Gamma Knife Radiosurgery For Hypersecreting Pituitary Adenomas: Experience In Han Subjects Of Southwestern China

Keywords: pituitary adenoma, acromegaly, gamma knife, Cushing's disease, outcome

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     Pituitary adenomas are very common brain tumors. In recent years, stereotactic radiosurgery has emerged as an important treatment modality in the management of pituitary adenomas in China.
     The goal of this research is to define accurately the efficacy, safety, complications, and role of stereotactic radiosurgery for treatment of pituitary adenomas especially in Han subjects with long term follow-up.
     Between 1999 and 2004 a total of 481 patients with hypersecreting pituitary adenomas treated with the Leksell Gamma Knife (LGK) and with at least 60 months of follow-up data were identified. In 47 of these patients some form of prior treatment such as transsphenoidal resection, or craniotomy and resection had been conducted. The others were deemed ineligible for microsurgery because of body health or private choice, and LGK served as the primary treatment modality.
     Endocrinological, ophthalmological, and neuroradiological responses were evaluated.
     LGK was tolerated well in these patients; acute radioreaction was rare and 195 patients had transient headaches with no clinical significance. 6 patients suffered transient visual impairment and 26 patients came up with transient pituitary endocrine deficiency. Late radioreactions were noted and 2 cases with permanent diabetes insipidus needed replacement therapies. 3 cases developed pituitary apoplexy within 6 months after LGK. Of the 75 patients with adrenocorticotropic hormone-secreting adenomas, 67 (89.3%) showed tumor volume decrease or remain unchanged and 21 (28.0%) experienced normalization of hormone level. Of the 341 patients with prolactinomas, 79 (23.2%) had normalization of hormone level and 306 (89.7%) showed tumor volume decrease or remain unchanged. Of the 62 patients with growth hormone-secreting adenomas, 58 (93.5%) experienced tumor volume decrease or remain unchanged and 23 (37.1%) showed normalization of hormone level. Of the 3 patients with thyrotropic-stimulating hormone-secreting adenomas, 66.7% experienced tumor volume decrease and 100% showed normalization of hormone level.
     This is a retrospective study.
     LGK is safe and effective in treating pituitary adenomas. None of the patients in our study suffered death related with LGK.
     LGK may serve as a primary treatment method in some or as a salvage treatment in the others. However, treatment must be tailored to meet the patient’s symptoms, tumor location, tumor morphometry, and overall health.


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