrated in most published papers. At the same time all authors accept that intraoperative neuromonitoring undoubtedly facilitate detection of laryngeal nerves and allow to convince their functional capacity. Taking into account that safety is a paradigm of contemporary endocrine surgery the intra operative neuromonitoring going towards further investigation and improvement.

This paper presents the treatment results of 75 patients with primary hyperparathyroidism (PHPT) caused by a solitary parathyroid adenoma (SPA). Patients in Group 1 had PHPT with concomitant diseases of the thy roid gland (TG). Group 2 consisted of patients with PHPT without thyroid disease. Group 3 included patients with PHPT and concurrent diseases of the parathyroid glands (PG) and thyroid gland, which were operated on without the use of the proposed integrated approach. Patients in groups 1 and 2 were operated on using the following techniques. Patients in group 1 underwent surgery usinga traditional incision with photodynamic visualization (PV) of the PG and exposure of the recur rent and superior laryngeal nerves (LN) (in some cases with the use of magnifying devices and neuromyog raphy). Patients in group 2 underwent surgery with minimally invasive access, utilizingendoscopic video devices and the universal retractor “Multifiks1”. During the intervention,PVof the PG and electrophysiolog ical monitoring (EM)of the recurrent LN were carried out. In groups 1 and 2, adequacy of the operationwas determined by the change in the level of intraoperative parathyroid hormone (PTH) and ionized calcium before and after the removal of the PG. Our proposed integrated method for the treatment of patients with PHPT allowed for a significant reduction in the risk of postoperative complications and consequently an improvement in quality of life.

Intraoperative nasal cerebrospinal fluid leak are common during the transnasal transsphenoidal interven tions. In certain cases, it is a feature of these interventions. However, its amplification needs a mandatory treatment. In this article, we describe the technique for closure dural defects that have developed during the transnasal removal of hormone active pituitary adenomas, using thrombin and fibrinogen containing colla genic sponge.