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Updated: Apr 29, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Whole-sellar stereotactic radiosurgery for functioning pituitary adenomas
Cheng-Chia Lee1, Ching-Jen Chen, Chun-Po Yen
1*Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; ‡Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; §School of Medicine, National Yang-Ming University, Taipei, Taiwan; ‖Department of Radiation Oncology, University of Virginia Health System, Charlottesville, Virginia.
Stereotactic radiosurgery (SRS) to the whole sella can achieve endocrine remission in functioning pituitary adenomas (FPAs) after surgery. Hypopituitarism is the most frequent complication, with higher doses linked to better remission and increased risk.
Area of Science:
- Neurosurgery
- Endocrinology
- Radiation Oncology
Background:
- Functioning pituitary adenomas (FPAs) present challenges in postoperative imaging, complicating stereotactic radiosurgery (SRS) targeting.
- Whole-sellar radiation delivery serves as a radiosurgical alternative to total hypophysectomy for difficult-to-delineate FPAs.
Purpose of the Study:
- To assess the outcomes of patients with functioning pituitary adenomas (FPAs) treated with whole-sellar stereotactic radiosurgery (SRS).
Main Methods:
- Retrospective review of 64 patients with FPA undergoing whole-sellar SRS after surgery for persistent hormonal elevation.
- Inclusion criteria: no visible lesions or tumor infiltration of surrounding structures post-surgery.
- Median SRS volume: 3.2 mL; median margin dose: 25 Gy.
Main Results:
- Endocrine remission rates at median 41-month follow-up: 68.8% for acromegaly, 71.4% for Cushing disease, 50.0% for prolactinoma.
- Actuarial remission rates: 54% (2 years), 78% (4 years), 87% (6 years).
- New-onset hypopituitarism occurred in 43.5% of patients; higher doses correlated with remission and hypopituitarism.
Conclusions:
- Whole-sellar SRS is a viable option for endocrine remission in invasive or imaging-negative FPAs post-failed resection.
- Hypopituitarism is the primary complication following whole-sellar SRS treatment for FPAs.
