Abstract
The objective of the present retrospective study was evaluation of results of “robotic microradiosurgery” of pituitary adenomas invading the cavernous sinus. Eighty-nine patients with such tumors underwent management using Leksell Gamma Knife model C with automatic positioning system. There were 77 residual and 12 recurrent neoplasms. The applied radiosurgical treatment plan was based on the use of multiple isocenters, mainly of smaller size, which were positioned compactly within the border of the lesion with resultant improved dose homogeneity, increased average dose within the target, and sharp dose fall outside the treated volume. The marginal dose varied from 12 to 25 Gy (mean, 18.2 Gy) in non-functional pituitary adenomas (43 cases), and from 12 to 35 Gy (mean, 25.2 Gy) in hormone-secreting ones (46 cases). The length of follow-up after treatment ranged from 24 to 76 months (mean, 36 months). Control of the tumor growth was attained in 86 cases (97%), whereas actual shrinkage of the lesion was marked in 57 cases (64%). In 18 out of 46 secreting neoplasms (39%), normalization of the excess of the pituitary hormone production was noted after radiosurgery. Treatment-associated morbidity was limited to transitory cranial nerve palsy in two patients (2%). No patient with either non-functional or hormone secreting tumor exhibited new pituitary hormone deficit after treatment. In conclusion, highly precise microanatomy-based Gamma Knife robotic microradiosurgery provides an opportunity for effective management of pituitary adenomas invading the cavernous sinus with preservation of the adjacent functionally important neuronal structures.
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Thoren M, Hoybye C, Grenback E, Degerblad M, Rahn T, Hulting AL (2001) The role of Gamma Knife radiosurgery in the management of pituitary adenomas. J Neurooncol 54:197–203
Sheehan JP, Niranjan A, Sheehan JM, Jane JA Jr, Laws ER, Kondziolka D, Flickinger J, Landolt AM, Loeffler JS, Lunsford LD (2005) Stereotactic radiosurgery for pituitary adenomas: an intermediate review of its safety, efficacy, and role in the neurosurgical treatment armamentarium. J Neurosurg 102:678–691
Jagannathan J, Yen CP, Pouratian N, Laws ER, Sheehan JP (2009) Stereotactic radiosurgery for pituitary adenomas: a comprehensive review of indications, techniques and long-term results using the Gamma Knife. J Neurooncol 92:345–356
Feigl GC, Bonelli CM, Berghold A, Mokry M (2002) Effects of Gamma Knife radiosurgery of pituitary adenomas on pituitary function. J Neurosurg 97(Suppl 5):415–421
Vladyka V, Liscak R, Novotny J Jr, Marek J, Jezkova J (2003) Radiation tolerance of functioning pituitary tissue in gamma knife surgery for pituitary adenomas. Neurosurgery 52:309–317
Kuo JS, Yu C, Giannotta SL, Petrovich Z, Apuzzo MLJ (2004) The Leksell Gamma Knife Model U versus Model C: a quantitative comparison of radiosurgical treatment parameters. Neurosurgery 55:168–173
Tlachacova D, Schmitt M, Novotny J Jr, Novotny J, Majali M, Liscak R (2005) A comparison of the Gamma Knife model C and the automatic positioning system with Leksell model B. J Neurosurg 102(Suppl):25–28
Hayashi M, Ochiai T, Nakaya K, Chernov M, Tamura N, Maruyama T, Yomo S, Izawa M, Hori T, Takakura K, Regis J (2006) Current treatment strategy for vestibular schwannoma: image-guided robotic microradiosurgery. J Neurosurg 105(Suppl):5–11
Yomo S, Hayashi M, Chernov M, Tamura N, Izawa M, Okada Y, Hori T, Iseki H (2009) Stereotactic radiosurgery of residual or recurrent craniopharyngioma: new treatment concept using Leksell Gamma Knife model C with automatic positioning system. Stereotact Funct Neurosurg 87:360–367
Hayashi M, Ochiai T, Nakaya K, Chernov M, Tamura N, Yomo S, Izawa M, Hori T, Takakura K, Regis J (2006) Image-guided microradiosurgery for skull base brain tumors: advantages of using gadolinium-enhanced constructive interference in steady state imaging. J Neurosurg 105(Suppl):12–17
Couldwell WT, Rosenow JM, Rovit RL, Benzil DL (2002) Hypophysopexy technique for radiosurgical treatment of cavernous sinus pituitary adenoma. Pituitary 5:169–173
Ahmadi J, North CM, Segall HD, Zee CS, Weiss MH (1986) Cavernous sinus invasion by pituitary adenomas. Am J Roengenol 146:257–262
Fahlbusch R, Buchfelder M (1988) Transsphenoidal surgery of parasellar pituitary adenomas. Acta Neurochir (Wien) 92:93–99
Marro B, Zouaoui A, Sahel M, Crozat N, Gerber S, Sourour N, Sag K, Marsault C (1997) MRI of pituitary adenomas in acromegaly. Neuroradiology 39:394–399
Iuchi T, Saeki N, Osato K, Yamaura A (2000) Proliferation, vascular endothelial growth factor expression and cavernous sinus invasion in growth hormone secreting pituitary adenomas. Acta Neurochir (Wien) 142:1345–1351
Pan LX, Chen ZP, Liu YS, Zhao JH (2005) Magnetic resonance imaging and biological markers in pituitary adenomas with invasion of the cavernous sinus space. J Neurooncol 74:71–76
Matsuno A, Sasaki T, Saito N, Mochizuki T, Fujimaki T, Kirino T, Takakura K (1995) Transcavernous surgery: an effective treatment for pituitary macroadenomas. Eur J Endocrinol 133:156–165
Kitano M, Taneda M, Shimono T, Nakao Y (2008) Extended transsphenoidal approach for surgical management of pituitary adenomas invading the cavernous sinus. J Neurosurg 108:26–36
Delgrange E, Duprez T, Maiter D (2006) Influence of parasellar extension of macroprolactinomas defined by magnetic resonance imaging on their responsiveness to dopamine agonist therapy. Clin Endocrinol (Oxford) 64:456–462
Ikeda H, Jokura H, Yoshimoto T (1998) Gamma Knife radiosurgery for pituitary adenomas: usefulness of combined transsphenoidal and Gamma Knife radiosurgery for adenomas invading the cavernous sinus. Radiat Oncol Investig 6:26–34
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
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):2–5
Chen JC, Giannotta SL, Yu C, Petrovich Z, Levy ML, Apuzzo MLJ (2001) Radiosurgical management of benign cavernous sinus tumors: dose profiles and acute complications. Neurosurgery 48:1022–1032
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
Ikeda H, Jokura H, Yoshimoto T (2001) Transsphenoidal surgery and adjuvant Gamma Knife treatment for growth hormone-secreting pituitary adenoma. J Neurosurg 95:285–291
Petrovich Z, Yu C, Giannotta SL, Zee CS, Apuzzo MLJ (2003) Gamma Knife radiosurgery for pituitary adenoma: early results. Neurosurgery 53:51–61
Kuo JS, Chen JCT, Yu C, Zelman V, Giannotta SL, Petrovich Z, MacPherson D, Apuzzo MLJ (2004) Gamma Knife radiosurgery for benign cavernous sinus tumors: quantitative analysis of treatment outcomes. Neurosurgery 54:1385–1394
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
Kim M, Paeng S, Pyo S, Jeong Y, Lee S, Jung Y (2006) Gamma Knife surgery for invasive pituitary macroadenoma. J Neurosurg 105(Suppl):26–30
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
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
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):19–22
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
Zhang N, Pan L, Wang EM, Dai JZ, Wang BJ, Cai PW (2000) Radiosurgery for growth hormone-producing pituitary adenomas. J Neurosurg 93(Suppl 3):6–9
Schindler K, Christ ER, Mindermann T, Wiesser HG (2006) Transient MR changes and symptomatic epilepsy following Gamma Knife treatment of a residual GH-secreting pituitary adenoma in the cavernous sinus. Acta Neurochir (Wien) 148:903–908
Tishler RB, Loeffler JS, Lunsford LD, Duma C, Alexander E III, Kooy HM, Flickinger JC (1993) Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 27:215–221
Pamir MN, Kilic T, Belirgen M, Abacioglu U, Karabekiroglu N (2007) Pituitary adenomas treated with Gamma Knife radiosurgery: volumetric analysis of 100 cases with minimum 3 year follow-up. Neurosurgery 61:270–280
Blevins LS Jr, Sanai N, Kunwar S, Devin JK (2009) An approach to the management of patients with residual Cushing`s disease. J Neurooncol 94:313–319
Ikeda H, Abe T, Watanabe K (2010) Usefulness of composite methionine-positron emission tomography/3.0-tesal magnetic resonance imaging to detect the localization and extent of early-stage Cushing adenoma. J Neurosurg 112:750–755
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This work was supported by the Program for Promoting the Establishment of Strategic Research Centers, Special Coordination Funds for Promoting Science and Technology, Ministry of Education, Culture, Sports, Science and Technology (Japan).
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Hayashi, M., Chernov, M., Tamura, N. et al. Gamma Knife robotic microradiosurgery of pituitary adenomas invading the cavernous sinus: treatment concept and results in 89 cases. J Neurooncol 98, 185–194 (2010). https://doi.org/10.1007/s11060-010-0172-2
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DOI: https://doi.org/10.1007/s11060-010-0172-2