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Cheng-Chia Lee, Hideyuki Kano, Huai-Che Yang, Zhiyuan Xu, Chun-Po Yen, Wen-Yuh Chung, David Hung-Chi Pan, L. Dade Lunsford and Jason P. Sheehan

volume. Tumor regression was defined as at least a 10% decrease in tumor volume. A tumor size that was ± 10% of its original volume was defined as stable. 27 No change or a reduction in tumor volume was defined as tumor control. Pituitary dysfunction related to radiosurgery was defined as a new or worsened endocrine deficiency after GKRS. Gamma Knife Radiosurgery Technique Patients underwent stereotactic frame placement after the application of a local anesthetic supplemented with conscious sedation as needed. Afterward, all patients underwent thin

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Diogo Cordeiro, Zhiyuan Xu, Chelsea E. Li, Christian Iorio-Morin, David Mathieu, Nathaniel D. Sisterson, Hideyuki Kano, Luca Attuati, Piero Picozzi, Kimball A. Sheehan, Cheng-chia Lee, Roman Liscak, Jana Jezkova, L. Dade Lunsford and Jason Sheehan

. Prescription doses for NS patients were administered similarly to those for patients with other functioning pituitary adenomas (18–25 Gy). However, as this was a retrospective study over nearly 3 decades, the dose and prescription isodose varied. Endocrine and Radiological Follow-Up After GKRS, patients were typically followed at 6-month intervals for the first 2 years and then yearly thereafter. Follow-up included radiographic assessment of the pituitary adenoma and sellar contents using thin-slice, volume acquisition, pre- and postcontrast T1-weighted MRI. All neuroimaging

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Jason P. Sheehan, Shota Tanaka, Michael J. Link, Bruce E. Pollock, Douglas Kondziolka, David Mathieu, Christopher Duma, A. Byron Young, Anthony M. Kaufmann, Heyoung McBride, Peter A. Weisskopf, Zhiyuan Xu, Hideyuki Kano, Huai-che Yang and L. Dade Lunsford

-three patients (39.6%) had initial subtotal surgical removal and therefore had histological confirmation of the tumor. Those without a histological diagnosis were classified as having had a glomus tumor on the basis of clinical presentation and imaging features (for example, location, MRI and/or CT characteristics, and growth behavior). Six patients (4.5%) previously underwent external beam fractionated radiation therapy and had additional tumor progression. The median total dose of prior radiation therapy was 56 Gy (range 18–79 Gy). One patient underwent volume

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Nasser Mohammed, Dale Ding, Yi-Chieh Hung, Zhiyuan Xu, Cheng-Chia Lee, Hideyuki Kano, Roberto Martínez-Álvarez, Nuria Martínez-Moreno, David Mathieu, Mikulas Kosak, Christopher P. Cifarelli, Gennadiy A. Katsevman, L. Dade Lunsford, Mary Lee Vance and Jason P. Sheehan

SD, whereas nonparametric continuous variables were analyzed using median and range. Categorical variables were reported as frequency and percentage. Patients in the primary SRS cohort were matched using propensity scores, in a 1:2 ratio, to those in the postoperative SRS cohort based on age, sex, SRS margin dose, pre-SRS IGF-1 levels, and baseline tumor volume. The “nearest neighbor” method was used for propensity matching with a caliper of 0.20. 3 , 13 The Mann-Whitney U-test and Student t-test were used to compare continuous variables, as appropriate. The chi

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Mohana Rao Patibandla, Dale Ding, Hideyuki Kano, Zhiyuan Xu, John Y. K. Lee, David Mathieu, Jamie Whitesell, John T. Pierce, Paul P. Huang, Douglas Kondziolka, Caleb Feliciano, Rafael Rodriguez-Mercado, Luis Almodovar, Inga S. Grills, Danilo Silva, Mahmoud Abbassy, Symeon Missios, Gene H. Barnett, L. Dade Lunsford and Jason P. Sheehan

T he Spetzler-Martin (SM) grading system is a 5-tier classification scheme that stratifies brain arteriovenous malformations (AVMs) into low-, intermediate-, and high-grade lesions (Grades I–II, Grade III, and Grades IV–V, respectively). 63 Although the SM grading system was originally devised to predict AVM surgical outcomes, it has also been shown to reliably correlate with outcomes after stereotactic radiosurgery (SRS) for smaller-volume AVMs. 18 , 24 , 25 , 36 , 39 SM Grade IV–V AVMs are difficult to successfully treat with any modality, 28 , 41 , 63 due

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Jason P. Sheehan, Hideyuki Kano, Zhiyuan Xu, Veronica Chiang, David Mathieu, Samuel Chao, Berkcan Akpinar, John Y.K. Lee, James B. Yu, Judith Hess, Hsiu-Mei Wu, Wen-Yuh Chung, John Pierce, Symeon Missios, Douglas Kondziolka, Michelle Alonso-Basanta, Gene H. Barnett and L. Dade Lunsford

/or coronal plane images were obtained after intravenous administration of a contrast agent. Radiosurgery dose planning was then performed by a neurosurgeon in conjunction with a radiation oncologist and medical physicist. All patients were treated with single-session radiosurgery. A typical Gamma Knife dose plan for a patient included in this series is shown in Fig. 1 . The mean volume of the FNSs was 1.8 cm 3 (median 0.79 cm 3 , range 0.04–8.7 cm 3 ). The mean prescription dose delivered to the tumor margin was 12.5 Gy (range 11–15 Gy). The mean prescription isodose

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Amitabh Gupta, Zhiyuan Xu, Hideyuki Kano, Nathaniel Sisterson, Yan-Hua Su, Michal Krsek, Ahmed M. Nabeel, Amr El-Shehaby, Khaled A. Karim, Nuria Martínez-Moreno, David Mathieu, Brendan J. McShane, Roberto Martínez-Álvarez, Wael A. Reda, Roman Liscak, Cheng-Chia Lee, L. Dade Lunsford and Jason P. Sheehan

remission was defined as the duration from date of GKS to normalization of endocrine values for patients with CD (normal UFC and morning serum cortisol levels) and for those with acromegaly (normal GH level < 1 ng/ml in response to a glucose challenge, and a normal serum level of IGF-I when matched for patient age and sex) when off suppressive medications. Hypopituitarism related to radiosurgery was defined as any new hormonal deficit following GKS. On the follow-up neuroimaging studies an adenoma progression was defined as an increase of at least 20% in tumor volume

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Yi-Chieh Hung, Cheng-Chia Lee, Huai-che Yang, Nasser Mohammed, Kathryn N. Kearns, Shi-Bin Sun, David Mathieu, Charles J. Touchette, Ahmet F. Atik, Inga S. Grills, Bryan Squires, Dale Ding, Brian J. Williams, Mehran B. Yusuf, Shiao Y. Woo, Roman Liscak, Jaromir Hanuska, Jay C. Shiao, Douglas Kondziolka, L. Dade Lunsford, Zhiyuan Xu and Jason P. Sheehan

demographics, treatments before SRS, tumor characteristics, and SRS parameters. The patient demographics included age at SRS, sex, and presenting symptoms. Treatments before SRS included the need for CSF shunt surgery, extent of tumor resection (gross-total resection [GTR], subtotal resection [STR], or biopsy), and time interval from tumor surgery to SRS. Tumor characteristics included location and volume. SRS variables included the number of tumors treated, treatment volume, margin dose, maximum dose, and isodose line. Composition of the Study Cohort The inclusion criteria

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I. Jonathan Pomeraniec, Hideyuki Kano, Zhiyuan Xu, Brandon Nguyen, Zaid A. Siddiqui, Danilo Silva, Mayur Sharma, Hesham Radwan, Jonathan A. Cohen, Robert F. Dallapiazza, Christian Iorio-Morin, Amparo Wolf, John A. Jane Jr., Inga S. Grills, David Mathieu, Douglas Kondziolka, Cheng-Chia Lee, Chih-Chun Wu, Christopher P. Cifarelli, Tomas Chytka, Gene H. Barnett, L. Dade Lunsford and Jason P. Sheehan

N onfunctioning pituitary adenomas (NFPAs) account for approximately 15%–30% of all pituitary tumors and typically grow slowly before the patient presents with visual deficits, headache, and hypopituitarism from compression of the optic apparatus and normal pituitary gland. 9 , 14 Transsphenoidal surgery and decompression of the optic chiasm is highly effective in providing symptomatic relief and the possibility of a long-term cure, but historic rates of total resection vary substantially. Complete resection can be limited due to adenoma volume and propensity

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Diogo Cordeiro, Zhiyuan Xu, Gautam U. Mehta, Dale Ding, Mary Lee Vance, Hideyuki Kano, Nathaniel Sisterson, Huai-che Yang, Douglas Kondziolka, L. Dade Lunsford, David Mathieu, Gene H. Barnett, Veronica Chiang, John Lee, Penny Sneed, Yan-Hua Su, Cheng-chia Lee, Michal Krsek, Roman Liscak, Ahmed M. Nabeel, Amr El-Shehaby, Khaled Abdel Karim, Wael A. Reda, Nuria Martinez-Moreno, Roberto Martinez-Alvarez, Kevin Blas, Inga Grills, Kuei C. Lee, Mikulas Kosak, Christopher P. Cifarelli, Gennadiy A. Katsevman and Jason P. Sheehan

, 37 Other SRS-related adverse effects, such as radiation-induced optic neuropathy and other cranial deficits, have been described. Radiological control of tumor growth has been reported to exceed 90% in most series of patients treated at high-volume centers, while the endocrine remission (a normal hormone level without medical management) is achieved in 50%–60% of patients with Cushing’s disease (CD) and acromegaly. 12 To date, published studies of SRS-induced hypopituitarism have largely been single-center series with a relatively low statistical power and