Residual and recurrent functioning pituitary adenomas can be difficult to delineate on postoperative MRI scans, making them difficult targets for stereotactic radio surgery. In such cases radiation delivery to the entire sellar has been utilised as a radio surgical equivalent of a total hypophysectomy. This paper evaluated the outcomes of 64 patients over about 20 years who underwent stereotactic radiosurgery to the whole sellar region. The median endocrine follow-up was 41 months. Sixty-nine per cent of patients with acromegaly, 71% of patients with Cushing’s disease and 50% of patients with a prolactinoma achieved endocrine remission. One patient developed a new visual field deficit, two patients had an oculomotor nerve palsy and one developed an abducens nerve palsy. A new onset hypopituitarism developed in 43.5% of patients. Therefore whole sellar stereotactic radio surgery for image negative or venous sinus invasive adenomas following failed resection, can offer reasonable rates of endocrine remission with hypopituatrism being the most common complication. 

Whole-sellar stereotactic radiosurgery for functioning pituitary adenomas.
Lee CC, Cheng CJ, Yen CP, et al.
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Showkat Mirza

FRCS, Department of Otorhinolaryngology-Head & Neck Surgery, Sheffield Teaching Hospitals, South Yorkshire, UK.

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