FACTORS ASSOCIATED WITH PITUITARY FUNCTION AFTER GAMMA KNIFE RADIOSURGERY (GKS) OF PITUITARY ADENOMAS

2011 ◽  
Vol 98 ◽  
pp. S38
Author(s):  
G. Sicignano ◽  
M. Losa ◽  
G.M. Cattaneo ◽  
A. Del Vecchio ◽  
R. Picozzi ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Gamma Knife Radiosurgery ◽  
Pituitary Function ◽  
Factors Associated

Pituitary Function Following Gamma Knife Radiosurgery for Pituitary Adenomas

2011 ◽  
Vol 81 (2) ◽  
pp. S639-S640
Author(s):  
M.W. Tee ◽  
R. Weil ◽  
J. Valerio-Pascua ◽  
A. Hamrahian ◽  
J.H. Suh ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Gamma Knife Radiosurgery ◽  
Pituitary Function

Dosimetric factors associated with pituitary function after Gamma Knife Surgery (GKS) of pituitary adenomas

2012 ◽  
Vol 104 (1) ◽  
pp. 119-124 ◽  
Author(s):  
Gianluisa Sicignano ◽  
Marco Losa ◽  
Antonella del Vecchio ◽  
Giovanni Mauro Cattaneo ◽  
Piero Picozzi ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Gamma Knife Surgery ◽  
Pituitary Function ◽  
Factors Associated

Radiation dose to neuroanatomical structures of pituitary adenomas and the effect of Gamma Knife radiosurgery on pituitary function

2020 ◽  
Vol 132 (5) ◽  
pp. 1499-1506
Author(s):  
I. Jonathan Pomeraniec ◽  
Davis G. Taylor ◽  
Or Cohen-Inbar ◽  
Zhiyuan Xu ◽  
Mary Lee Vance ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Gamma Knife Radiosurgery ◽  
Endocrine Function ◽  
Pituitary Function ◽  
Pituitary Stalk ◽  
Pituitary Insufficiency ◽  
Normal Gland

OBJECTIVEGamma Knife radiosurgery (GKRS) provides a safe and effective management option for patients with all types of pituitary adenomas. The long-term adverse effects of targeted radiation to the hypothalamic-pituitary axis in relationship to radiation dose remain unclear. In this retrospective review, the authors investigated the role of differential radiation doses in predicting long-term clinical outcomes and pituitary function after GKRS for pituitary adenomas.METHODSA cohort of 236 patients with pituitary tumors (41.5% nonfunctioning, 58.5% functioning adenomas) was treated with GKRS between 1998 and 2015. Point dosimetric measurements, with no minimum volume, to 14 consistent points along the hypothalamus bilaterally, pituitary stalk, and normal pituitary were made. Statistical analyses were performed to determine the impact of doses to critical structures on clinical, radiological, and endocrine outcomes.RESULTSWith a median follow-up duration of 42.9 months, 18.6% of patients developed new loss of pituitary function. The median time to endocrinopathy was 21 months (range 2–157 months). The median dose was 2.1 Gy to the hypothalamus, 9.1 Gy to the pituitary stalk, and 15.3 Gy to the normal pituitary. Increasing age (p = 0.015, HR 0.98) and ratio of maximum dose to the pituitary stalk over the normal pituitary gland (p = 0.013, HR 0.22) were independent predictors of new or worsening hypopituitarism in the multivariate analysis. Sex, margin dose, treatment volume, nonfunctioning adenoma status, or ratio between doses to the pituitary stalk and hypothalamus were not significant predictors.CONCLUSIONSGKRS offers a low rate of delayed pituitary insufficiency for pituitary adenomas. Doses to the hypothalamus are low and generally do not portend endocrine deficits. Patients who are treated with a high dose to the pituitary stalk relative to the normal gland are at higher risk of post-GKRS endocrinopathy. Point dosimetry to specific neuroanatomical structures revealed that a ratio of stalk-to-gland radiation dose of 0.8 or more significantly increased the risk of endocrinopathy following GKRS. Improvement in the gradient index toward the stalk and normal gland may help preserve endocrine function.

Effects of gamma knife radiosurgery of pituitary adenomas on pituitary function

2002 ◽  
Vol 97 ◽  
pp. 415-421 ◽  
Author(s):  
Günther Christian Feigl ◽  
Christine Maria Bonelli ◽  
Andrea Berghold ◽  
Michael Mokry
Keyword(s):  
Pituitary Gland ◽  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Gamma Knife Radiosurgery ◽  
Pituitary Function ◽  
Pituitary Insufficiency ◽  
Content Type ◽  
The Mean ◽  
Fine Print ◽  
Stimulating Hormone

Object. The authors undertook a retrospective analysis of the incidence and time course of pituitary insufficiency following gamma knife radiosurgery (GKS) for pituitary adenomas. Methods. Pituitary adenomas in 92 patients were analyzed. There were 61 hormonally inactive tumors, 18 prolactinomas, and nine somatotropic and four adrenocorticotropic adenomas. The mean tumor volume was 3.8 cm3 (range 0.2–14.6 cm3). The mean prescription dose was 15 Gy. The mean prescription isodose was 50.7%. The mean follow-up time was 4.6 years (range 1.2–10 years). The following new or deteriorating insufficiencies that did not require treatment were recorded for the different pituitary axes: follicle-stimulating hormone (FSH)/luteinizing hormone (LH) 19 (20.6%), thyroid-stimulating hormone (TSH) 32 (34.8%), adenocorticotropic hormone (ACTH) 10 (10.9%), and growth hormone (GH) 26 (28.3%). For new insufficiencies or deterioration requiring replacement therapy, the figures were as follows: FSH/LH 20 (21.7%), TSH 22 (23.9%), ACTH eight (8.7%), and GH 12 (13%). Spot dosimetry was performed in 59 patients in the hypothalamic region, the pituitary gland, and pituitary stalk. The pituitary stalks in patients with deterioration of pituitary function received a statistically higher dosage of radiation, 7.7 ± 3.7 Gy compared with 5.5 ± 3 Gy (p = 0.03). Conclusions. The function of the residual normal pituitary gland is less affected following GKS of pituitary adenomas than after fractionated radiotherapy. Nonetheless, increased attention needs to be exercised to reduce the dose to the stalk and pituitary gland to minimize the incidence of these complications.

Factors related to complete occlusion of arteriovenous malformations after gamma knife radiosurgery

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 96-101 ◽  
Author(s):  
Jong Hee Chang ◽  
Jin Woo Chang ◽  
Yong Gou Park ◽  
Sang Sup Chung
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Maximum Diameter ◽  
Content Type ◽  
Complete Occlusion ◽  
Factors Associated ◽  
Martin Grade ◽  
Fine Print

Object. The authors sought to evaluate the effects of gamma knife radiosurgery (GKS) on cerebral arteriovenous malformations (AVMs) and the factors associated with complete occlusion. Methods. A total of 301 radiosurgical procedures for 277 cerebral AVMs were performed between December 1988 and December 1999. Two hundred seventy-eight lesions in 254 patients who were treated with GKS from May 1992 to December 1999 were analyzed. Several clinical and radiological parameters were evaluated. Conclusions. The total obliteration rate for the cases with an adequate radiological follow up of more than 2 years was 78.9%. In multivariate analysis, maximum diameter, angiographically delineated shape of the AVM nidus, and the number of draining veins significantly influenced the result of radiosurgery. In addition, margin radiation dose, Spetzler—Martin grade, and the flow pattern of the AVM nidus also had some influence on the outcome. In addition to the size, topography, and radiosurgical parameters of AVMs, it would seem to be necessary to consider the angioarchitectural and hemodynamic aspects to select proper candidates for radiosurgery.

Gamma Knife Radiosurgery for Patients With Nonfunctioning Pituitary Adenomas: Results From a 15-Year Experience

2008 ◽  
Vol 70 (5) ◽  
pp. 1325-1329 ◽  
Author(s):  
Bruce E. Pollock ◽  
Joseph Cochran ◽  
Neena Natt ◽  
Paul D. Brown ◽  
Dana Erickson ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Gamma Knife Radiosurgery ◽  
Nonfunctioning Pituitary Adenomas

scholarly journals Pituitary hemorrhage in pituitary adenomas treated with gamma knife radiosurgery: incidence, risk factors and prognosis

2021 ◽  
Vol 12 (5) ◽  
pp. 1365-1372
Author(s):  
Junyi Fu ◽  
Yanli Li ◽  
Lisha Wu ◽  
Xin Yang ◽  
Tingting Quan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Gamma Knife Radiosurgery ◽  
Incidence Risk

Radiation Tolerance of Functioning Pituitary Tissue in Gamma Knife Surgery for Pituitary Adenomas

Neurosurgery ◽  
2003 ◽  
Vol 52 (2) ◽  
pp. 309-317 ◽  
Author(s):  
Vilibald Vladyka ◽  
Roman Liščák ◽  
Josef Novotný ◽  
Josef Marek ◽  
Jana Ježková
Keyword(s):  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Growth Control ◽  
Gamma Knife Surgery ◽  
Pituitary Function ◽  
Radiation Tolerance ◽  
Early Results ◽  
Treatment Dose ◽  
Treatment Plans

Abstract OBJECTIVE This study is intended to contribute to a determination of the sensitivity of preserved hypophyseal function to focal radiation in pituitary adenomas. METHODS We compared two subgroups of patients followed up for a median of 5 years after gamma knife surgery (GKS). Subgroup 1 (n = 30) showed postirradiation hypopituitarism. Subgroup 2 (n = 33) was continually eupituitary. These subgroups were taken from a previously published study relating to a larger group of 163 patients with pituitary adenomas treated by GKS and evaluated after a median follow-up period of 2 years. A relatively high treatment dose was used in this larger group (median, 20 Gy to the tumor margin for growth control in nonfunctioning adenomas; median, 35 Gy for hypersecreting adenomas). Early results approached those of microsurgery, and there were only a few side effects. In the present study, we compared 16 different variables in the same two subgroups to discover the relationships that caused a delayed appearance of postirradiation hypopituitarism. The main pretreatment and treatment parameters were measured on reconstructed treatment plans. This database was used for statistical evaluation. RESULTS The relationship between the mean dose and the volume of functioning hypophysis was stronger in terms of worsening of pituitary function than that of the spot dose to different intrasellar structures. We found that for our group of patients, the safe mean dose of radiation to the hypophysis was 15 Gy for gonadotropic and thyrotropic functions and 18 Gy for adrenocorticotropic function. The worsening of pituitary function was also significantly dependent on the dose to different anatomic levels of the infundibulum, but we did not succeed in fully characterizing this relationship. In addition, we discovered significant levels of dependency of postirradiation pituitary damage to different pretreatment and treatment variables. CONCLUSION Knowledge of the radiation tolerance of functioning pituitary structures subjected to GKS can ensure better preservation of pituitary function after irradiation. This is valid for the group of patients we studied. Our study's findings can be used as a guideline for GKS treatment of new patients with pituitary adenomas, and it can serve for comparison with the experience of other gamma knife centers.

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