scholarly journals Transsphenoidal surgery in Cushing disease: The challenging microadenoma (Local experience)

2018 ◽  
Vol 32 (1) ◽  
pp. 116-124
Author(s):  
Wael K. Zakaria ◽  
Ahmed N. Taha
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Imaging Study ◽  
Disease Diagnosis ◽  
Mri Imaging ◽  
Cushing Disease ◽  
Csf Rhinorrhea ◽  
Disease Remission ◽  
Tumor Identification ◽  
Acth Secreting

Abstract Background: Cushing disease is uncommon challenging disease. The adenomas are usually small in size in most case making the disease diagnosis and management is sometimes difficult. In some cases, the tumor cannot be identified on imaging studies and in many cases the adenoma is eccentric in location adding more difficulties to the trans-sphenoid approach for excision of such tricky tumors. Object: to evaluate the challenge of diagnosis and trans-sphenoid surgery for ACTH pituitary microadenomas. Methods: 21 patients with ACTH secreting adenomas were involved in this retrospective study. All cases were operated up on via trans-sphenoid approach during the period from January 2009 till October 2015. All of them were microadenomas. All patients had obvious Cushing manifestations. In all cases magnetic resonance (MR) imaging and CT paranasal sinuses were performed. In this study: cases with macroadenomas and recurrent cases after previous trans-sphenoid approach or gamma knife radiosurgery were excluded. Results: Among the 21 patients; 14 were female and 7 weremale with age ranging from 21 to 44 years. The imaging study was positive for microadenoma in 18 patients while in 3 cases; no tumor was seen on the MRI imaging. All were operated via the trans-sphenoid approach (12 patients via the microscopic technique and other 9 patients via the endoscopic technique). The adenoma was successfully removed in 15 out of the 18 patients with evident adenoma on pre-operative MRI imaging while partial hypophysectomy were done in 5 cases without an evident adenoma on pre-operative MRI study or difficult adenoma identification. In one patient; the procedure was aborted because of sphenoid sinus abnormalities and the tumor was successfully removed via trans-cranial approach. Disease remission was achieved in 17 patients. In 4 patients; complete remission was not achieved and gamma knife radiosurgery was done after surgery. Disease progression occurred in two patients with initial remission and was treated gamma knife radiosurgery. 13 patients had an ACTH deficiency after surgery while other hormonal replacement therapy is needed in only 5 cases. CSF rhinorrhea occurred in 2 patients and was managed with transient lumbar drain without any subsequent morbidities. Transient diabetes insipidus occurred in 6 cases and was treated conservatively. Conclusions: The transsphenoidal approach ACTH secreting pituitary microadenomas is considered safe and effective for achieving disease remission despite the challenge of diagnosis and intra-operative tumor identification.

Delayed CSF Rhinorrhea after Gamma Knife Radiosurgery with or Without Preceding Transsphenoidal Hypophysectomy for Pituitary Pathology

2016 ◽  
Vol 77 (S 01) ◽  
Author(s):  
Avital Perry ◽  
Christopher Graffeo ◽  
William Copeland ◽  
Kathryn Van Abel ◽  
Matthew Carlson ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Csf Rhinorrhea

Gamma knife radiosurgery in the treatment of Cushing disease: long-term results

2002 ◽  
Vol 97 ◽  
pp. 422-428 ◽  
Author(s):  
Tatsuya Kobayashi ◽  
Yoshihisa Kida ◽  
Yoshimasa Mori
Keyword(s):  
Gamma Knife ◽  
Response Rate ◽  
Complete Response Rate ◽  
Gamma Knife Radiosurgery ◽  
Complete Response ◽  
Cushing Disease ◽  
Content Type ◽  
Hormone Levels ◽  
Fine Print

Object. The authors sought to analyze the long-term outcome of patients with Cushing disease who underwent gamma knife radiosurgery (GKS) as either an adjuvant or primary treatment. Methods. Twenty-five patients with Cushing disease were treated by GKS and followed for more than 2.5 years (mean 5.3 years). The overall results showed a complete response rate of 30%, a response rate of 85%, and a tumor control rate of 100%. Tumor size and radiation dose were the most important factors related to the treatment response. The complete response rate for microadenomas and small adenomas was significantly higher than that for macroadenomas. An 83.2% complete response rate was obtained using a maximum dose of more than 55 Gy and/or a margin dose of more than 40 Gy. Serum adrenocorticotropic hormone and cortisol levels were normalized in 35% of patients, decreased significantly in 60%, and decreased in 85%. Fifty-one of 85 characteristic signs and symptoms of Cushing disease improved without any side effects. The overall outcome was excellent in seven cases, good in six, fair in four, and poor in four cases; one patient died. The initial treatment was GKS in four patients, two of whom had a complete response and two of whom had a partial response. Hormone levels returned to normal in the patients in whom there was a complete response. The results in the six patients in whom Nelson syndrome was present were less favorable; the response rate was only 33%, although the control rate was 100%. Hormone levels decreased in two patients. Conclusions. Gamma knife radiosurgery is safe and effective for the treatment of Cushing disease as an adjuvant or initial therapy when selective and accurate dose planning is performed.

Repeated Transsphenoidal Surgery or Gamma Knife Radiosurgery in Recurrent Cushing Disease After Transsphenoidal Surgery

2013 ◽  
Vol 75 (02) ◽  
pp. 091-097 ◽  
Author(s):  
Mohammad Bodaghabadi ◽  
Hooman Riazi ◽  
Shima Aran ◽  
Mazdak Alikhani ◽  
Mahmud Alahverdi ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Transsphenoidal Surgery ◽  
Gamma Knife Radiosurgery ◽  
Cushing Disease

scholarly journals Gamma Knife Radiosurgery for Acromegaly

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
John D. Rolston ◽  
Lewis S. Blevins
Keyword(s):  
Side Effects ◽  
Medical Treatment ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Cranial Nerve ◽  
Remission Rate ◽  
Gamma Knife Radiosurgery ◽  
Substantial Proportion ◽  
Disease Remission ◽  
Cranial Nerve Palsies

Acromegaly is debilitating disease occasionally refractory to surgical and medical treatment. Stereotactic radiosurgery, and in particular Gamma Knife surgery (GKS), has proven to be an effective noninvasive adjunct to traditional treatments, leading to disease remission in a substantial proportion of patients. Such remission holds the promise of eliminating the need for expensive medications, along with side effects, as well as sparing patients the damaging sequelae of uncontrolled acromegaly. Numerous studies of radiosurgical treatments for acromegaly have been carried out. These illustrate an overall remission rate over 40%. Morbidity from radiosurgery is infrequent but can include cranial nerve palsies and hypopituitarism. Overall, stereotactic radiosurgery is a promising therapy for patients with acromegaly and deserves further study to refine its role in the treatment of affected patients.

Gamma knife radiosurgery for craniopharyngiomas: longterm results in the first Swedish patients

2002 ◽  
Vol 97 ◽  
pp. 613-622 ◽  
Author(s):  
Elfar Úlfarsson ◽  
Christer Lindquist ◽  
Maud Roberts ◽  
Tiit Rähn ◽  
Melker Lindquist ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Imaging Study ◽  
Term Treatment ◽  
Stereotactic Techniques ◽  
Content Type ◽  
Long Term Treatment ◽  
Fine Print

Object. The purpose of this study was to assess the long-term treatment efficacy and morbidity of patients who undergo gamma knife radiosurgery (GKS) for craniopharyngioma. Methods. Twenty-one consecutive Swedish patients were evaluated retrospectively: 11 children (≤ 15 years) and 10 adults. The time from diagnosis to the most recent follow-up imaging study was 6.3 to 34.3 years (mean 18.2 years, median 16.8 years). Tumor volumes and morbidity from GKS or other treatments were assessed at the time of the most recent imaging study or at the time of a subsequent new treatment. The observation period ranged from 0.5 to 29 years (mean 7.5 years, median 3.5 years). The prescription dose ranged from less than 3 Gy to 25 Gy. The mean tumor volume was 7.8 cm3 (range 0.4–33 cm3). There were 22 tumors in 21 patients treated with GKS. Five of these tumors were reduced in size, three were unchanged, and 14 increased. Tumor progression correlated with a low dose to the tumor margin. Eleven (85%) of 13 tumors that received a dose of less than 6 Gy to the margin increased in size, whereas only three (33%) of nine tumors that received 6 Gy increased. This difference was statistically significant (p = 0.01). In five of six patients tumors that became smaller after GKS there were no recurrences within a mean follow-up period of 12 years. Nine (82%) of 11 tumors in children ultimately increased after GKS, compared with five (50%) of 10 in adults. In eight patients there was a deterioration of visual function. In all except one this could be related to a volume increase but radiation-induced damage could not be excluded as a factor in any of them. Four patients developed pituitary deficiencies. Conclusions. Gamma knife radiosurgery is effective in controlling growth of craniopharyngiomas with a minimum dose of 6 Gy. The findings also suggest that other stereotactic techniques, such as cyst aspiration and intracystic treatment, are only of value in reducing tumor volume in preparation for safe GKS.

scholarly journals Gamma Knife Radiosurgery for Pituitary Tumors: A Systematic Review and Meta-Analysis

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4998
Author(s):  
Luigi Albano ◽  
Marco Losa ◽  
Lina Raffaella Barzaghi ◽  
Ajay Niranjan ◽  
Zaid Siddiqui ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Meta Analysis ◽  
Gamma Knife Radiosurgery ◽  
Pituitary Tumors ◽  
Progression Free Survival ◽  
Pooled Analysis ◽  
Tumor Control ◽  
Acth Secreting

To describe and evaluate outcomes of Gamma Knife radiosurgery (GK) for the treatment of pituitary tumors over the past twenty years, a systematic review and meta-analysis according to PRISMA statement was performed. Articles counting more than 30 patients were included. A weighted random effects models was used to calculate pooled outcome estimates. From 459 abstract reviews, 52 retrospective studies were included. Among them, 18 reported on non-functioning pituitary adenomas (NFPA), 13 on growth hormone (GH)-secreting adenomas, six on adrenocorticotropic hormone (ACTH)-secreting adenomas, four on prolactin hormone (PRL)-secreting adenomas, and 11 on craniopharyngiomas. Overall tumor control and five-year progression free survival (PFS) estimate after one GK procedure for NFPA was 93% (95% CI 89–97%) and 95% (95% CI 91–99%), respectively. In case of secreting pituitary adenomas, overall remission (cure without need for medication) estimates were 45% (95% CI 35–54%) for GH-secreting adenomas, 64% (95% CI 0.52–0.75%) for ACTH-secreting adenomas and 34% (95% CI: 19–48%) for PRL-secreting adenomas. The pooled analysis for overall tumor control and five-year PFS estimate after GK for craniopharyngioma was 74% (95% CI 67–81%) and 70% (95% CI: 64–76%), respectively. This meta-analysis confirms and quantifies safety and effectiveness of GK for pituitary tumors.

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