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Postoperative Gamma Knife Radiosurgery for Cavernous Sinus-Invading Growth Hormone-Secreting Pituitary Adenomas

 Eui Hyun Kim  ;  Min Chul Oh  ;  Jong Hee Chang  ;  Ju Hyung Moon  ;  Cheol Ryong Ku  ;  Won-Seok Chang  ;  Eun Jig Lee  ;  Sun Ho Kim 
 WORLD NEUROSURGERY, Vol.110 : e534-e545, 2018 
Journal Title
Issue Date
Adenoma/diagnostic imaging/*radiotherapy/surgery ; Adult ; Cavernous Sinus/diagnostic imaging/*surgery ; Female ; Follow-Up Studies ; Growth Hormone-Secreting Pituitary Adenoma/diagnostic imaging/*radiotherapy/surgery ; Humans ; Kaplan-Meier Estimate ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Postoperative Period ; *Radiosurgery/adverse effects ; Adjuvant/adverse effects Radiotherapy ; Retrospective Studies ; Treatment Outcome ; Young Adult
Acromegaly ; Cavernous sinus ; Gamma knife radiosurgery ; Growth hormone ; Pituitary adenoma
OBJECTIVE: We aimed to determine the long-term effects of Gamma knife radiosurgery (GKS) on remnants in the cavernous sinus (CS) after transsphenoidal surgery (TSS) for acromegaly and to identify its possible adverse effects. METHODS: Thirty patients who had remnant tumors only inside the CS after TSS and who consequently underwent GKS were included. They were followed for a median period of 47 months after GKS with regular hormonal and radiologic examinations. RESULTS: The mean tumor volume and margin dose irradiated by GKS was 3.7 cm(3) and 26.2 Gy, respectively. Radiologic tumor control was identified in all patients, and no tumor regrowth or recurrent tumors were identified. For 14 patients who achieved endocrinologic remission, the median duration from GKS until remission was 35 months. The actuarial rates of remission at 2, 5, and 10 years were 7.1%, 43.6%, and 65.6%, respectively. The degree of decrease in the nadir GH level in the OGTT at 6 months after GKS was a statistically significant predictor of remission. Newly developed hypopituitarism frequently developed in a time-dependent manner. Radiation necrosis developed in 4 patients with relatively large remnant volumes. CONCLUSIONS: GKS is an effective adjuvant treatment option for remnant tumors inside the CS after TSS. Maximal surgical resection, leaving minimal volume of remnants only inside the CS, allows the safe and sufficient delivery of a radiation dose to tumors, thereby increasing the possibility of remission. However, the risk of new hypopituitarism and radiation necrosis should be considered when tumors inside the CS are treated with GKS.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Ku, Cheol Ryong(구철룡) ORCID logo https://orcid.org/0000-0001-8693-9630
Kim, Sun Ho(김선호) ORCID logo https://orcid.org/0000-0003-0970-3848
Kim, Eui Hyun(김의현) ORCID logo https://orcid.org/0000-0002-2523-7122
Moon, Ju Hyung(문주형)
Lee, Eun Jig(이은직) ORCID logo https://orcid.org/0000-0002-9876-8370
Chang, Won Seok(장원석) ORCID logo https://orcid.org/0000-0003-3145-4016
Chang, Jong Hee(장종희)
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