Gamma Knife robotic microradiosurgery of pituitary adenomas invading the cavernous sinus: treatment concept and results in 89 cases.
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.
Hayashi
Motohiro
M
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. GKRmoto@aol.com
Chernov
Mikhail
M
Tamura
Noriko
N
Nagai
Mariko
M
Yomo
Shoji
S
Ochiai
Taku
T
Amano
Kosaku
K
Izawa
Masahiro
M
Hori
Tomokatsu
T
Muragaki
Yoshihiro
Y
Iseki
Hiroshi
H
Okada
Yoshikazu
Y
Takakura
Kintomo
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002426:Cavernous Sinus / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000145:classification / Q000473:pathology / Q000601:surgery; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000556:secondary* / Q000601:surgery*; D055815:Young Adult
J Neurosurg. 2005 Jan;102 Suppl:25-8
15662775
Stereotact Funct Neurosurg. 2001;76(3-4):213-7
12378100
Int J Radiat Oncol Biol Phys. 1993 Sep 30;27(2):215-21
8407394
Acta Neurochir (Wien). 2000;142(12):1345-51
11214627
J Neurosurg. 2006 Dec;105 Suppl:26-30
18503326
J Neurooncol. 2005 Aug;74(1):71-6
16078111
Stereotact Funct Neurosurg. 2009;87(6):360-7
19752595
Neurosurgery. 2003 Jul;53(1):51-9; discussion 59-61
12823873
J Neurooncol. 2001 Sep;54(2):197-203
11761436
J Neurooncol. 2009 Sep;94(3):313-9
19381447
Neurosurgery. 2004 Jun;54(6):1385-93; discussion 1393-4
15157295
Neurosurgery. 2001 May;48(5):1022-30; discussion 1030-2
11334268
J Neurosurg. 2000 Dec;93 Suppl 3:2-5
11143249
AJR Am J Roentgenol. 1986 Feb;146(2):257-62
3484572
Radiat Oncol Investig. 1998;6(1):26-34
9503487
J Neurosurg. 2006 Dec;105 Suppl:5-11
18503323
Acta Neurochir (Wien). 1988;92(1-4):93-9
3407479
J Neurosurg. 2010 Apr;112(4):750-5
19698042
Stereotact Funct Neurosurg. 1999;72 Suppl 1:132-9
10681701
J Neurooncol. 2009 May;92(3):345-56
19357961
J Neurosurg. 2000 Dec;93 Suppl 3:19-22
11143245
Eur J Endocrinol. 1995 Aug;133(2):156-65
7655639
Stereotact Funct Neurosurg. 2005;83(1):45-51
15860936
J Neurosurg. 2005 Apr;102(4):678-91
15871511
J Neurosurg. 2006 Dec;105 Suppl:12-7
18503324
Neurosurgery. 2003 Feb;52(2):309-16; discussion 316-7
12535358
Pituitary. 2002;5(3):169-73
12812308
J Neurosurg. 2001 Aug;95(2):285-91
11780899
Clin Endocrinol (Oxf). 2006 Apr;64(4):456-62
16584520
J Neurosurg. 2006 Jun;104(6):876-83
16776330
Neurosurgery. 2004 Jul;55(1):168-72; discussion 172-3
15214986
Neuroradiology. 1997 Jun;39(6):394-9
9225316
Stereotact Funct Neurosurg. 1999;72 Suppl 1:111-8
10681698
J Neurosurg. 2002 Dec;97(5 Suppl):415-21
12507067
Neurosurgery. 2007 Aug;61(2):270-80; discussion 280
17762739
Acta Neurochir (Wien). 2006 Aug;148(8):903-8; discussion 908
16761113
J Neurosurg. 2000 Dec;93 Suppl 3:6-9
11143264
Acta Neurochir (Wien). 1998;140(5):437-43
9728242
J Neurosurg. 2008 Jan;108(1):26-36
18173307