الفهرس 
HISTORICAL PERSPECTIVEOnly 14 pages are availabe for public view
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Abstract
Pituitary adenomas are one of the most common intracranial lesions. With a reported annual incidence of 20% they constitute 10-20% of all primary brain tumors. Pituitary adenomas are generally classified as either “functioning” or “non-functioning,” with the former (secreting adenomas) representing about 70% of all pituitary tumors. The most frequent functioning pituitary adenomas are prolactinomas, growth hormone hormones secreting adenomas and Cushing’s disease.
The management of functioning pituitary adenomas is sophisticated involving a spectrum of therapeutic options amongst which are: medical therapy, surgical resection, and stereotactic radiosurgery (SRS), or different combinations of these options.
Although surgery is the first line treatment for functioning pituitary adenomas with the exception of prolactinomas, Radiosurgery has been used as an adjuvant therapy since surgery does not always culminate to complete/permanent remission. Over the last decade the indications of radiosurgery have been expanded to engage it as a first line treatment in a selected number of patients not amenable to surgery.
The objectives of our study were to evaluate the effectivenessGamma Knife Radiosurgery (GK SRS) in terms of tumor volume control and biochemical remission and explore their prognostic factors. We further assessed the effect of tumor and biochemical control on vision. Finally, we assessed the morbidity association with GK SRS for functioning pituitary adenomas.
A total of 129 patients with a minimum follow up duration of 24 months were included in our study amongst which were 58 patients with prolactinomas, 16 cases with Cushing’s disease and 55 cases with growth hormone secreting adenomas.
Normalization of hypersecretion was achieved in 78.2% (43 cases) of GH-omas, 81.3% (13 cases) of ACTH-omas and 72.4% (42 patients) with prolactinomas.The median biochemical normalization time was 28months .
Tumor volume control was achieved in all the cases of Cushing’s disease [16 cases] and Prolactinomas (48 patients) and in 54 cases (98.2%) of acromegaly.
Tumor shrinkage was achieved in 83.6% (46 cases) of GH-omas, 62.5% (10 cases) of ACTH-omas and 77.6 % (45 patients) with prolactinomas.The median tumor shrinkage time was 18 months.
“Visual Control” (normal, improved and stable vision) was achieved in 49 (91 %) of the 54 cases with pre-GK visual field affection.
No patient developed new hypopituitarism after GK radiosurgery. There was no case of adverse radiation effect. Ocular nerve palsy causing diplopia was observed in two patients. Two patients had a deterioration of vision. There was no mortality.
Gamma Knife Stereotactic Radiosurgery is an effective and safe treatment option as a complementary therapeutic procedure to classic surgery or as a first line treatment to selected number of patients with functioning pituitary adenomas.