Stereotactic radiosurgery for pituitary adenomas: a comprehensive review of indications, techniques and long-term results using the Gamma Knife

  • Jay Jagannathan
  • Chun-Po Yen
  • Nader Pouratian
  • Edward R. Laws
  • Jason P. Sheehan
Topic Review


Object This study reviews the long-term clinical results of stereotactic radiosurgery in the treatment of pituitary adenoma patients. Methods We reviewed the outcomes of 298 patients who underwent Gamma Knife radiosurgery for recurrent or residual pituitary adenomas. These results are compared to other contemporary radiosurgical series. Results Pituitary tumors are well-suited for radiosurgery, since radiation can be focused on a well circumscribed region, while adjacent neural structures in the suprasellar and parasellar regions are spared. The overall rate of volume reduction following stereotactic radiosurgery is 85% for non-secretory adenomas that are followed for more than 1-year. The rates of hormonal normalization in patients with hypersecretory adenomas can vary considerably, and tends to be higher in patients with Cushing’s Disease and acromegaly (remission rate of approximately 53% and 54%, respectively) when compared with patients who have prolactinomas (24% remission) and Nelson’s syndrome (29%) remission. Advances in dose delivery and modulation of adenoma cells at the time of radiosurgery may further improve results. Conclusions Although the effectiveness of radiosurgery varies considerably depending on the adenoma histopathology, volume, and radiation dose, most studies indicate that radiosurgery when combined with microsurgery is effective in controlling pituitary adenoma growth and hormone hypersecretion. Long-term follow-up is essential to determine the rate of endocrinopathy, visual dysfunction, hormonal recurrence, and adenoma volume control.


Adenoma Pituitary Radiosurgery Stereotactic 


  1. 1.
    Laws ER Jr, Vance ML (1999) Radiosurgery for pituitary tumors and craniopharyngiomas. Neurosurg Clin N Am 10:327–336PubMedGoogle Scholar
  2. 2.
    Laws ER, Sheehan JP (2006) Pituitary surgery: a modern approach. Karger, BaselGoogle Scholar
  3. 3.
    Kovács K, Horvath E, Universities Associated for Research and Education in Pathology (1986) Tumors of the pituitary gland. Armed Forces Institute of Pathology: For sale by the Armed Forces Institute of Pathology, Washington, D.C., 20306-6000Google Scholar
  4. 4.
    Lyman JT, Phillips MH, Frankel KA, Levy RP, Fabrikant JI (1992) Radiation physics for particle beam radiosurgery. Neurosurg Clin N Am 3:1–8PubMedGoogle Scholar
  5. 5.
    Hopewell JW, Wright EA (1970) The nature of latent cerebral irradiation damage and its modification by hypertension. Br J Radiol 43:161–167PubMedGoogle Scholar
  6. 6.
    Laws ER Jr, Thapar K (1996) Recurrent pituitary adenomas. In: Landolt AM, Vance ML, Reilly PL (eds) Pituitary adenomas. Churchill-Livingtone, Edinburgh, pp 385–394Google Scholar
  7. 7.
    Nieman LK (2002) Medical therapy of Cushing’s disease. Pituitary 5:77–82. doi:10.1023/A:1022308429992 PubMedCrossRefGoogle Scholar
  8. 8.
    Vance ML (1998) Endocrinological evaluation of acromegaly. J Neurosurg 89:499–500PubMedGoogle Scholar
  9. 9.
    Kanter AS, Diallo AO, Jane JA Jr, Sheehan JP, Asthagiri AR, Oskouian RJ, Okonkwo DO, Sansur CA, Vance ML, Rogol AD, Laws ER Jr (2005) Single-center experience with pediatric Cushing’s disease. J Neurosurg 103:413–420PubMedGoogle Scholar
  10. 10.
    Jagannathan J, Dumont AS, Jane JA Jr, Laws ER Jr (2005) Pediatric sellar tumors: diagnostic procedures and management. Neurosurg Focus 18:6. doi:10.3171/foc.2005.18.6.7 CrossRefGoogle Scholar
  11. 11.
    Laws ER Jr, Ebersold MJ, Piepgras DG, Randall RV, Salassa RM (1985) The results of transsphenoidal surgery in specific clinical entities. In: Laws ER Jr, Randall RV, Kern EB et al (eds) Management of pituitary adenomas and related lesions with emphasis on transsphenoidal microsurgery. Appleton-Century-Crofts, New York, pp 277–305Google Scholar
  12. 12.
    Laws ER Jr, Fode NC, Redmond MJ (1985) Transsphenoidal surgery following unsuccessful prior therapy. An assessment of benefits and risks in 158 patients. J Neurosurg 63:823–829PubMedGoogle Scholar
  13. 13.
    Laws ER, Vance ML, Thapar K (2000) Pituitary surgery for the management of acromegaly. Horm Res 53(Suppl 3):71–75. doi:10.1159/000023538 PubMedCrossRefGoogle Scholar
  14. 14.
    Ciric I, Ragin A, Baumgartner C, Pierce D (1997) Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40:225–236 discussion 236–227PubMedCrossRefGoogle Scholar
  15. 15.
    Landolt AM, Haller D, Lomax N, Scheib S, Schubiger O, Siegfried J, Wellis G (2000) Octreotide may act as a radioprotective agent in acromegaly. J Clin Endocrinol Metab 85:1287–1289. doi:10.1210/jc.85.3.1287 PubMedCrossRefGoogle Scholar
  16. 16.
    Landolt AM, Lomax N (2000) Gamma knife radiosurgery for prolactinomas. J Neurosurg 93(Suppl 3):14–18PubMedGoogle Scholar
  17. 17.
    Pouratian N, Sheehan J, Jagannathan J, Laws ER Jr, Steiner L, Vance ML (2006) Gamma knife radiosurgery for medically and surgically refractory prolactinomas. Neurosurgery 59:255–266 discussion 255–266PubMedCrossRefGoogle Scholar
  18. 18.
    Pollock BE, Jacob JT, Brown PD, Nippoldt TB (2007) Radiosurgery of growth hormone-producing pituitary adenomas: factors associated with biochemical remission. J Neurosurg 106:833–838. doi:10.3171/jns.2007.106.5.833 PubMedCrossRefGoogle Scholar
  19. 19.
    Landolt AM, Haller D, Lomax N, Scheib S, Schubiger O, Siegfried J, Wellis G (1998) Stereotactic radiosurgery for recurrent surgically treated acromegaly: comparison with fractionated radiotherapy. J Neurosurg 88:1002–1008PubMedGoogle Scholar
  20. 20.
    Hayashi M, Taira T, Chernov M, Fukuoka S, Liscak R, Yu CP, Ho RT, Regis J, Katayama Y, Kawakami Y, Hori T (2002) Gamma knife surgery for cancer pain-pituitary gland-stalk ablation: a multicenter prospective protocol since 2002. J Neurosurg 97:433–437PubMedGoogle Scholar
  21. 21.
    Levivier M, Massager N, Wikler D, Devriendt D, Goldman S (2007) Integration of functional imaging in radiosurgery: the example of PET scan. Prog Neurol Surg 20:68–81. doi:10.1159/000100096 PubMedCrossRefGoogle Scholar
  22. 22.
    Alexander E 3rd, Loeffler JS (1992) Radiosurgery using a modified linear accelerator. Neurosurg Clin N Am 3:167–190PubMedGoogle Scholar
  23. 23.
    Flickinger JC, Lunsford LD, Wu A, Maitz AH, Kalend AM (1990) Treatment planning for gamma knife radiosurgery with multiple isocenters. Int J Radiat Oncol Biol Phys 18:1495–1501PubMedGoogle Scholar
  24. 24.
    Wu A, Lindner G, Maitz AH, Kalend AM, Lunsford LD, Flickinger JC, Bloomer WD (1990) Physics of gamma knife approach on convergent beams in stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 18:941–949PubMedGoogle Scholar
  25. 25.
    Paddick I (2000) A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg 93(Suppl 3):219–222PubMedGoogle Scholar
  26. 26.
    Flickinger JC (1989) An integrated logistic formula for prediction of complications from radiosurgery. Int J Radiat Oncol Biol Phys 17:879–885PubMedGoogle Scholar
  27. 27.
    Flickinger JC, Lunsford LD, Kondziolka D (1992) Dose prescription and dose-volume effects in radiosurgery. Neurosurg Clin N Am 3:51–59PubMedGoogle Scholar
  28. 28.
    Jagannathan J, Sheehan JP, Pouratian N, Laws ER, Steiner L, Vance ML (2007) Gamma knife surgery for Cushing’s disease. J Neurosurg 106:980–987. doi:10.3171/jns.2007.106.6.980 PubMedCrossRefGoogle Scholar
  29. 29.
    Leber KA, Bergloff J, Langmann G, Mokry M, Schrottner O, Pendl G (1995) Radiation sensitivity of visual and oculomotor pathways. Stereotact Funct Neurosurg 64(Suppl 1):233–238PubMedGoogle Scholar
  30. 30.
    Leber KA, Bergloff J, Pendl G (1998) Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg 88:43–50PubMedGoogle Scholar
  31. 31.
    Chen JC, Giannotta SL, Yu C, Petrovich Z, Levy ML, Apuzzo ML (2001) Radiosurgical management of benign cavernous sinus tumors: dose profiles and acute complications. Neurosurgery 48:1022–1030 discussion 1030–1022PubMedCrossRefGoogle Scholar
  32. 32.
    Lim YL, Leem W, Kim TS, Rhee BA, Kim GK (1998) Four years’ experiences in the treatment of pituitary adenomas with gamma knife radiosurgery. Stereotact Funct Neurosurg 70(Suppl 1):95–109. doi:10.1159/000056412 PubMedCrossRefGoogle Scholar
  33. 33.
    Sheehan JM, Vance ML, Sheehan JP, Ellegala DB, Laws ER Jr (2000) Radiosurgery for Cushing’s disease after failed transsphenoidal surgery. J Neurosurg 93:738–742PubMedGoogle Scholar
  34. 34.
    Witt TC, Kondziolka D, Flickinger JC, Lunsford LD (1998) Gamma knife radiosurgery for pituitary tumors. In: Lunsford LD, Kondziolka D, Flickinger J (eds) Gamma knife brain surgery progress in neurological surgery. Karger, Basel, pp 114–127Google Scholar
  35. 35.
    Tishler RB, Loeffler JS, Lunsford LD, Duma C, Alexander E 3rd, Kooy HM, Flickinger JC (1993) Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 27:215–221PubMedGoogle Scholar
  36. 36.
    Sheehan JP, Jagannathan J, Pouratian N, Steiner L (2006) Stereotactic radiosurgery for pituitary adenomas: a review of the literature and our experience. Front Horm Res 34:185–205. doi:10.1159/000091581 PubMedCrossRefGoogle Scholar
  37. 37.
    Sheehan JP, Kondziolka D, Flickinger J, Lunsford LD (2002) Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma. J Neurosurg 97:408–414PubMedGoogle Scholar
  38. 38.
    Liu AL, Wang C, Sun S, Wang M, Liu P (2005) Gamma knife radiosurgery for tumors involving the cavernous sinus. Stereotact Funct Neurosurg 83:45–51. doi:10.1159/000085544 PubMedCrossRefGoogle Scholar
  39. 39.
    Kuo JS, Chen JC, Yu C, Zelman V, Giannotta SL, Petrovich Z, MacPherson D, Apuzzo ML (2004) Gamma knife radiosurgery for benign cavernous sinus tumors: quantitative analysis of treatment outcomes. Neurosurgery 54:1385–1393 discussion 1393–1384PubMedCrossRefGoogle Scholar
  40. 40.
    Peker S, Kilic T, Sengoz M, Pamir MN (2004) Radiosurgical treatment of cavernous sinus cavernous haemangiomas. Acta Neurochir (Wien) 146:337–341 discussion 340CrossRefGoogle Scholar
  41. 41.
    Nakamura N, Shin M, Tago M, Terahara A, Kurita H, Nakagawa K, Ohtomo K (2002) Gamma knife radiosurgery for cavernous hemangiomas in the cavernous sinus. Report of three cases. J Neurosurg 97:477–480PubMedGoogle Scholar
  42. 42.
    Lim YJ, Leem W, Park JT, Kim TS, Rhee BA, Kim GK (1999) Cerebral infarction with ICA occlusion after Gamma Knife radiosurgery for pituitary adenoma: a case report. Stereotact Funct Neurosurg 72(Suppl 1):132–139. doi:10.1159/000056449 PubMedCrossRefGoogle Scholar
  43. 43.
    Mampalam TJ, Tyrrell JB, Wilson CB (1988) Transsphenoidal microsurgery for Cushing disease. A report of 216 cases. Ann Intern Med 109:487–493PubMedGoogle Scholar
  44. 44.
    Martinez R, Bravo G, Burzaco J, Rey G (1998) Pituitary tumors and gamma knife surgery. Clinical experience with more than two years of follow-up. Stereotact Funct Neurosurg 70(Suppl 1):110–118. doi:10.1159/000056413 PubMedCrossRefGoogle Scholar
  45. 45.
    Shin M, Kurita H, Sasaki T, Tago M, Morita A, Ueki K, Kirino T (2000) Stereotactic radiosurgery for pituitary adenoma invading the cavernous sinus. J Neurosurg 93(Suppl 3):2–5PubMedGoogle Scholar
  46. 46.
    Mingione V, Yen CP, Vance ML, Steiner M, Sheehan J, Laws ER, Steiner L (2006) Gamma surgery in the treatment of nonsecretory pituitary macroadenoma. J Neurosurg 104:876–883. doi:10.3171/jns.2006.104.6.876 PubMedCrossRefGoogle Scholar
  47. 47.
    Pamir MN, Peker S (2006) Microvascular decompression for trigeminal neuralgia: a long-term follow-up study. Minim Invasive Neurosurg 49:342–346. doi:10.1055/s-2006-960487 PubMedCrossRefGoogle Scholar
  48. 48.
    Inoue HK, Kohga H, Hirato M, Sasaki T, Ishihara J, Shibazaki T, Ohye C, Andou Y (1999) Pituitary adenomas treated by microsurgery with or without Gamma Knife surgery: experience in 122 cases. Stereotact Funct Neurosurg 72(Suppl 1):125–131. doi:10.1159/000056448 PubMedCrossRefGoogle Scholar
  49. 49.
    Izawa M, Hayashi M, Nakaya K, Satoh H, Ochiai T, Hori T, Takakura K (2000) Gamma knife radiosurgery for pituitary adenomas. J Neurosurg 93(Suppl 3):19–22PubMedGoogle Scholar
  50. 50.
    Jackson IM, Noren G (1999) Gamma knife radiosurgery for pituitary tumours. Best Pract Res Clin Endocrinol Metab 13:461–469. doi:10.1053/beem.1999.0033 CrossRefGoogle Scholar
  51. 51.
    Feigl GC, Bonelli CM, Berghold A, Mokry M (2002) Effects of gamma knife radiosurgery of pituitary adenomas on pituitary function. J Neurosurg 97:415–421PubMedGoogle Scholar
  52. 52.
    Ganz JC, Backlund EO, Thorsen FA (1993) The effects of Gamma Knife surgery of pituitary adenomas on tumor growth and endocrinopathies. Stereotact Funct Neurosurg 61(Suppl 1):30–37. doi:10.1159/000100656 PubMedGoogle Scholar
  53. 53.
    Hayashi M, Izawa M, Hiyama H, Nakamura S, Atsuchi S, Sato H, Nakaya K, Sasaki K, Ochiai T, Kubo O, Hori T, Takakura K (1999) Gamma Knife radiosurgery for pituitary adenomas. Stereotact Funct Neurosurg 72(Suppl 1):111–118. doi:10.1159/000056446 PubMedCrossRefGoogle Scholar
  54. 54.
    Losa M, Valle M, Mortini P, Franzin A, da Passano CF, Cenzato M, Bianchi S, Picozzi P, Giovanelli M (2004) Gamma knife surgery for treatment of residual nonfunctioning pituitary adenomas after surgical debulking. J Neurosurg 100:438–444PubMedGoogle Scholar
  55. 55.
    Kim SH, Huh R, Chang JW, Park YG, Chung SS (1999) Gamma Knife radiosurgery for functioning pituitary adenomas. Stereotact Funct Neurosurg 72(Suppl 1):101–110. doi:10.1159/000056445 PubMedCrossRefGoogle Scholar
  56. 56.
    Hoybye C, Grenback E, Rahn T, Degerblad M, Thoren M, Hulting AL (2001) Adrenocorticotropic hormone-producing pituitary tumors: 12- to 22-year follow-up after treatment with stereotactic radiosurgery. Neurosurgery 49:284–291 discussion 291–282PubMedCrossRefGoogle Scholar
  57. 57.
    Ikeda H, Jokura H, Yoshimoto T (2001) Transsphenoidal surgery and adjuvant gamma knife treatment for growth hormone-secreting pituitary adenoma. J Neurosurg 95:285–291PubMedGoogle Scholar
  58. 58.
    Kobayashi T, Kida Y, Mori Y (2002) Gamma knife radiosurgery in the treatment of Cushing disease: long-term results. J Neurosurg 97:422–428PubMedGoogle Scholar
  59. 59.
    Mokry M, Ramschak-Schwarzer S, Simbrunner J, Ganz JC, Pendl G (1999) A six year experience with the postoperative radiosurgical management of pituitary adenomas. Stereotact Funct Neurosurg 72(Suppl 1):88–100. doi:10.1159/000056444 PubMedCrossRefGoogle Scholar
  60. 60.
    Wowra B, Stummer W (2002) Efficacy of gamma knife radiosurgery for nonfunctioning pituitary adenomas: a quantitative follow up with magnetic resonance imaging-based volumetric analysis. J Neurosurg 97:429–432PubMedGoogle Scholar
  61. 61.
    Yoon SC, Suh TS, Jang HS, Chung SM, Kim YS, Ryu MR, Choi KH, Son HY, Kim MC, Shinn KS (1998) Clinical results of 24 pituitary macroadenomas with linac-based stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 41:849–853. doi:10.1016/S0360-3016(98)00124-2 PubMedGoogle Scholar
  62. 62.
    Abe T, Yamamoto M, Taniyama M, Tanioka D, Izumiyama H, Matsumoto K (2002) Early palliation of oculomotor nerve palsy following gamma knife radiosurgery for pituitary adenoma. Eur Neurol 47:61–63. doi:10.1159/000047951 PubMedCrossRefGoogle Scholar
  63. 63.
    Hayashi M, Taira T, Ochiai T, Chernov M, Takasu Y, Izawa M, Kouyama N, Tomida M, Tokumaru O, Katayama Y, Kawakami Y, Hori T, Takakura K (2005) Gamma knife surgery of the pituitary: new treatment for thalamic pain syndrome. J Neurosurg 102:38–41 SupplPubMedGoogle Scholar
  64. 64.
    Chang SD, Murphy M, Geis P, Martin DP, Hancock SL, Doty JR, Adler JR Jr (1998) Clinical experience with image-guided robotic radiosurgery (the Cyberknife) in the treatment of brain and spinal cord tumors. Neurol Med Chir (Tokyo) 38:780–783. doi:10.2176/nmc.38.780 CrossRefGoogle Scholar
  65. 65.
    Adler JR Jr, Chang SD, Murphy MJ, Doty J, Geis P, Hancock SL (1997) The Cyberknife: a frameless robotic system for radiosurgery. Stereotact Funct Neurosurg 69:124–128. doi:10.1159/000099863 PubMedCrossRefGoogle Scholar
  66. 66.
    Kajiwara K, Saito K, Yoshikawa K, Kato S, Akimura T, Nomura S, Ishihara H, Suzuki M (2005) Image-guided stereotactic radiosurgery with the CyberKnife for pituitary adenomas. Minim Invasive Neurosurg 48:91–96. doi:10.1055/s-2004-830261 PubMedCrossRefGoogle Scholar
  67. 67.
    Kim MS, Lee SI, Sim JH (1999) Gamma Knife radiosurgery for functioning pituitary microadenoma. Stereotact Funct Neurosurg 72(Suppl 1):119–124. doi:10.1159/000056447 PubMedCrossRefGoogle Scholar
  68. 68.
    Giustina A, Barkan A, Casanueva FF, Cavagnini F, Frohman L, Ho K, Veldhuis J, Wass J, Von Werder K, Melmed S (2000) Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab 85:526–529. doi:10.1210/jc.85.2.526 PubMedCrossRefGoogle Scholar
  69. 69.
    Jagannathan JSJ, Pouratien N, Laws ER Jr, Steiner L, Vance ML (2008) Gamma Knife radiosurgery for acromegaly: outcomes after failed transsphenoidal surgery. Neurosurgery 62:1262–1270PubMedCrossRefGoogle Scholar
  70. 70.
    Buchfelder M, Fahlbusch R, Schott W, Honegger J (1991) Long-term follow-up results in hormonally active pituitary adenomas after primary successful transsphenoidal surgery. Acta Neurochir Suppl (Wien) 53:72–76Google Scholar
  71. 71.
    Cozzi R, Barausse M, Asnaghi D, Dallabonzana D, Lodrini S, Attanasio R (2001) Failure of radiotherapy in acromegaly. Eur J Endocrinol 145:717–726. doi:10.1530/eje.0.1450717 PubMedCrossRefGoogle Scholar
  72. 72.
    Freda PU (2003) How effective are current therapies for acromegaly? Growth Horm IGF Res 13(Suppl A):S144–S151PubMedCrossRefGoogle Scholar
  73. 73.
    Fukuoka S, Ito T, Takanashi M, Hojo A, Nakamura H (2001) Gamma knife radiosurgery for growth hormone-secreting pituitary adenomas invading the cavernous sinus. Stereotact Funct Neurosurg 76:213–217. doi:10.1159/000066721 PubMedCrossRefGoogle Scholar
  74. 74.
    Horvath E, Kovacs K, Scheithauer BW, Randall RV, Laws ER Jr, Thorner MO, Tindall GT, Barrow DL (1983) Pituitary adenomas producing growth hormone, prolactin, and one or more glycoprotein hormones: a histologic, immunohistochemical, and ultrastructural study of four surgically removed tumors. Ultrastruct Pathol 5:171–183. doi:10.3109/01913128309141837 PubMedCrossRefGoogle Scholar
  75. 75.
    Jezkova J, Marek J, Hana V, Krsek M, Weiss V, Vladyka V, Lisak R, Vymazal J, Pecen L (2006) Gamma knife radiosurgery for acromegaly – long-term experience. Clin Endocrinol (Oxf) 64:588–595. doi:10.1111/j.1365-2265.2006.02513.x CrossRefGoogle Scholar
  76. 76.
    Arnaldi G, Angeli A, Atkinson AB, Bertagna X, Cavagnini F, Chrousos GP, Fava GA, Findling JW, Gaillard RC, Grossman AB, Kola B, Lacroix A, Mancini T, Mantero F, Newell-Price J, Nieman LK, Sonino N, Vance ML, Giustina A, Boscaro M (2003) Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 88:5593–5602. doi:10.1210/jc.2003-030871 PubMedCrossRefGoogle Scholar
  77. 77.
    Chu JW, Matthias DF, Belanoff J, Schatzberg A, Hoffman AR, Feldman D (2001) Successful long-term treatment of refractory Cushing’s disease with high-dose mifepristone (RU 486). J Clin Endocrinol Metab 86:3568–3573. doi:10.1210/jc.86.8.3568 PubMedCrossRefGoogle Scholar
  78. 78.
    Morange-Ramos I, Regis J, Dufour H, Andrieu JM, Grisoli F, Jaquet P, Peragut JC (1998) Gamma-knife surgery for secreting pituitary adenomas. Acta Neurochir (Wien) 140:437–443. doi:10.1007/s007010050121 CrossRefGoogle Scholar
  79. 79.
    Petrovich Z, Yu C, Giannotta SL, Zee CS, Apuzzo ML (2003) Gamma knife radiosurgery for pituitary adenoma: early results. Neurosurgery 53:51–59 discussion 59–61PubMedCrossRefGoogle Scholar
  80. 80.
    Mahmoud-Ahmed AS, Suh JH (2002) Radiation therapy for Cushing’s disease: a review. Pituitary 5:175–180. doi:10.1023/A:1023365200437 PubMedCrossRefGoogle Scholar
  81. 81.
    Rahn T, Thoren M, Hall K, Backlund EO (1980) Stereotactic radiosurgery in Cushing’s syndrome: acute radiation effects. Surg Neurol 14:85–92PubMedGoogle Scholar
  82. 82.
    Post KD, Habas JE (1990) Comparison of long term results between prolactin secreting adenomas and ACTH secreting adenomas. Can J Neurol Sci 17:74–77PubMedGoogle Scholar
  83. 83.
    Yildiz F, Zorlu F, Erbas T, Atahan L (1999) Radiotherapy in the management of giant pituitary adenomas. Radiother Oncol 52:233–237. doi:10.1016/S0167-8140(99)00098-5 PubMedCrossRefGoogle Scholar
  84. 84.
    Witt TC (2003) Stereotactic radiosurgery for pituitary tumors. Neurosurg Focus 14:e10. doi:10.3171/foc.2003.14.5.11 PubMedCrossRefGoogle Scholar
  85. 85.
    Pan L, Zhang N, Wang EM, Wang BJ, Dai JZ, Cai PW (2000) Gamma knife radiosurgery as a primary treatment for prolactinomas. J Neurosurg 93(Suppl 3):10–13PubMedGoogle Scholar
  86. 86.
    Molitch ME (1992) Pathologic hyperprolactinemia. Endocrinol Metab Clin North Am 21:877–901PubMedGoogle Scholar
  87. 87.
    Nagesser SK, van Seters AP, Kievit J, Hermans J, Krans HM, van de Velde CJ (2000) Long-term results of total adrenalectomy for Cushing’s disease. World J Surg 24:108–113. doi:10.1007/s002689910020 PubMedCrossRefGoogle Scholar
  88. 88.
    Mauermann WJ, Sheehan JP, Chernavvsky DR, Laws ER, Steiner L, Vance ML (2007) Gamma Knife surgery for adrenocorticotropic hormone-producing pituitary adenomas after bilateral adrenalectomy. J Neurosurg 106:988–993. doi:10.3171/jns.2007.106.6.988 PubMedCrossRefGoogle Scholar
  89. 89.
    Pollock BE, Young WF Jr (2002) Stereotactic radiosurgery for patients with ACTH-producing pituitary adenomas after prior adrenalectomy. Int J Radiat Oncol Biol Phys 54:839–841. doi:10.1016/S0360-3016(02)02975-9 PubMedGoogle Scholar
  90. 90.
    Wolffenbuttel BH, Kitz K, Beuls EM (1998) Beneficial gamma-knife radiosurgery in a patient with Nelson’s syndrome. Clin Neurol Neurosurg 100:60–63. doi:10.1016/S0303-8467(97)00124-8 PubMedCrossRefGoogle Scholar
  91. 91.
    Levy RP, Fabrikant JI, Frankel KA, Phillips MH, Lyman JT, Lawrence JH, Tobias CA (1991) Heavy-charged-particle radiosurgery of the pituitary gland: clinical results of 840 patients. Stereotact Funct Neurosurg 57:22–35. doi:10.1159/000099553 PubMedCrossRefGoogle Scholar
  92. 92.
    Ganz JC (2002) Gamma knife radiosurgery and its possible relationship to malignancy: a review. J Neurosurg 97:644–652PubMedGoogle Scholar
  93. 93.
    Pollock BE, Kondziolka D, Lunsford LD, Flickinger JC (1994) Stereotactic radiosurgery for pituitary adenomas: imaging, visual and endocrine results. Acta Neurochir Suppl (Wien) 62:33–38Google Scholar
  94. 94.
    Jane JA Jr, Vance ML, Woodburn CJ, Laws ER Jr (2003) Stereotactic radiosurgery for hypersecreting pituitary tumors: part of a multimodality approach. Neurosurg Focus 14:e12. doi:10.3171/foc.2003.14.5.13 PubMedCrossRefGoogle Scholar
  95. 95.
    Adler JR Jr, Gibbs IC, Puataweepong P, Chang SD (2006) Visual field preservation after multisession cyberknife radiosurgery for perioptic lesions. Neurosurgery 59:244–254 discussion 244–254PubMedCrossRefGoogle Scholar
  96. 96.
    Pham CJ, Chang SD, Gibbs IC, Jones P, Heilbrun MP, Adler JR Jr (2004) Preliminary visual field preservation after staged CyberKnife radiosurgery for perioptic lesions. Neurosurgery 54:799–810 discussion 810–812PubMedCrossRefGoogle Scholar
  97. 97.
    Shalet SM (1993) Radiation and pituitary dysfunction. N Engl J Med 328:131–133. doi:10.1056/NEJM199301143280211 PubMedCrossRefGoogle Scholar
  98. 98.
    Blacklay A, Grossman A, Ross RJ, Savage MO, Davies PS, Plowman PN, Coy DH, Besser GM (1986) Cranial irradiation for cerebral and nasopharyngeal tumours in children: evidence for the production of a hypothalamic defect in growth hormone release. J Endocrinol 108:25–29PubMedCrossRefGoogle Scholar
  99. 99.
    Piedra MP, Brown PD, Carpenter PC, Link MJ (2004) Resolution of diabetes insipidus following gamma knife surgery for a solitary metastasis to the pituitary stalk. Case report. J Neurosurg 101:1053–1056PubMedCrossRefGoogle Scholar
  100. 100.
    Loeffler JS, Niemierko A, Chapman PH (2003) Second tumors after radiosurgery: tip of the iceberg or a bump in the road? Neurosurgery 52:1436–1440 discussion 1440–1432PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2009

Authors and Affiliations

  • Jay Jagannathan
    • 1
  • Chun-Po Yen
    • 1
  • Nader Pouratian
    • 1
  • Edward R. Laws
    • 2
  • Jason P. Sheehan
    • 1
  1. 1.Department of Neurological SurgeryUniversity of Virginia Health Sciences CenterCharlottesvilleUSA
  2. 2.Department of Neurological SurgeryBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA

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