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Gamma knife radiosurgery for acromegaly: outcomes after failed transsphenoidal surgery.

AbstractOBJECTIVE:
This study evaluates the safety and efficacy of gamma knife radiosurgery (GKRS) in patients with a growth hormone-secreting adenoma.
METHODS:
A retrospective review of data collected from a prospective database of GKRS patients between January 1988 and September 2006 was performed in patients with acromegaly. Successful endocrine outcome was defined as normalization of the insulin-like growth factor level. Tumor volume was also assessed. At least 18 months of follow-up was available in 95 patients who received radiosurgery during the study period. Mean endocrine follow-up was 57 months (range, 18-168 mo).
RESULTS:
Normal insulin-like growth factor levels were achieved in 50 patients (53%) at an average time of 29.8 months after radiosurgery (median, 23.5 mo). A decrease in tumor volume control was achieved in 83 (92%) of 90 patients. Five patients (6%) had no change in tumor volume, and two patients (2%) had an increase in tumor volume. New endocrine deficiencies developed in 32 patients (34%). Four patients developed new-onset partial visual acuity deficits; three of these patients had received previous conventional fractionated radiation therapy.
CONCLUSION:
GKRS is a complementary treatment for recurrent or residual growth hormone-secreting pituitary adenomas. Although infrequent, tumor growth, new-onset pituitary hormone deficiency, recurrence, and neurological dysfunction require careful clinical, radiological, and endocrinological follow-up.
AuthorsJay Jagannathan, Jason P Sheehan, Nader Pouratian, Edward R Laws Jr, Ladislau Steiner, Mary L Vance
JournalNeurosurgery (Neurosurgery) Vol. 62 Issue 6 Pg. 1262-9; discussion 1269-70 (Jun 2008) ISSN: 1524-4040 [Electronic] United States
PMID18824992 (Publication Type: Journal Article)
Topics
  • Acromegaly (etiology, surgery)
  • Adenoma (pathology, surgery)
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Growth Hormone-Secreting Pituitary Adenoma (pathology, surgery)
  • Humans
  • Male
  • Middle Aged
  • Radiosurgery
  • Reoperation
  • Retrospective Studies
  • Treatment Failure

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