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Related Experiment Video

Updated: Aug 12, 2025

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
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Effects of Neuroanatomic Structural Distances on Pituitary Function After Stereotactic Radiosurgery: A Multicenter

Natasha Ironside1, Ching-Jen Chen2, Zhiyuan Xu1

  • 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.

Neurosurgery
|January 26, 2023
PubMed
Summary

Maintaining a distance of at least 3.95 mm between the pituitary stalk and radiation margin preserves anterior pituitary function after stereotactic radiosurgery for pituitary adenomas. For smaller tumors, 2.95 mm is sufficient.

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Area of Science:

  • Neurosurgery
  • Radiation Oncology
  • Endocrinology

Background:

  • Delayed hypopituitarism is a common complication following stereotactic radiosurgery (SRS) for pituitary adenomas.
  • Preserving anterior pituitary function after SRS is crucial for patient outcomes.

Purpose of the Study:

  • To investigate the relationship between the distance of neuroanatomic structures from the radiation target and anterior pituitary function preservation after SRS.
  • To identify predictive factors for anterior pituitary function preservation following SRS for pituitary adenomas.

Main Methods:

  • Retrospective review of the International Radiosurgery Research Foundation database (2002-2021).
  • Analysis of 487 adult patients with pituitary adenomas treated with SRS and >6 months follow-up.
  • Measurement of distances between hypothalamic-pituitary axis structures and SRS target volumes using MRI; multivariable logistic regression and AUROC analyses.

Main Results:

  • A larger distance between the pituitary stalk center and tumor margin isodose was a positive predictor of pituitary function preservation (aOR=1.162, P=.005).
  • Pre-SRS hypopituitarism and larger treatment volumes were near negative predictors.
  • An optimal distance of ≥3.95 mm predicted function preservation, with an AUROC of 0.620. For smaller treatment volumes (<2.34 mL), an optimal distance of ≥2.95 mm yielded an AUROC of 0.719.

Conclusions:

  • A distance of ≥3.95 mm between the pituitary stalk and tumor margin isodose predicts anterior pituitary function preservation after SRS for pituitary adenomas.
  • For smaller treatment volumes (<2.34 mL), a distance of ≥2.95 mm is optimal.
  • These distances may be modifiable during trans-sphenoidal resection to enhance pituitary function preservation.