Gamma-knife surgery for secreting pituitary adenomas

• Published in: Acta neurochirurgica Vol. 140; no. 5; pp. 437 - 443
• Main Authors: Morange-Ramos, I, Regis, J, Dufour, H, Andrieu, J M, Grisoli, F, Jaquet, P, Peragut, J C
• Format: Journal Article
• Language: English
• Published: Austria Springer Nature B.V 01-01-1998
• Subjects: Acromegaly - blood; Acromegaly - surgery; Adenoma - blood; Adenoma - surgery; Adenoma - urine; Adolescent; Adult; Child; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pituitary gland; Pituitary Neoplasms - blood; Pituitary Neoplasms - surgery; Pituitary Neoplasms - urine; Prolactinoma - blood; Prolactinoma - surgery; Radiosurgery - adverse effects; Radiosurgery - standards; Remission Induction; Sphenoid Bone - surgery; Stereotaxic Techniques; Treatment Outcome
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s007010050121

We report our preliminary results concerning 25 patients with secreting pituitary adenomas treated with stereotactic radiosurgery after partial transsphenoidal surgery and followed over a 6-36 month-period. Among the 15 acromegalic patients, a decrease of 65% in mean GH levels was achieved after 6 months and of 77% at 12 months after radiosurgery. Presently, only 3 patients (20%) are considered as in remission (mean GH and IGF1 level into the normal range). A decrease of 46% and 64% was observed at 6 and 12 months after radiosurgery in 4 patients with prolactinomas although no normalization of PRL levels occurred. Presently, 3/4 patients have individual PRL level slightly above the normal range. A normalization of Urinary Free Cortisol (UFC) was noticed in 4/6 (66%) patients with Cushing's disease within 6-12 months. No pituitary deficiency was noticed in this series with the exception of 4/25 patients (16%) who received subtotal or total pituitary irradiation for post-operative remnants of secreting adenomas poorly defined on MRI. One woman, who had undergone previously a conventional irradiation and presenting with a cavernous sinus adenoma reaching the optic nerve, developed an optic neuropathy. A second woman, with a cavernous sinus remnant, presented a cranial nerve palsy (VI) after the irradiation. We can conclude that radiosurgery using the Cobalt-60 Gamma-unit is, at least, as effective as conventional radiotherapy in the control of pituitary hormone hypersecretion from postoperative adenomas remnants with less adverse effects.