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Gamma knife surgery for Cushing's disease
Y Seo1, S Fukuoka, M Takanashi
1Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan.
Surgical Neurology
|February 1, 1995
Summary
Gamma knife surgery offers a viable treatment for recurrent Cushing's disease, particularly when pituitary adenomas are clearly visualized by MRI and distant from critical structures. This radiosurgery approach achieved remission in two patients without adverse effects.
Area of Science:
- Neurosurgery
- Endocrinology
- Radiation Oncology
Background:
- Cushing's disease efficacy of gamma knife surgery is not well established.
- Previous gamma knife treatments for Cushing's disease relied on CT or pneumoencephalography for targeting.
- This study reports on two cases of recurrent pituitary-dependent Cushing's disease managed with gamma knife surgery guided by stereotactic MRI.
Observation:
- Recurrent microadenomas were identified as hypointense lesions on gadolinium-enhanced MRI following two transsphenoidal surgeries.
- Irradiation doses were 35 Gy and 20 Gy to tumor margins.
- Doses to the optic apparatus and cranial nerves were kept below 8 Gy and 21 Gy, respectively.
Findings:
- Both patients achieved clinical remission, evidenced by normalized serum cortisol and adrenocorticotrophic hormone levels.
- A 2-year follow-up revealed no endocrinologic deficiencies or neurological deterioration.
- Successful treatment was achieved using stereotactic MRI for precise tumor localization.
Implications:
- Gamma knife surgery presents a potential alternative therapeutic option for Cushing's disease.
- Effective treatment is feasible for recurrent pituitary adenomas when clearly visualized by MRI and positioned away from the optic apparatus.
- This technique offers a minimally invasive approach for managing complex pituitary tumors.