Microsurgical resectability, outcomes, and tumor control in meningiomas occupying the cavernous sinus

OBJECTIVE Cavernous sinus meningiomas (CSMs) represent a cohort of challenging skull base tumors. Proper management requires achieving a balance between optimal resection, restoration of cranial nerve (CN) function, and maintaining or improving quality of life. The objective of this study was to assess the pre-, intra-, and postoperative factors related to clinical and neurological outcomes, morbidity, mortality, and tumor control in patients with CSM. METHODS A retrospective review of a single surgeon's experience with microsurgical removal of CSM in 65 patients between January 1996 and August 2013 was done. Sekhar's classification, modified Kobayashi grading, and the Karnofsky Performance Scale were used to define tumor extension, tumor removal, and clinical outcomes, respectively. RESULTS Preoperative CN dysfunction was evident in 64.6% of patients. CN II deficits were most common. The greatest improvement was seen for CN V deficits, whereas CN II and CN IV deficits showed the smallest degree of recovery. Complete resection was achieved in 41.5% of cases and was not significantly associated with functional CN recovery. Internal carotid artery encasement significantly limited the complete microscopic resection of CSM (p < 0.0001). Overall, 18.5% of patients showed symptomatic recurrence after their initial surgery (mean follow-up 60.8 months [range 3–199 months]). The use of adjuvant stereotactic radiosurgery (SRS) after microsurgery independently decreased the recurrence rate (p = 0.009; OR 0.036; 95% CI 0.003–0.430). CONCLUSIONS Modified Kobayashi tumor resection (Grades I–IIIB) was possible in 41.5% of patients. CN recovery and tumor control were independent of extent of tumor removal. The combination of resection and adjuvant SRS can achieve excellent tumor control. Furthermore, the use of adjuvant SRS independently decreases the recurrence rates of CSM.

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Individualized Cerebral Artery Protection Strategies for the Surgical Treatment of Parasellar Meningiomas Based on Preoperative Imaging

10.21203/rs.3.rs-466385/v1 ◽

2021 ◽

Author(s):

Yang Li ◽

Xingshu Zhang ◽

Chaoying Qin ◽

Jun Su ◽

Xiangyu Wang ◽

...

Keyword(s):

Quality Of Life ◽

Cerebral Artery ◽

Cerebral Arteries ◽

Tumor Resection ◽

Preoperative Imaging ◽

Karnofsky Performance Scale ◽

Simpson Grade ◽

Protection Strategies

Abstract OBJECTIVE Parasellar meningiomas represent a cohort of skull base tumors localize to parasellar region. Those meningiomas tend to compress, encase or even invade cerebral arteries and their perforating branches. Surgical resection of PMs is a challenging operation without damaging perforating arteries. The study aimed to analyze functional outcomes in a series of patients who underwent surgery with individualized cerebral arteries protection strategy based on preoperative imaging. METHODS A retrospective review of a single surgeon’s experience with microsurgical removal of PMs in 163 patients between January 2012 to March 2020. Individualized approaches with bidirectional dissection strategy were used. Cerebral Artery invasion classification, neurological outcomes, MRC Scale Muscle Strength Grading, and Karnofsky Performance Scale were used to assess the tumor vascular invasion, functional outcome, and patient quality-of-life outcomes, respectively. RESULTS Total resection (Simpson Grade I or II) was achieved in 114 (69.9%) patients in our series. Vision improved in 44.7% of patients with consecutive follow-up, was stable in 51.1% and deteriorated in 3.8%. Improvement in cranial nerve IIII, IV, and VI was observed in 41.1%, 36.2%, and 44.8%, respectively. The mean follow-up time was (38.8±27.9) months and KPS at the last follow-up was (89.6±8.5). Recurrence was observed in 8 (13.8%) patients with CSMs while the rate was only 3.8% and 2.8% in ACMs and MSWMs. CONCLUSIONS Preoperative imaging is of great significance in the selection of surgical approach. Maximum tumor resection and cerebral artery protection can be achieved concurrently utilizing bidirectional dissection. Those Individualized cerebral artery protection strategies not only are of great utility to neurosurgeons but also can improve patient’s quality of life.

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Olfactory Groove Meningiomas: Clinical Outcome and Recurrence Rates after Tumor Removal Through the Frontolateral and Bifrontal Approach

Neurosurgery ◽

10.1227/01.neu.0000255453.20602.80 ◽

2007 ◽

Vol 60 (5) ◽

pp. 844-852 ◽

Cited By ~ 92

Author(s):

Makoto Nakamura ◽

Melena Struck ◽

Florian Roser ◽

Peter Vorkapic ◽

Madjid Samii

Keyword(s):

Clinical Outcome ◽

Recurrence Rate ◽

Tumor Resection ◽

Surgical Removal ◽

Tumor Removal ◽

Recurrence Rates ◽

Olfactory Groove ◽

Total Tumor Removal ◽

Frontolateral Approach

Abstract OBJECTIVE Olfactory groove meningiomas account for 8 to 13% of all intracranial meningiomas. Surgical removal is often performed through the bifrontal, unilateral subfrontal (frontolateral), or pterional approach. We report on the clinical outcome and recurrence rate after surgical treatment of olfactory groove meningiomas in our neurosurgical department. METHODS A retrospective study was conducted by analyzing the charts of the patients, including surgical records, discharge letters, histological records, follow-up records, and imaging studies. RESULTS A total of 1800 meningiomas were operated on between 1978 and 2002 in our department. There were 82 patients with olfactory groove meningiomas, including 63 women and 19 men with a mean age of 57.8 years (age range, 33–91 yr). Most patients presented with mental disturbance. Tumors were operated through the bifrontal (n = 46), frontolateral (n = 34), and pterional (n = 2) approaches. Total tumor removal (Simpson Grade 1 or 2) was achieved in most cases (91.2% frontolateral, 93.5% bifrontal). Perioperative mortality was 4.9% (four out of 82 patients, all operated through the bifrontal approach). The overall recurrence rate was 4.9%, with four patients requiring surgery. The mean follow-up period was 63.4 months (range, 4–270 mo). CONCLUSION Olfactory groove meningiomas were removed mainly through two different surgical approaches. Even in large tumors, high rates of total tumor resection could also be achieved with low recurrence rates using the simple and minimally invasive frontolateral approach. In recent years, we have preferred to use the frontolateral approach, which provides quick access to the tumor with less brain exposure while still enabling total tumor removal with a low morbidity rate and no mortality.

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Individualized Cerebral Artery Protection Strategies for the Surgical Treatment of Parasellar Meningiomas on the Basis of Preoperative Imaging

Frontiers in Oncology ◽

10.3389/fonc.2021.771431 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yang Li ◽

XingShu Zhang ◽

Jun Su ◽

Chaoying Qin ◽

Xiangyu Wang ◽

...

Keyword(s):

Quality Of Life ◽

Cerebral Artery ◽

Tumor Resection ◽

Cranial Nerves ◽

Preoperative Imaging ◽

Surgical Approaches ◽

Karnofsky Performance Scale ◽

Protection Strategies

ObjectiveParasellar meningiomas (PMs) represent a cohort of skull base tumors that are localized in the parasellar region. PMs tend to compress, encase, or even invade the cerebral arteries and their perforating branches. The surgical resection of PMs without damaging neurovascular structures is challenging. This study aimed to analyze functional outcomes in a series of patients who underwent surgery with individualized cerebral artery protection strategies based on preoperative imaging.MethodsA retrospective review was performed on a single surgeon’s experience of the microsurgical removal of PMs in 163 patients between January 2012 and March 2020. Individualized approaches with a bidirectional dissection strategy were used. Cerebral artery invasion classification, neurological outcomes, MRC Scale for muscle strength, and Karnofsky performance scale were used to assess tumor vascular invasion, functional outcome, and patient quality-of-life outcomes, respectively.ResultsTotal resection (Simpson grade I or II) was achieved in 114 patients (69.9%) in our study. A total of 44.7% of patients had improved vision at consecutive follow-ups, 51.1% were stable, and 3.8% deteriorated. Improvements in cranial nerves III, IV, and VI were observed in 41.1%, 36.2%, and 44.8% of patients, respectively. The mean follow-up time was (38.8 ± 27.9) months, and the KPS at the last follow-up was 89.6 ± 8.5. Recurrence was observed in eight patients (13.8%) with cavernous sinus meningiomas, and the recurrence rates in anterior clinoid meningiomas and medial sphenoid wing meningiomas were 3.8% and 2.8%, respectively.ConclusionsPreoperative imaging is important in the selection of surgical approaches. Maximum tumor resection and cerebral artery protection can be achieved concurrently by utilizing the bidirectional dissection technique. Individualized cerebral artery protection strategies provide great utility in improving a patient’s quality of life.

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Stereotactic radiosurgery for treating meningiomas eligible for complete resection

Radiation Oncology ◽

10.1186/s13014-021-01748-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Maximilian I. Ruge ◽

Juman Tutunji ◽

Daniel Rueß ◽

Eren Celik ◽

Christian Baues ◽

...

Keyword(s):

Adverse Events ◽

Stereotactic Radiosurgery ◽

Medical Condition ◽

Local Tumor Control ◽

Complete Resection ◽

Neurological Deficits ◽

Tumor Control ◽

Recurrence Rates ◽

Treatment Volume

Abstract Background For meningiomas, complete resection is recommended as first-line treatment while stereotactic radiosurgery (SRS) is established for meningiomas of smaller size considered inoperable. If the patient´s medical condition or preference excludes surgery, SRS remains a treatment option. We evaluated the efficacy and safety of SRS in a cohort comprising these cases. Methods In this retrospective single-centre analysis we included patients receiving single fraction SRS either by modified LINAC or robotic guidance by Cyberknife for potentially resectable intracranial meningiomas. Treatment-related adverse events as well as local and regional control rates were determined from follow-up imaging and estimated by the Kaplan–Meier method. Results We analyzed 188 patients with 218 meningiomas. The median radiological, and clinical follow-up periods were 51.4 (6.2–289.6) and 55.8 (6.2–300.9) months. The median tumor volume was 4.2 ml (0.1–22), and the mean marginal radiation dose was 13.0 ± 3.1 Gy, with reference to the 80.0 ± 11.2% isodose level. Local recurrence was observed in one case (0.5%) after 239 months. The estimated 2-, 5-, 10- and 15-year regional recurrence rates were 1.5%, 3.0%, 6.6% and 6.6%, respectively. Early adverse events (≤ 6 months after SRS) occurred in 11.2% (CTCEA grade 1–2) and resolved during follow-up in 7.4% of patients, while late adverse events were documented in 14.4% (grade 1–2; one case grade 3). Adverse effects (early and late) were associated with the presence of symptoms or neurological deficits prior to SRS (p < 0.03) and correlated with the treatment volume (p < 0.02). Conclusion In this analysis SRS appears to be an effective treatment for patients with meningiomas eligible for complete resection and provides reliable long-term local tumor control with low rates of mild morbidity.

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RADT-19. EFFECTS OF RADIATION DOSE-RATE AND TUMOR CHARACTERISTICS ON LOCAL CONTROL AND TOXICITY AFTER RADIOSURGERY FOR ACOUSTIC NEUROMAS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.772 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii185-ii185

Author(s):

Conrad Josef Villafuerte ◽

Fred Gentili ◽

David Shultz ◽

Alejandro Berlin ◽

Robert Heaton ◽

...

Keyword(s):

Dose Rate ◽

Proportional Hazards Model ◽

Multivariable Analysis ◽

Tumor Resection ◽

Local Failure ◽

Tumor Control ◽

Tumor Diameter ◽

Radiation Dose Rate ◽

Acoustic Neuromas

Abstract INTRODUCTION The effect of stereotactic radiosurgery (SRS) dose-rate on tumor control for acoustic neuroma (AN, or vestibular schwannoma) is unclear. METHODS This was a retrospective study of all patients treated for AN with frame-based cobalt-60 SRS at the Toronto Western Hospital between 2005-2019. Dose rates on the day of SRS were calculated from the calibration dose-rate while accounting for the cobalt-60 half-life of 5.2713 years. Local failure was defined as continued tumor growth >36 months post-SRS, tumor resection for LF, or use of any repeat SRS for LF. Cumulative incidence of LF was reported after accounting for competing risks of death, on a per-lesion basis. Comparisons of actuarial LF were made using Gray’s test. Multivariable analysis of LF was performed using a proportional hazards model. RESULTS A total of 607 patients were treated for 617 acoustic neuromas. Median follow-up was 5.0 years. 158 tumors (26%) were cystic. 71 tumors (12%) had previous resection. Nine patients received 10-11 Gy due to large tumor size; all remaining patients received 12 Gy to approximately the 50% isodose line. Median dose rate was 2.4 Gy/min (range, 1.3-3.7). There was no association between dose rate and LF (≥ 2.4 Gy/min vs. < 2.4 Gy/min, 6.07% vs. 6.12% at 5-year follow-up, p = 0.75). The adjusted local failure-specific hazard ratio (HR) for dose rate (per Gy/min) was 1.2 (95% CI 0.69-2.1, p = 0.52). Patients with previous surgery had higher LF, with a HR of 3.6 (95% CI 1.7-7.8, p = 0.0012), after adjusting for presence of cysts (HR 0.27, p = 0.034) and maximum tumor diameter (HR 1.055 per cm, p = 0.071). CONCLUSIONS In a large cohort of patients with acoustic neuromas, radiosurgery dose-rate was not associated with tumor control. Previous resection was a strong risk factor for local failure after SRS.

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Slowly resorbable biosynthetic mesh: 2-year results in VHWG grade 3 hernia repair

Hernia ◽

10.1007/s10029-021-02453-1 ◽

2021 ◽

Author(s):

M. M. J. Van Rooijen ◽

T. Tollens ◽

L. N. Jørgensen ◽

T. S. de Vries Reilingh ◽

G. Piessen ◽

...

Keyword(s):

Quality Of Life ◽

Hernia Repair ◽

Hernia Recurrence ◽

Recurrence Rates ◽

Elective Repair ◽

Significant Difference ◽

Grade 3

Abstract Introduction Information on the long-term performance of biosynthetic meshes is scarce. This study analyses the performance of biosynthetic mesh (Phasix™) over 24 months. Methods A prospective, international European multi-center trial is described. Adult patients with a Ventral Hernia Working Group (VHWG) grade 3 incisional hernia larger than 10 cm2, scheduled for elective repair, were included. Biosynthetic mesh was placed in sublay position. Short-term outcomes included 3-month surgical site occurrences (SSO), and long-term outcomes comprised hernia recurrence, reoperation, and quality of life assessments until 24 months. Results Eighty-four patients were treated with biosynthetic mesh. Twenty-two patients (26.2%) developed 34 SSOs, of which 32 occurred within 3 months (primary endpoint). Eight patients (11.0%) developed a hernia recurrence. In 13 patients (15.5%), 14 reoperations took place, of which 6 were performed for hernia recurrence (42.9%), 3 for mesh infection (21.4%), and in 7 of which the mesh was explanted (50%). Compared to baseline, quality of life outcomes showed no significant difference after 24 months. Despite theoretical resorption, 10.7% of patients reported presence of mesh sensation in daily life 24 months after surgery. Conclusion After 2 years of follow-up, hernia repair with biosynthetic mesh shows manageable SSO rates and favorable recurrence rates in VHWG grade 3 patients. No statistically significant improvement in quality of life or reduction of pain was observed. Few patients report lasting presence of mesh sensation. Results of biosynthetic mesh after longer periods of follow-up on recurrences and remodeling will provide further valuable information to make clear recommendations. Trial registration Registered on clinicaltrials.gov (NCT02720042), March 25, 2016.

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RADT-30. MULTISESSION RADIOSURGERY ALONE FOR TREATMENT OF PRESUMED MENINGIOMAS: AN INTERIM REPORT FROM A SINGLE INSTITUTION PROTOCOL

Neuro-Oncology ◽

10.1093/neuonc/noab196.188 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi47-vi48

Author(s):

Michael Carrasquilla ◽

Alexander Tai ◽

Matthew Forsthoefel ◽

Edina Wang ◽

Siyuan Lei ◽

...

Keyword(s):

Local Control ◽

Tumor Resection ◽

Symptom Improvement ◽

Tumor Control ◽

Single Institution ◽

Robotic Radiosurgery ◽

Early Results ◽

Alternative Treatment Option

Abstract PURPOSE Meningiomas are the most commonly diagnosed primary intracranial tumor. Resection and single-fraction radiosurgery are treatment options with well-established long-term outcomes data. Multisession radiosurgery is an alternative treatment option with promising early results. However, mature outcomes literature does not yet exist. In this study, we report our institution’s interim results on the efficacy and safety of 5-fraction radiosurgery alone for radiographically diagnosed meningiomas. MATERIALS AND METHODS Between 2005-2015 all patients who completed treatment on a single institution protocol utilizing 5-fraction robotic radiosurgery alone for the treatment of progressing radiographically diagnosed meningiomas were eligible for inclusion. Local control was calculated using the Kaplan-Meier Method. RESULTS Forty-four consecutive predominately female patients (84%) ranging in age from 33-85 (median: 59) were included in the present study. Median tumor volume was 4.05mm3 (range: 0.94-15.4mm3) and the majority of tumors were located at the base of skull (66%). A median dose of 25Gy (range: 25Gy-35Gy), was delivered to a median isodose line of 82%, (range: 70%-90%) over a median of 7 days (range: 5-11 days). Acute toxicity was minimal with 7 patients (15%) requiring a short course of steroids for symptomatic edema during treatment. Of 16 patients who presented with a cranial nerve deficit, symptom improvement was noted in 11 patients (69%). No permanent treatment related toxicity was noted in our cohort. The median radiographic follow-up was 6.9 years (range: 0.5-14.8 years). The 5 and 8-year local control rates were 100% and 95%. The median time to local failure (n=2) in our cohort was 8.2 years. CONCLUSIONS The treatment of radiographically diagnosed meningiomas with 5-fraction robotic radiosurgery provides excellent local control to date, with low rates of acute and late toxicity. However, with late failures noted in our series, continued follow-up is needed to determine the optimal dose required for long-term tumor control.

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Endoscopic endonasal management of non-functioning pituitary adenomas with cavernous sinus invasion: a 10- year experience

Rhinology Journal ◽

10.4193/rhino14.309 ◽

2015 ◽

Vol 53 (4) ◽

pp. 308-316

Author(s):

F. Ferreli ◽

M. Turri-Zanoni ◽

F.R. Canevari ◽

P. Battaglia ◽

M. Bignami ◽

...

Keyword(s):

Cavernous Sinus ◽

Tumor Resection ◽

Mass Effect ◽

Extent Of Resection ◽

Tumor Control ◽

Endoscopic Endonasal ◽

Cavernous Sinus Invasion ◽

Visual Outcomes ◽

Contrast Enhanced ◽

Wait And See

Background: The management of Non-Functioning Pituitary Adenoma (NFPA) invading the cavernous sinus (CS) is currently a balancing act between the surgical decompression of neural structures, radiotherapy and a wait-and-see policy. Methods: We undertook a retrospective review of 56 cases of NFPA with CS invasion treated through an endoscopic endonasal approach (EEA) between 2000 and 2010. The Knosp classification was adopted to describe CS involvement using information from preoperative MRI and intraoperative findings. Extent of resection and surgical outcomes were evaluated on the basis of postoperative contrast-enhanced MRI. Endocrinological improvement and visual outcomes were assessed according to the most recent consensus criteria. Results: EEA was performed using direct para-septal, trans-ethmoidal-sphenoidal or trans-ethmoidal-pterygoidal-sphenoidal approach. Visual outcomes improved in 30 (81%) patients. Normalization or at least improvement of previous hypopituitarism was obtained in 55% of cases. A gross total resection was achieved in 30.3% of cases. The recurrence-free survival was 87.5%, with a mean follow-up of 61 months (range, 36-166 months). No major intraoperative or postoperative complications occurred. Discussion: EEA is a minimally-invasive, safe and effective procedure for the management of NFPA invading the CS. The extent of CS involvement was the main factor limiting the degree of tumor resection. The EEA was able to resolve the mass effect, preserving or restoring visual function, and obtaining adequate long-term tumor control.

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Vulva Cancer Treatment with Cryosurgery

Journal of Gynecological Oncology ◽

10.25107/2689-9396-v4-id1050 ◽

2018 ◽

Vol 4 (1) ◽

pp. 1-10

Author(s):

Mauro JE ◽

Storino C ◽

Bianconi MI ◽

Farah C ◽

D’Atri FJ

Keyword(s):

Quality Of Life ◽

Genital Tract ◽

Vulvar Cancer ◽

Tumor Resection ◽

Safety Margin ◽

Previous Treatment ◽

Complete Healing ◽

High Morbidity

Vulvar cancer represents 4% to 5% of Low Genital Tract Tumors (LGTT) and 1% of all cancers in women. Treatment depends on stage, and when possible surgery is preferable. Advanced cancers require large resections (with needs grafts and-or rotating flaps), radio and/or chemotherapy, all of which can lead to high morbidity and quality of life impairment. To minimize these effects, in 1994, we developed a cryosurgery prospective protocol to manage vulvar cancer in patients with comorbid conditions.Patients and Methods: Between 1994 and 2019 we treated n=41 patients: FIGO stages I: n=2 (4.88%) II: n=9 (21.95%), III: n=28 (68.29%), IV: n=2 (4.88%). Median age 64.3 (28 to 90 years old), and 70% were 70 years old or older, 59% had severe comorbidities (diabetes, autoimmune diseases, immunosuppressive user).Cryosurgery Protocol:Firstly, tumor resection, hemostasis, and 2 rapid freezing- slow thawing cycles with Liquid Nitrogen (LN) spray. The cycles should include the logde and a 1.5 cm safety margin. After complete healing (between 45 and 95 days after cryosurgery), nodes are treated according to FIGO stages. Result:All patients after the effects of the anesthesia were able to urinate spontaneously, walk, had minimal analgesic requirements, with good postoperative. The patients remained in the hospital for one or two days, and with rare exceptions, were discharged the following day with controls twice a week at the hospital. None of the patients required flaps or grafts to repair the treated areas. After complete healing they maintained the vulvar sensitivity and considerably improved their quality of life. Some of them, who had a partner, were able to resume their sexual intercourse.Mean follow-up: 55.39 (3 months to 258 months). Five patients had local recurrences between 12 and 72 months after treatment, and were controlled with a new cryosurgery. Six patients had HPV related lesions located in other areas of the lower genital tract, which were also controlled with cryosurgery. Twenty five of them died 19 due to an unrelated cause of death, and 6 due to disease progression in the nodes without vulvar recurrence, 9 patients survived and were free of disease with a mean follow-up of 53 months. Seven patients, after a disease free follow up of 17.2 months, weren ́t able to be controlled, as they lived more than 400 km way from the hospital. Local control was achieved in all patients.Comments: Cryosurgery can be done after any previous treatment, and can be repeated to control recurrences.Conclusion: Given the simplicity of the technique, its low cost, the possibility of being used in patients with multiple co-morbidities, the absence of major complications, and the anatomical and functional results obtained, we believe that cryosurgery can be considered among the best options to control of vulvar cancer, even large or advanced cases, in elderly patients and-or with severe comorbidities.

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Gamma Knife surgery for invasive pituitary macroadenoma

Journal of Neurosurgery ◽

10.3171/sup.2006.105.7.26 ◽

2006 ◽

Vol 105 (Supplement) ◽

pp. 26-30 ◽

Cited By ~ 10

Author(s):

Mooseong Kim ◽

Sunghwa Paeng ◽

Seyoung Pyo ◽

Yeonggyun Jeong ◽

Sunil Lee ◽

...

Keyword(s):

Gamma Knife ◽

Cavernous Sinus ◽

Pituitary Adenomas ◽

Gamma Knife Surgery ◽

Tumor Control ◽

Pituitary Macroadenoma ◽

Female Ratio ◽

Fractionated Radiotherapy ◽

The Mean

ObjectPituitary adenomas have been treated using a variety of modalities including resection, medication, fractionated radiotherapy, and stereotactic radiosurgery. The policy has been that all adenomas should first be treated with resection to reduce the volume of the tumor. The authors' study was conducted to determine the efficacy of using Gamma Knife surgery (GKS) for pituitary adenomas invading the cavernous sinus.MethodsOf 397 patients with pituitary tumors who underwent GKS between October 1994 and October 2005, 68 patients had pituitary macroadenomas invading the cavernous sinus. Sixty-seven cases were available for follow up. The mean age of the patients in these cases was 42.8 years (range 14–73 years). The male/female ratio was 0.8:1. The mean adenoma volume was 9.3 cm3. A total of 24 patients had undergone craniotomies and resection, and 11 patients had undergone transsphenoidal surgery prior to GKS. The mean follow-up period was 32.8 months. Tumor control was defined as a decrease or no change in tumor volume after GKS. Endocrinological improvement was defined as a decline in hormone levels to below 50% of the pre-GKS level.Tumor control was achieved in 95.5% of the cases. Endocrinological improvement was achieved in 68% of 25 patients. One patient suffered hypopituitarism after GKS.Conclusions Gamma Knife surgery is a safe and effective treatment for invasive pituitary macroadenoma with few complications.

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