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Updated: May 9, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Gamma knife surgery for patients with volumetric classification of nonfunctioning pituitary adenomas: a systematic
Yong Chen1, Zhi Feng Li, Fei Xiang Zhang
1Department of Neurosurgery, Yueyang Second People's Hospital, Yueyang 414000, China.
Objective:
The aim of this study was to scrutinize the literature to determine the efficacy and safety of gamma knife surgery (GKS) for the treatment of nonfunctioning pituitary adenomas (NFPAs) with volumetric classification.
Methods:
Electronic databases including MedLine, PubMed, and Cochrane Central were searched. The literature related to patients with NFPAs treated with GKS was collected. Eligible studies reported on the rate of tumor control (RTC), the rate of radiosurgery-induced optic neuropathy injury (RRIONI), the rate of radiosurgery-induced endocrinological deficits (RRIED), and other parameters.
Results:
A total of 17 studies met the criteria. based on the tumor volume, nfpas were divided into three groups: the RTC of group I (93 patients) with tumor volumes <2 ml was 99% (95% CI 96-100%), the RRIONI was 1% (95% CI 0-4%), and the RRIED was 1% (95% CI 0-4%). The RTC of group II (301 patients) with volumes from 2 to 4 ml was 96% (95% CI 92-99%), the RRIONI was 0 (95% CI 0-2%), and RRIED was 7% (95% CI 2-14%). The RTC of group III (531 patients) with volumes larger than 4 ml was 91% (95% CI 89-94%), the RRIONI was 2% (95% CI 0-5%), and the RRIED was 22% (95% CI 14-31%). There were significant differences in the RTC and in the RRIED among the three groups (P<0.001), indicating that there were higher RRIED and lower RTC with the increase of tumor volume.
Conclusions:
NFPAs, according to tumor volume classification, need stratification for GKS treatment. GKS is the optimal choice for the treatment of group II NFPAs. Patients with residual tumor volumes of <4 ml will benefit most from GKS treatment.
Insights
Gamma Knife Surgery (GKS) is effective for nonfunctioning pituitary adenomas (NFPAs). Smaller NFPAs (<4 ml) show better tumor control and fewer side effects with GKS treatment.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Endocrinology
Background:
- Nonfunctioning pituitary adenomas (NFPAs) are common intracranial tumors.
- Gamma Knife Surgery (GKS) is a stereotactic radiosurgery technique used for various brain lesions.
- Volumetric classification of NFPAs may influence treatment outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of Gamma Knife Surgery (GKS) for treating nonfunctioning pituitary adenomas (NFPAs).
- To analyze treatment outcomes based on tumor volume classification.
Main Methods:
- Systematic literature review of MedLine, PubMed, and Cochrane Central.
- Inclusion of studies reporting on tumor control, optic neuropathy, and endocrinological deficits.
- Categorization of NFPAs into three volume groups (<2 ml, 2-4 ml, >4 ml).
Main Results:
- Tumor control rates were 99%, 96%, and 91% for groups I, II, and III, respectively.
- Radiosurgery-induced endocrinological deficits (RRIED) were 1%, 7%, and 22% for groups I, II, and III.
- Increased tumor volume correlated with lower tumor control and higher RRIED (P<0.001).
Conclusions:
- Volumetric classification is crucial for stratifying NFPAs for GKS treatment.
- GKS is optimal for NFPAs in the 2-4 ml volume range (Group II).
- Patients with residual NFPAs <4 ml generally benefit most from GKS.
