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

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Abstract

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.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Virginia Health Sciences Center, Box 800212, Charlottesville, VA, 22908, USA

    Jay Jagannathan, Chun-Po Yen, Nader Pouratian & Jason P. Sheehan

  2. Department of Neurological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Edward R. Laws

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  2. Chun-Po Yen
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  3. Nader Pouratian
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  4. Edward R. Laws
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  5. Jason P. Sheehan
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Correspondence to Jay Jagannathan.

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Jagannathan, J., Yen, CP., Pouratian, N. et al. Stereotactic radiosurgery for pituitary adenomas: a comprehensive review of indications, techniques and long-term results using the Gamma Knife. J Neurooncol 92, 345–356 (2009). https://doi.org/10.1007/s11060-009-9832-5

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  • DOI: https://doi.org/10.1007/s11060-009-9832-5

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