Summary
To determine the endocrine, ophthalmologic, and tumor growth control responses after stereotactic radiosurgery using the gamma unit, we reviewed our experience in 35 patients with pituitary adenomas. Twenty-four females and 11 males (mean age 47 years, range 9–81 years) had radiosurgery with average follow-up of 26 months (range 6–60 months). Most patients were refractory to surgical removal.
Fifteen patients had Cushing’s disease. Prior transsphenoidal resection was performed in 14 patients (6 had two prior operations), fractionated radiotherapy in 3, and adrenalectomy in 2. In 11 evaluable patients, the hormone response was normalized in 8, decreased in 2 and increased in 1. Five patients remained on Cortisol suppression. Of 12 patients with imaging follow-up, 4 had decreased tumor size, 6 had no change, and 2 had an increase; these 2 patients underwent subsequent surgery.
Ten patients had acromegaly, and 6 had undergone prior surgery. Of 8 evaluable patients, growth hormone secretion has normalized in 3, decreased in 3, and increased in 2. Six tumors decreased in size, and 2 were unchanged. One patient had repeat resection 21 months after radiosurgery and one patient underwent repeat radiosurgery.
Ten patients had non-secreting adenomas; all 10 had prior operations (1–4 operations, 6 underwent frontal craniotomy) and 5 had undergone fractionated radiotherapy. Eight patients had panhypopituitarism prior to radiosurgery. Four tumors decreased in size and 6 were without change. One patient had worsening of vision and had optic nerve decompression without improvement; 2 had improvement in visual function after radiosurgery. One patient died 16 months later from hypothalamic insufficiency (after 4 prior operations and fractionated radiotherapy).
Radiosurgery is a potentially effective management option for recurrent small pituitary adenomas or for primary management of tumors unsuitable for microsurgery. Radiosurgical dose planning with selective beam blocking and shifting is necessary to preserve visual function. Dose escalation or repeat irradiation may be necessary to improve endocrine control in secreting tumors.
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© 1994 Springer-Verlag
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Pollock, B.E., Kondziolka, D., Lunsford, L.D., Flickinger, J.C. (1994). Stereotactic Radiosurgery for Pituitary Adenomas: Imaging, Visual and Endocrine Results. In: Lindquist, C., Kondziolka, D., Loeffler, J.S. (eds) Advances in Radiosurgery. Acta Neurochirurgica Supplementum, vol 62. Springer, Vienna. https://doi.org/10.1007/978-3-7091-9371-6_7
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DOI: https://doi.org/10.1007/978-3-7091-9371-6_7
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