• Davis G Taylor, Andrew Janssen, Dale Ding, Zhiyuan Xu, Gautam U Mehta, Roman Liscak, Hideyuki Kano, Mikulas Kosak, Nuria Martinez-Moreno, Landon Hobbs, Ching-Jen Chen, Inga S Grills, David Mathieu, L Dade Lunsford, Mary Lee Vance, and Jason P Sheehan.
• Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
• Neurosurgery. 2020 May 1; 86 (5): 656-664.

BackgroundTargeted stereotactic radiosurgery (SRS) with sparing of the residual pituitary is the traditional radiosurgical method for pituitary adenomas. Whole-sella SRS is an alternative choice for radiologically indeterminate or large adenomas, the safety and efficacy of which has yet to be determined.ObjectiveTo determine if whole-sella SRS in acromegaly would have comparable radiographic and biochemical control to targeted SRS. We performed a multicenter, retrospective matched cohort study to compare outcomes between groups.MethodsWe conducted a retrospective review of acromegalic patients who underwent SRS from 1990 to 2016 at 10 centers participating in the International Radiosurgery Research Foundation. Whole-sella and targeted SRS patients were then matched in a 1:1 ratio.ResultsA total of 128 patients were eligible for inclusion. Whole-sella patients had a higher pre-SRS random serum growth hormone, larger treatment volume, and higher maximum point dose to the optic apparatus. The rates of initial/durable endocrine remission, new loss of pituitary function, and new cranial neuropathy were similar between groups. Mortality and new visual deficit were higher in the whole-sella cohort, though not statistically significant.ConclusionThere was no difference in biochemical remission or recurrence between treatment groups. Although not statistically significant, the higher rates of tumor regression and lower rates of mortality and new visual deficit may suggest consideration of targeted SRS over whole-sella SRS in acromegaly treatment. Further research is needed to determine the association between visual deficits and mortality with whole-sella SRS.Copyright © 2019 by the Congress of Neurological Surgeons.

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