Stereotactic Radiosurgery for Pituitary Tumors
Stereotactic Radiosurgery for Pituitary Tumors
Pituitary adenomas frequently pose challenging clinical problems. Stereotactic radiosurgery (SRS) is one treatment option in selected patients. The purpose of this report is to identify the advantages and disadvantages of radiosurgery in cases of pituitary tumors to assess better its role in relation to other treatment. Methods for optimizing outcome are described. The author reviews several recent series to determine rates of growth control, endocrine response, and complications. In general, growth control is excellent, complications are very low, and reduction of excessive hormone secretion is fair. Depending on the clinical situation, SRS may be the treatment of choice in selected patients.
Although pituitary adenomas are histologically benign, the unrelated neurological and physiological consequences can be devastating. Compression of the optic apparatus (nerves, chiasm, tracts) may lead to blindness or loss of peripheral vision. Interference with the function of nerves traversing the cavernous sinus can result in diplopia and/or facial paresthesias. Further expansion of the tumor laterally into the temporal lobes or posteriorly into the hypothalamus can lead to significant cognitive problems. Excessive GH production associated with acromegaly can lead to life-threatening cardiovascular and respiratory conditions, diabetes mellitus, and possibly an increased risk of colon cancer. Prolonged hypersecretion of ACTH in Cushing disease can lead to severe problems with hypertension and osteoporosis. In patients with prolactinomas, galactorrhea and infertility may occur.
Successful management of these tumors can be challenging. Treatment options include microresection, medical therapy, fractionated radiotherapy, and SRS. Stereotactic radiosurgery was defined in 1951 by Lars Leksell as the "closed skull destruction of an intracranial target using ionizing radiation." Applied to pituitary adenomas, destruction of the target means prevention of the tumor's growth and normalization of hormone production. Destruction of surrounding neural, endocrine, and vascular structures must not occur. The purpose of this report is to analyze the current status of SRS for pituitary tumors and to examine its utility compared with other treatment modalities.
Pituitary adenomas frequently pose challenging clinical problems. Stereotactic radiosurgery (SRS) is one treatment option in selected patients. The purpose of this report is to identify the advantages and disadvantages of radiosurgery in cases of pituitary tumors to assess better its role in relation to other treatment. Methods for optimizing outcome are described. The author reviews several recent series to determine rates of growth control, endocrine response, and complications. In general, growth control is excellent, complications are very low, and reduction of excessive hormone secretion is fair. Depending on the clinical situation, SRS may be the treatment of choice in selected patients.
Although pituitary adenomas are histologically benign, the unrelated neurological and physiological consequences can be devastating. Compression of the optic apparatus (nerves, chiasm, tracts) may lead to blindness or loss of peripheral vision. Interference with the function of nerves traversing the cavernous sinus can result in diplopia and/or facial paresthesias. Further expansion of the tumor laterally into the temporal lobes or posteriorly into the hypothalamus can lead to significant cognitive problems. Excessive GH production associated with acromegaly can lead to life-threatening cardiovascular and respiratory conditions, diabetes mellitus, and possibly an increased risk of colon cancer. Prolonged hypersecretion of ACTH in Cushing disease can lead to severe problems with hypertension and osteoporosis. In patients with prolactinomas, galactorrhea and infertility may occur.
Successful management of these tumors can be challenging. Treatment options include microresection, medical therapy, fractionated radiotherapy, and SRS. Stereotactic radiosurgery was defined in 1951 by Lars Leksell as the "closed skull destruction of an intracranial target using ionizing radiation." Applied to pituitary adenomas, destruction of the target means prevention of the tumor's growth and normalization of hormone production. Destruction of surrounding neural, endocrine, and vascular structures must not occur. The purpose of this report is to analyze the current status of SRS for pituitary tumors and to examine its utility compared with other treatment modalities.
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