Liscák R, Vladyka V, Marek J, Simonová G, Vymazal J
Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic.
Acta Neurochir (Wien). 2007 Oct;149(10):999-1006; discussion 1006. doi: 10.1007/s00701-007-1253-7. Epub 2007 Aug 6.
The goal of nonsecreting pituitary adenoma radiosurgery is to halt tumour growth and to maintain normal performance of the hypophysis and the functionally important structures around the sella. The effectiveness of gamma knife radiosurgery was evaluated.
Over a period of 10 years (1993-2003), 140 patients with nonsecreting pituitary adenoma were treated by Leksell gamma knife at our Centre. Seventy-nine of them were followed up for longer than 3 years. Their age range was 24-73 years, with a median of 54 years. Eighty-five percent of them had previous open surgery. Fifteen patients had adenoma contact with the optic tract. Fourteen patients had a normally functioning hypophysis, 48 patients had complete panhypopituitarism, while the rest retained partial functions of the normal hypophysis. Adenoma volumes ranged between 0.1 and 31.3, the median being 3.45 ccm. The marginal dose ranged between 12 and -35 Gy, with a median of 20 Gy.
The follow-up ranged from 36 to 122 months, with a median of 60 months. No adenoma growth was detected; 89% of treated adenomas decreased in size, with a median volume reduction of 61%. There was no perimeter vision impairment after radiosurgery, while 4 out of 52 patients with abnormal perimeter vision reported improvement. There was no impairment of oculomotor nerve function. Impairment of hypophysis function was observed in 2 patients.
Radiosurgery has a reliable antiproliferative effect on nonsecreting pituitary adenomas. It is a safe treatment with a low risk of morbidity. Short contact between a nonsecreting pituitary adenoma and the optic pathway is not an absolute contraindication for Gamma knife radiosurgery.
无分泌功能垂体腺瘤放射外科手术的目标是阻止肿瘤生长，并维持垂体及鞍区周围功能重要结构的正常功能。评估了伽玛刀放射外科手术的有效性。
在10年期间（1993 - 2003年），我们中心用Leksell伽玛刀治疗了140例无分泌功能垂体腺瘤患者。其中79例随访时间超过3年。他们的年龄范围为24 - 73岁，中位数为54岁。其中85%的患者曾接受过开颅手术。15例患者的腺瘤与视束接触。14例患者垂体功能正常，48例患者完全垂体功能减退，其余患者保留部分垂体正常功能。腺瘤体积在0.1至31.3之间，中位数为3.45立方厘米。边缘剂量在12至35 Gy之间，中位数为20 Gy。
随访时间为36至122个月，中位数为60个月。未检测到腺瘤生长；89%的治疗腺瘤体积缩小，体积中位数减少61%。放射外科手术后未出现周边视野缺损，52例周边视野异常的患者中有4例报告症状改善。动眼神经功能未受损。2例患者出现垂体功能损害。
放射外科手术对无分泌功能垂体腺瘤具有可靠的抗增殖作用。它是一种安全的治疗方法，发病率低。无分泌功能垂体腺瘤与视路的短时间接触不是伽玛刀放射外科手术的绝对禁忌证。
