title: Gamma Knife robotic microradiosurgery of pituitary adenomas invading the cavernous sinus: treatment concept and results in 89 cases.
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.
authors.affiliation: Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. GKRmoto@aol.com
authors.forename: Motohiro
authors.initials: M
authors.lastname: Hayashi
authors.forename: Mikhail
authors.initials: M
authors.lastname: Chernov
authors.forename: Noriko
authors.initials: N
authors.lastname: Tamura
authors.forename: Mariko
authors.initials: M
authors.lastname: Nagai
authors.forename: Shoji
authors.initials: S
authors.lastname: Yomo
authors.forename: Taku
authors.initials: T
authors.lastname: Ochiai
authors.forename: Kosaku
authors.initials: K
authors.lastname: Amano
authors.forename: Masahiro
authors.initials: M
authors.lastname: Izawa
authors.forename: Tomokatsu
authors.initials: T
authors.lastname: Hori
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Muragaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iseki
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Okada
authors.forename: Kintomo
authors.initials: K
authors.lastname: Takakura
mesh_terms: 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
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