In this study we have considered 77 patients with an age group from 22-66 years old who underwent transs-phenoidal surgery for the removal of GH secreting pituitary adenoma, and further treatment with stereotactic radiosurgery with Gamma Knife for the residual adenoma and active acromegaly. To be included in this study both procedures: surgical and radiosurgical had to be performed at the IRCCS San Raffaele in Milan. Moreover patients had to receive clinical and imaging follow up care for at least 6 months after Gamma Knife, All patients underwent a clinical, imaging and hormonal assessment before Gamma Knife treatment. This evaluation was repeated 6 months post radiotherapy. The criteria for follow up care in patients with acromegaly used in our study is serum IGF-1 dose which must be within nomal limits for both age and sex. There were no complications noted on the day of treatment. In about half of the patients treated a slight headache was documented. Three patients complained of a worsening of their headaches already present however, before treatment with Gamma Knife. Visual function after stereotactic radiosurgery had not worsened in any of the patients whose visual function was normal before treatment and resulted unchanged in 6 who had visual camp deficit before treatment. In the same way there was no transitory or permanent damage to ocular motor nerves. The mean levels of GH are reduced progressively during follow up reaching stability 3 years after treatment. Also the mean levels of IGF-1 are progressively reduced during follow up even though slower compared to GH levels. The probability to obtain normalization of IGF-1 was achieved in 33,6% at 3 years (95% confidence interval 21,9-45,3%) and of 58,5% at 5 years (95% confidence interval, 45,1-71,9%). Based on our results our experience suggestes that radiosurgery is the elective treatment method after surgery in selected cases.
|Translated title of the contribution||Combined surgery and radiosurgery treatment by Gamma knife of GH-pituitary adenomas|
|Number of pages||7|
|Publication status||Published - Mar 2007|
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