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Neurosurgery. 2008 Jun;62(6):1262-9; discussion 1269-70. doi: 10.1227/01.neu.0000333297.41813.3d.

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

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  • 1Lars Leksell Gamma Knife Center, Department of Neurosurgery, University of Virginia Health Sciences Center, Charlottesville, Virginia, USA.

Abstract

OBJECTIVE:

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.

[PubMed - indexed for MEDLINE]
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