The goal of pituitary adenoma radiosurgery is to halt tumor growth, normalize hormonal hypersecretion if present, maintain normal pituitary function, and preserve important structures around the sella. The radiation dose necessary to stop tumor growth is lower than the dose necessary to achieve normalization of hormonal hypersecretion. The minimum distance required between the irradiated target and the optic pathway should be 2 mm for secreting adenomas, but in cases of nonsecreting adenomas this distance is even lower. The current role of radiosurgery in most cases is as an adjuvant treatment of residual or recurrent adenomas after previous microsurgery.
Key points
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Radiosurgery is mainly used after transsphenoidal surgery for residual or recurrent tumors.
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The minimum distance required between the secreting adenomas and the optic pathway should be 2 mm; in cases of nonsecreting adenomas this distance is even lower.
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An antiproliferative effect is achieved by radiosurgery in more than 90% of patients.
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The rate of biochemical remission of hypersecreting adenomas is comparable with the results of transsphenoidal surgery, but requires a latency of several years.
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A mean dose of less than 15 Gy applied to the hypophysis can avoid the risk of hypopituitarism after radiosurgery in 97% of patients.

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