Gamma surgery in the treatment of nonsecretory pituitary macroadenoma

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The authors report on a retrospective analysis of the imaging and clinical outcomes following gamma surgery in 100 patients with nonsecretory pituitary macroadenoma.


Between June 1989 and March 2004, 100 consecutive patients with nonsecretory pituitary macroadenoma were treated at the Lars Leksell Center for Gamma Surgery, University of Virginia Health System (Charlottesville, VA). Ninety-two patients had residual or recurrent macroadenoma following one or more surgical procedures. In eight patients, gamma surgery was the primary treatment. Ten patients received conventional fractionated radiotherapy before the gamma surgery. Sixty-nine patients required hormone replacement therapy for one or more deficits before gamma knife treatment. Peripheral doses between 5 and 25 Gy (mean 18.5 Gy) were administered.

Imaging and endocrinological follow-up evaluations were performed in 90 patients; these studies ranged from 6 to 142 months (mean 44.9 months) and 6 to 127 months (mean 47.9 months), respectively. Tumor volume decreased in 59 patients (65.6%), remained unchanged in 24 (26.7%), and increased in seven (7.8%). The minimal effective peripheral dose was 12 Gy; peripheral doses greater than 20 Gy did not seem to provide additional benefit. Of 61 patients with a partially or fully functioning pituitary gland and follow-up data, 12 (19.7%) suffered new hormone deficits following gamma surgery. In patients with endocrinological follow-up data that had been collected over more than 2 years, the rate of new deficits was 25%. No neurological morbidity or death was related to treatment.


Current experience suggests that gamma surgery is an appropriate means of managing recurrent or residual nonsecretory pituitary macroadenoma following microsurgery and a primary treatment in selected patients. To evaluate definite rates of recurrence and new endocrine deficiencies, long-term follow-up studies are needed.

Abbreviations used in this paper:CT = computerized tomography; GKS = gamma knife surgery; LINAC = linear accelerator; MR = magnetic resonance.

Article Information

Address reprint requests to: Ladislau Steiner, M.D., Ph.D., Department of Neurological Surgery, Lars Leksell Center for Gamma Surgery, University of Virginia Health System, 1215 Lee Street, Room G-512, Charlottesville, Virginia 22908. email:

© AANS, except where prohibited by US copyright law.



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    Pie chart showing the imaging outcome in 92 patients with nonsecretory pituitary macroadenoma treated using gamma surgery and followed up for 6 to 142 months.

  • View in gallery

    Sagittal T1-weighted MR images demonstrating residual nonsecretory pituitary macroadenoma treated using gamma surgery following three microsurgical removals in a 34-year-old man. Images were obtained before (upper) and 30 months after (lower) gamma surgery. The patient recovered visual acuity, had resolution of the visual field defect, and returned to his job as a police officer. Reprinted from Operative Neurosurgical Techniques, ed 5, Schmidek H, Roberts D, 2005, with permission from Elsevier.

  • View in gallery

    Graph showing the time from gamma surgery to the development of new pituitary deficits requiring hormone replacement.


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