• Eui Hyun Kim, Min Chul Oh, Jong Hee Chang, Ju Hyung Moon, Cheol Ryong Ku, Won-Seok Chang, Eun Jig Lee, and Sun Ho Kim.
• Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea; Pituitary Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
• World Neurosurg. 2018 Feb 1; 110: e534-e545.

ObjectiveWe aimed to determine the long-term effects of Gamma knife radiosurgery (GKS) on remnants in the cavernous sinus (CS) after transsphenoidal surgery (TSS) for acromegaly and to identify its possible adverse effects.MethodsThirty patients who had remnant tumors only inside the CS after TSS and who consequently underwent GKS were included. They were followed for a median period of 47 months after GKS with regular hormonal and radiologic examinations.ResultsThe mean tumor volume and margin dose irradiated by GKS was 3.7 cm3 and 26.2 Gy, respectively. Radiologic tumor control was identified in all patients, and no tumor regrowth or recurrent tumors were identified. For 14 patients who achieved endocrinologic remission, the median duration from GKS until remission was 35 months. The actuarial rates of remission at 2, 5, and 10 years were 7.1%, 43.6%, and 65.6%, respectively. The degree of decrease in the nadir GH level in the OGTT at 6 months after GKS was a statistically significant predictor of remission. Newly developed hypopituitarism frequently developed in a time-dependent manner. Radiation necrosis developed in 4 patients with relatively large remnant volumes.ConclusionsGKS is an effective adjuvant treatment option for remnant tumors inside the CS after TSS. Maximal surgical resection, leaving minimal volume of remnants only inside the CS, allows the safe and sufficient delivery of a radiation dose to tumors, thereby increasing the possibility of remission. However, the risk of new hypopituitarism and radiation necrosis should be considered when tumors inside the CS are treated with GKS.Copyright © 2017 Elsevier Inc. All rights reserved.

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