Abstract
Pituitary adenomas are common intracranial tumors. Depending upon the underlying pituitary adenoma type, medical or surgical therapy is typically the initial treatment for patients with pituitary adenomas. However, these patients typically live long enough to require multiple treatments. Stereotactic radiosurgery is an important secondary or adjuvant treatment for these lesions. It can provide a high rate of tumor control and an opportunity for biochemical remission. Radiosurgery conveys a small risk of new or worsening neurological deficit or hypopituitarism.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Dekkers OM, Pereira AM, Romijn JA. Treatment and follow-up of clinically nonfunctioning pituitary macroadenomas. J Clin Endocrinol Metab. 2008;93(10):3717–26.
Vance ML. Treatment of patients with a pituitary adenoma: one clinician’s experience. Neurosurg Focus. 2004;16(4):1–6.
Cushing H. The pituitary body and its disorders. Philadelphia: Lippincott; 1912.
Seymour ZA, Cohen-Gadol AA. Cushing’s lost cases of “radium bomb” brachytherapy for gliomas. J Neurosurg. 2010;113(1):141–8.
Schulder M, Loeffler JS, Howes AE, Alexander 3rd E, Black PM. Historical vignette: the radium bomb: Harvey Cushing and the interstitial irradiation of gliomas. J Neurosurg. 1996;84(3):530–2.
Leksell L. The stereotaxic method and radiosurgery of the brain. Acta Chir Scand. 1951;102(4):316–9.
Barnett GH, Linskey ME, Adler JR, Cozzens JW, Friedman WA, Heilbrun MP, et al. Stereotactic radiosurgery—an organized neurosurgery-sanctioned definition. J Neurosurg. 2007;106(1):1–5.
Friedman WA, Foote KD. Linear accelerator radiosurgery in the management of brain tumours. Ann Med. 2000;32(1):64–80.
Chen CC, Chapman P, Petit J, Loeffler J. Proton radiosurgery in neurosurgery. Neurosurg Focus. 2007;23(6):E5.
Höybye C, Rähn T. Adjuvant gamma knife radiosurgery in non-functioning pituitary adenomas; low risk of long-term complications in selected patients. Pituitary. 2009;12(3):211–6.
Pan L, Zhang N, Wang E, Wang B, Xu W. Pituitary adenomas: the effect of gamma knife radiosurgery on tumor growth and endocrinopathies. Stereotact Funct Neurosurg. 1998;70 Suppl 1:119–26.
Feigl GC, Bonelli CM, Berghold A, Mokry M. Effects of gamma knife radiosurgery of pituitary adenomas on pituitary function. J Neurosurg. 2002;97(5 Suppl):415–21.
Hayashi M, Izawa M, Hiyama H, Nakamura S, Atsuchi S, Sato H, et al. Gamma knife radiosurgery for pituitary adenomas. Stereotact Funct Neurosurg. 1999;72 Suppl 1:111–8.
Inoue HK, Kohga H, Hirato M, Sasaki T, Ishihara J, Shibazaki T, et al. Pituitary adenomas treated by microsurgery with or without gamma knife surgery: experience in 122 cases. Stereotact Funct Neurosurg. 1999;72 Suppl 1:125–31.
Izawa M, Hayashi M, Nakaya K, Satoh H, Ochiai T, Hori T, et al. Gamma knife radiosurgery for pituitary adenomas. J Neurosurg. 2000;93 Suppl 3:19–22.
Kajiwara K, Saito K, Yoshikawa K, Kato S, Akimura T, Nomura S, et al. Image-guided stereotactic radiosurgery with the CyberKnife for pituitary adenomas. Minim Invasive Neurosurg. 2005;48(2):91–6.
Kobayashi T. Long-term results of stereotactic gamma knife radiosurgery for pituitary adenomas. Specific strategies for different types of adenoma. Prog Neurol Surg. 2009;22:77–95.
Lim YL, Leem W, Kim TS, Rhee BA, Kim GK. Four years’ experiences in the treatment of pituitary adenomas with gamma knife radiosurgery. Stereotact Funct Neurosurg. 1998;70 Suppl 1:95–109.
Liscak R, Vladyka V, Marek J, Simonova G, Vymazal J. Gamma knife radiosurgery for endocrine-inactive pituitary adenomas. Acta Neurochir (Wien). 2007;149(10):999–1006; discussion.
Losa M, Valle M, Mortini P, Franzin A, da Passano CF, Cenzato M, et al. Gamma knife surgery for treatment of residual nonfunctioning pituitary adenomas after surgical debulking. J Neurosurg. 2004;100(3):438–44.
Martinez R, Bravo G, Burzaco J, Rey G. Pituitary tumors and gamma knife surgery. Clinical experience with more than two years of follow-up. Stereotact Funct Neurosurg. 1998;70 Suppl 1:110–8.
Mingione V, Yen CP, Vance ML, Steiner M, Sheehan J, Laws ER, et al. Gamma surgery in the treatment of nonsecretory pituitary macroadenoma. J Neurosurg. 2006;104(6):876–83.
Mitsumori M, Shrieve DC, Alexander 3rd E, Kaiser UB, Richardson GE, Black PM, et al. Initial clinical results of LINAC-based stereotactic radiosurgery and stereotactic radiotherapy for pituitary adenomas. Int J Radiat Oncol Biol Phys. 1998;42(3):573–80.
Mokry M, Ramschak-Schwarzer S, Simbrunner J, Ganz JC, Pendl G. A six year experience with the postoperative radiosurgical management of pituitary adenomas. Stereotact Funct Neurosurg. 1999;72 Suppl 1:88–100.
Muacevic A, Uhl E, Wowra B. Gamma knife radiosurgery for nonfunctioning pituitary adenomas. Acta Neurochir. 2004;91:51–4.
Muramatsu J, Yoshida M, Shioura H, Kawamura Y, Ito H, Takeuchi H, et al. [Clinical results of LINAC-based stereotactic radiosurgery for pituitary adenoma]. Nippon Igaku Hoshasen Gakkai Zasshi. 2003;63(5):225–30.
Petrovich Z, Jozsef G, Yu C, Apuzzo ML. Radiotherapy and stereotactic radiosurgery for pituitary tumors. Neurosurg Clin N Am. 2003;14(1):147–66.
Picozzi P, Losa M, Mortini P, Valle MA, Franzin A, Attuati L, et al. Radiosurgery and the prevention of regrowth of incompletely removed nonfunctioning pituitary adenomas. J Neurosurg. 2005;102(Suppl):71–4.
Pollock BE, Cochran J, Natt N, Brown PD, Erickson D, Link MJ, et al. Gamma knife radiosurgery for patients with nonfunctioning pituitary adenomas: results from a 15-year experience. Int J Radiat Oncol Biol Phys. 2008;70(5):1325–9.
Sheehan JP, Kondziolka D, Flickinger J, Lunsford LD. Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma. J Neurosurg. 2002;97(5 Suppl):408–14.
Shin M, Kurita H, Sasaki T, Tago M, Morita A, Ueki K, et al. Stereotactic radiosurgery for pituitary adenoma invading the cavernous sinus. J Neurosurg. 2000;93 Suppl 3:2–5.
Voges J, Kocher M, Runge M, Poggenborg J, Lehrke R, Lenartz D, et al. Linear accelerator radiosurgery for pituitary macroadenomas: a 7-year follow-up study. Cancer. 2006;107(6):1355–64.
Witt TC, Kondziolka D, Flickinger J, Lunsford LD. Gamma knife radiosurgery for pituitary tumors. In: Lunsford LD, Kondziolka D, Flickinger J, editors. Gamma knife brain surgery. Basel: Karger; 1998. p. 114–27.
Wowra B, Stummer W. Efficacy of gamma knife radiosurgery for nonfunctioning pituitary adenomas: a quantitative follow up with magnetic resonance imaging-based volumetric analysis. J Neurosurg. 2002;97(5 Suppl):429–32.
Yoon SC, Suh TS, Jang HS, Chung SM, Kim YS, Ryu MR, et al. Clinical results of 24 pituitary macroadenomas with linac-based stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 1998;41(4):849–53.
Starke RM, Williams BJ, Jane Jr JA, Sheehan JP. Gamma knife surgery for patients with nonfunctioning pituitary macroadenomas: predictors of tumor control, neurological deficits, and hypopituitarism. J Neurosurg. 2012;117(1):129–35.
Gopalan R, Schlesinger D, Vance ML, Laws E, Sheehan J. Long-term outcomes after gamma knife radiosurgery for patients with a nonfunctioning pituitary adenoma. Neurosurgery. 2011;69(2):284–93.
Biller BMK, Grossman AB, Stewart PM, Melmed S, Bertagna X, Bertherat J, et al. Treatment of adrenocorticotropin-dependent Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab. 2008;93(7):2454–62.
Castinetti F, Nagai M, Dufour H, Kuhn JM, Morange I, Jaquet P, et al. Gamma knife radiosurgery is a successful adjunctive treatment in Cushing’s disease. Eur J Endocrinol. 2007;156(1):91–8.
Castinetti F, Nagai M, Morange I, Dufour H, Caron P, Chanson P, et al. Long-term results of stereotactic radiosurgery in secretory pituitary adenomas. J Clin Endocrinol Metab. 2009;94(9):3400–7.
Choi JY, Chang JH, Chang JW, Ha Y, Park YG, Chung SS. Radiological and hormonal responses of functioning pituitary adenomas after gamma knife radiosurgery. Yonsei Med J. 2003;44(4):602–7.
Degerblad M, Rahn T, Bergstrand G, Thoren M. Long-term results of stereotactic radiosurgery to the pituitary gland in Cushing’s disease. Acta Endocrinol. 1986;112(3):310–4.
Devin JK, Allen GS, Cmelak AJ, Duggan DM, Blevins LS. The efficacy of linear accelerator radiosurgery in the management of patients with Cushing’s disease. Stereotact Funct Neurosurg. 2004;82(5–6):254–62.
Ganz JC, Backlund EO, Thorsen FA. The effects of gamma knife surgery of pituitary adenomas on tumor growth and endocrinopathies. Stereotact Funct Neurosurg. 1993;61 Suppl 1:30–7.
Hoybye C, Grenback E, Rahn T, Degerblad M, Thoren M, Hulting AL. Adrenocorticotropic hormone-producing pituitary tumors: 12- to 22-year follow-up after treatment with stereotactic radiosurgery. Neurosurgery. 2001;49(2):284–91; discussion 91–2.
Jagannathan J, Sheehan JP, Pouratian N, Laws ER, Steiner L, Vance ML. Gamma knife surgery for Cushing’s disease. J Neurosurg. 2007;106(6):980–7.
Kajiwara K, Saito K, Yoshikawa K, Kato S, Akimura T, Nomura S, et al. Image-guided stereotactic radiosurgery with the CyberKnife for pituitary adenomas. Minim Invasive Neurosurg. 2005;48(2):91–6.
Kim SH, Huh R, Chang JW, Park YG, Chung SS. Gamma knife radiosurgery for functioning pituitary adenomas. Stereotact Funct Neurosurg. 1999;72 Suppl 1:101–10.
Kobayashi T, Kida Y, Mori Y. Gamma knife radiosurgery in the treatment of Cushing disease: long-term results. J Neurosurg. 2002;97(5 Suppl):422–8.
Laws ER, Reitmeyer M, Thapar K, Vance ML. Cushing’s disease resulting from pituitary corticotrophic microadenoma. Treatment results from transsphenoidal microsurgery and gamma knife radiosurgery. Neurochirurgie. 2002;48(2–3 Pt 2):294–9.
Levy RP, Fabrikant JI, Frankel KA, Phillips MH, Lyman JT, Lawrence JH, et al. Heavy-charged-particle radiosurgery of the pituitary gland: clinical results of 840 patients. Stereotact Funct Neurosurg. 1991;57(1–2):22–35.
Morange-Ramos I, Regis J, Dufour H, Andrieu JM, Grisoli F, Jaquet P, et al. Gamma-knife surgery for secreting pituitary adenomas. Acta Neurochir. 1998;140(5):437–43.
Petit JH, Biller BMK, Coen JJ, Swearingen B, Ancukiewicz M, Bussiere M, et al. Proton stereotactic radiosurgery in management of persistent acromegaly. Endocr Pract. 2007;13(7):726–34.
Pollock BE, Brown PD, Nippoldt TB, Young Jr WF. Pituitary tumor type affects the chance of biochemical remission after radiosurgery of hormone-secreting pituitary adenomas. Neurosurgery. 2008;62(6):1271–6; discussion 6–8.
Pollock BE, Nippoldt TB, Stafford SL, Foote RL, Abboud CF. Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas: factors associated with endocrine normalization. J Neurosurg. 2002;97(3):525–30.
Seo Y, Fukuoka S, Takanashi M, Sasaki T, Suematsu K, Nakamura J. Gamma knife surgery for Cushing’s disease. Surg Neurol. 1995;43(2):170–6.
Sheehan JM, Vance ML, Sheehan JP, Ellegala DB, Laws Jr ER. Radiosurgery for Cushing’s disease after failed transsphenoidal surgery. J Neurosurg. 2000;93(5):738–42.
Tinnel BA, Henderson MA, Witt TC, Fakiris AJ, Worth RM, Des Rosiers PM, et al. Endocrine response after gamma knife-based stereotactic radiosurgery for secretory pituitary adenoma. Stereotact Funct Neurosurg. 2008;86(5):292–6.
Voges J, Kocher M, Runge M, Poggenborg J, Lehrke R, Lenartz D, et al. Linear accelerator radiosurgery for pituitary macroadenomas: a 7-year follow-up study. Cancer. 2006;107(6):1355–64.
Wan H, Chihiro O, Yuan S. MASEP gamma knife radiosurgery for secretory pituitary adenomas: experience in 347 consecutive cases. J Exp Clin Cancer Res. 2009;28:36.
Witt TC. Stereotactic radiosurgery for pituitary tumors. Neurosurg Focus. 2003;14(5):e10.
Wong GK, Leung CH, Chiu KW, Ma R, Cockram CS, Lam MJ, et al. LINAC radiosurgery in recurrent Cushing’s disease after transsphenoidal surgery: a series of 5 cases. Minim Invasive Neurosurg. 2003;46(6):327–30.
Melmed S. Acromegaly. N Engl J Med. 2006;355(24):2558–73.
Attanasio R, Epaminonda P, Motti E, Giugni E, Ventrella L, Cozzi R, et al. Gamma-knife radiosurgery in acromegaly: a 4-year follow-up study. J Clin Endocrinol Metab. 2003;88(7):3105–12.
Castinetti F, Taieb D, Kuhn J-M, Chanson P, Tamura M, Jaquet P, et al. Outcome of gamma knife radiosurgery in 82 patients with acromegaly: correlation with initial hypersecretion. J Clin Endocrinol Metab. 2005;90(8):4483–8.
Fukuoka S, Ito T, Takanashi M, Hojo A, Nakamura H. Gamma knife radiosurgery for growth hormone-secreting pituitary adenomas invading the cavernous sinus. Stereotact Funct Neurosurg. 2001;76(3–4):213–7.
Ikeda H, Jokura H, Yoshimoto T. Transsphenoidal surgery and adjuvant gamma knife treatment for growth hormone-secreting pituitary adenoma. J Neurosurg. 2001;95(2):285–91.
Jagannathan J, Sheehan JP, Pouratian N, Laws Jr ER, Steiner L, Vance ML. Gamma knife radiosurgery for acromegaly: outcomes after failed transsphenoidal surgery. Neurosurgery. 2008;62(6):1262–9; discussion 9–70.
Jezkova J, Marek J, Hana V, Krsek M, Weiss V, Vladyka V, et al. Gamma knife radiosurgery for acromegaly—long-term experience. Clin Endocrinol (Oxf). 2006;64(5):588–95.
Kobayashi T, Mori Y, Uchiyama Y, Kida Y, Fujitani S. Long-term results of gamma knife surgery for growth hormone-producing pituitary adenoma: is the disease difficult to cure? J Neurosurg. 2005;102(Suppl):119–23.
Landolt AM, Haller D, Lomax N, Scheib S, Schubiger O, Siegfried J, et al. Stereotactic radiosurgery for recurrent surgically treated acromegaly: comparison with fractionated radiotherapy. J Neurosurg. 1998;88(6):1002–8.
Laws Jr ER, Vance ML. Radiosurgery for pituitary tumors and craniopharyngiomas. Neurosurg Clin N Am. 1999;10(2):327–36.
Losa M, Gioia L, Picozzi P, Franzin A, Valle M, Giovanelli M, et al. The role of stereotactic radiotherapy in patients with growth hormone-secreting pituitary adenoma. J Clin Endocrinol Metab. 2008;93(7):2546–52 [see comment].
Muramatsu J, Yoshida M, Shioura H, Kawamura Y, Ito H, Takeuchi H, et al. [Clinical results of LINAC-based stereotactic radiosurgery for pituitary adenoma]. Nihon Igaku Hoshasen Gakkai Zasshi. 2003;63(5):225–30.
Pollock BE, Jacob JT, Brown PD, Nippoldt TB. Radiosurgery of growth hormone-producing pituitary adenomas: factors associated with biochemical remission. J Neurosurg. 2007;106(5):833–8.
Pollock BE, Nippoldt TB, Stafford SL, Foote RL, Abboud CF. Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas: factors associated with endocrine normalization. J Neurosurg. 2002;97(3):525–30.
Thoren M, Rahn T, Guo WY, Werner S. Stereotactic radiosurgery with the cobalt-60 gamma unit in the treatment of growth hormone-producing pituitary tumors. Neurosurgery. 1991;29(5):663–8.
Vik-Mo EO, Oksnes M, Pedersen P-H, Wentzel-Larsen T, Rodahl E, Thorsen F, et al. Gamma knife stereotactic radiosurgery for acromegaly. Eur J Endocrinol. 2007;157(3):255–63.
Franzin A, Spatola G, Losa M, Picozzi P, Mortini P. Results of gamma knife radiosurgery in acromegaly. Int J Endocrinol. 2012;2012:342034.
Sheehan JP, Pouratian N, Steiner L, Laws ER, Vance ML. Gamma knife surgery for pituitary adenomas: factors related to radiological and endocrine outcomes. J Neurosurg. 2011;114(2):303–9.
Landolt AM, Lomax N. Gamma knife radiosurgery for prolactinomas. J Neurosurg. 2000;93 Suppl 3:14–8.
Pan L, Zhang N, Wang EM, Wang BJ, Dai JZ, Cai PW. Gamma knife radiosurgery as a primary treatment for prolactinomas. J Neurosurg. 2000;93 Suppl 3:10–3.
Choi JY, Chang JH, Chang JW, Ha Y, Park YG, Chung SS. Radiological and hormonal responses of functioning pituitary adenomas after gamma knife radiosurgery. Yonsei Med J. 2003;44(4):602–7.
Pouratian N, Sheehan J, Jagannathan J, Laws Jr ER, Steiner L, Vance ML. Gamma knife radiosurgery for medically and surgically refractory prolactinomas. Neurosurgery. 2006;59(2):255–66; discussion −66.
Jezkova J, Hana V, Krsek M, Weiss V, Vladyka V, Liscak R, et al. Use of the Leksell gamma knife in the treatment of prolactinoma patients. Clin Endocrinol (Oxf). 2009;70(5):732–41.
Kobayashi T. Long-term results of stereotactic gamma knife radiosurgery for pituitary adenomas. Specific strategies for different types of adenoma. Prog Neurol Surg. 2009;22:77–95.
Tanaka S, Link MJ, Brown PD, Stafford SL, Young Jr WF, Pollock BE. Gamma knife radiosurgery for patients with prolactin-secreting pituitary adenomas. World Neurosurg. 2010;74(1):147–52.
Sun DQ, Cheng JJ, Frazier JL, Batra S, Wand G, Kleinberg LR, et al. Treatment of pituitary adenomas using radiosurgery and radiotherapy: a single center experience and review of literature. Neurosurg Rev. 2011;34(2):181–9.
Ma ZM, Qiu B, Hou YH, Liu YS. [Gamma knife treatment for pituitary prolactinomas]. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2006;31(5):714–6.
Liu X, Kano H, Kondziolka D, Park KJ, Iyer A, Shin S, et al. Gamma knife stereotactic radiosurgery for drug resistant or intolerant invasive prolactinomas. Pituitary. 2013;16(1):68–75.
Jagannathan J, Yen C-P, Pouratian N, Laws ER, Sheehan JP. Stereotactic radiosurgery for pituitary adenomas: a comprehensive review of indications, techniques and long-term results using the gamma knife. J Neurooncol. 2009;92(3):345–56.
Landolt AM, Haller D, Lomax N, Scheib S, Schubiger O, Siegfried J, et al. Octreotide may act as a radioprotective agent in acromegaly. J Clin Endocrinol Metab. 2000;85(3):1287–9.
Taussky P, Kalra R, Coppens J, Mohebali J, Jensen R, Couldwell WT. Endocrinological outcome after pituitary transposition (hypophysopexy) and adjuvant radiotherapy for tumors involving the cavernous sinus. J Neurosurg. 2011;115(1):55–62.
Lim YJ, Leem W, Park JT, Kim TS, Rhee BA, Kim GK. Cerebral infarction with ICA occlusion after gamma knife radiosurgery for pituitary adenoma: a case report. Stereotact Funct Neurosurg. 1999;72 Suppl 1:132–9.
Loeffler JS, Niemierko A, Chapman PH. Second tumors after radiosurgery: tip of the iceberg or a bump in the road? Neurosurgery. 2003;52(6):1436–40; discussion 40–2.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer Science+Business Media New York
About this chapter
Cite this chapter
Sheehan, J.P., Williams, B. (2015). Stereotactic Radiosurgery for Pituitary Adenomas. In: Chin, L., Regine, W. (eds) Principles and Practice of Stereotactic Radiosurgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8363-2_26
Download citation
DOI: https://doi.org/10.1007/978-1-4614-8363-2_26
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-8362-5
Online ISBN: 978-1-4614-8363-2
eBook Packages: MedicineMedicine (R0)