title: Gamma knife surgery for Cushing's disease.
abstract: BACKGROUND
  The efficacy of gamma knife surgery on Cushing's disease is not well known to date. In most reported cases of Cushing's disease treated with gamma knife, the area to be irradiated was determined with computed tomography or pneumoencephalography. We report two cases of recurrent pituitary-dependent Cushing's disease treated with gamma knife using stereotactic magnetic resonance imaging (MRI).
  
  
  METHODS
  Recurrent microadenomas were visualized as hypointense areas using gadolinium-enhanced MRI after two transsphenoidal surgeries in both cases. The doses of irradiation given were 35 Gy and 20 Gy to the margin of the tumors, and less than 8 Gy and 21 Gy to the optic apparatus and cranial nerves in the cavernous sinus, respectively.
  
  
  RESULTS
  Both patients had clinical remission with normal serum cortisol and adrenocorticotrophic hormone levels, during 2-year follow-up after radiosurgery, without endocrinologic deficiency or neurologic deterioration.
  
  
  CONCLUSIONS
  Gamma knife surgery can be an alternative therapy for Cushing's disease when pituitary adenomas are apart from the optic apparatus and can be visualized clearly by MRI, even if tumors are recurrent after microsurgery.
authors.affiliation: Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Seo
authors.forename: S
authors.initials: S
authors.lastname: Fukuoka
authors.forename: M
authors.initials: M
authors.lastname: Takanashi
authors.forename: T
authors.initials: T
authors.lastname: Sasaki
authors.forename: K
authors.initials: K
authors.lastname: Suematsu
authors.forename: J
authors.initials: J
authors.lastname: Nakamura
mesh_terms: D000236:Adenoma / Q000150:complications; D000328:Adult; D003480:Cushing Syndrome / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D010911:Pituitary Neoplasms / Q000150:complications; D016634:Radiosurgery / Q000295:instrumentation*