Evaluation of Gamma Knife Effect on Patients with Pituitary Adenoma

BACKGROUND:
Pituitary adenomas are common benign brain tumors which account for 15% of all primary brain tumors & 25% of benign brain tumors. It's treatment modality includes medical management and surgery either transcranial or trans-sphenoidal. In recent years, gamma knife radiosurgery has emerged as a treatment modality in the management of pituitary adenoma especially for those cases who have residual tumor and/or those who are not candidate for surgery.
PATIENT AND METHODS:
This prospective and retrospective study was conducted on 132 pituitary adenoma patients (54 males and 78 females) with a mean age of 45.6 years. Patients were of four groups, 67 with prolactinoma, 10 with somatotroph adenoma, 22 with Cushing disease (ACTH releasing), and 33 with non-functional adenoma. Before performing the gamma knife treatment, a pre-MRI examination was done to these pituitary adenoma patients, then the post-MRI examination was done after 6 months, 1 year and 1.5 year of gamma knife treatment as well as clinical evaluation by examining the type of secretion and hormonal laboratory investigation with visual field assessment.
RESULTS:
In our study, the most pituitary adenoma group treated with gamma knife was prolactinoma patients (67), with a size of treatment ranging from 2-55 mm, showing 88.05% tumor necrosis; with hormonal level normalization reaching to 82.08%. In the (10) growth hormone releasing adenoma patients, the size of treatment ranged from 5-48 mm, with (90%) tumor necrosis, and (90%) hormonal level normalization. In the (22) ACTH-releasing adenoma patients, the size treated ranged from 3-29 mm, with tumor necrosis of (86.36%), and (81.81%) hormone level normalization, whereas in the (33) non-secretory type of adenoma, the size of treatment ranged from 18-67 mm and the tumor necrosis was 93.93%.
CONCLUSION:
It can be concluded from this study that gamma knife is an effective and safe option to treat pituitary adenomas by it's low incidence of both morbidity and mortality rate; the tumor necrosis is the highest in non-secretory type when the dose was above 18 grey, but the peri-tumoral edema was found in prolactinoma when the dose of irradiation was above 22 grey.

Keywords

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