Giorgio Spatola1, Laura Frosio2, Marco Losa3, Antonella Del Vecchio4, Martina Piloni1, Pietro Mortini1. 1. Department of Neurosurgery and Stereotactic Radiosurgery, Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132 Milan, Italy. 2. Department of Endocrinology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy. 3. Department of Neurosurgery and Stereotactic Radiosurgery, Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; Department of Endocrinology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy. 4. Department of Medical Physics, IRCCS Ospedale San Raffaele, 20132 Milan, Italy.
Abstract
BACKGROUND: Gamma knife radiosurgery is an effective and safe treatment modality in the management of pituitary adenomas. Internal carotid occlusion is a rare but possible complication of Gamma Knife Radiosurgery for lesions within the cavernous sinus. AIM: To stress the importance of considering the Internal carotid artery as an organ at risk in cavernous sinus invading adenomas and reduce the dose delivered to this structure whenever possible. CASE DESCRIPTION: We report two cases of asymptomatic occlusion of the intracavernous segment of the internal carotid artery seven years after treatment in acromegalic patients. After trans-sphenoidal surgery, residual tumour was treated with gamma knife radiosurgery. The maximal doses to the affected artery were higher than 40 Gy and the 90% isodose was close to the arterial wall. CONCLUSION: Every effort should be done to minimize the radiation dose to the internal carotid artery. If not possible, "hot spots" exceeding the 90% isodose close to this vessel should be avoided.
BACKGROUND: Gamma knife radiosurgery is an effective and safe treatment modality in the management of pituitary adenomas. Internal carotid occlusion is a rare but possible complication of Gamma Knife Radiosurgery for lesions within the cavernous sinus. AIM: To stress the importance of considering the Internal carotid artery as an organ at risk in cavernous sinus invading adenomas and reduce the dose delivered to this structure whenever possible. CASE DESCRIPTION: We report two cases of asymptomatic occlusion of the intracavernous segment of the internal carotid artery seven years after treatment in acromegalicpatients. After trans-sphenoidal surgery, residual tumour was treated with gamma knife radiosurgery. The maximal doses to the affected artery were higher than 40 Gy and the 90% isodose was close to the arterial wall. CONCLUSION: Every effort should be done to minimize the radiation dose to the internal carotid artery. If not possible, "hot spots" exceeding the 90% isodose close to this vessel should be avoided.
Authors: L D Lunsford; D Kondziolka; J C Flickinger; D J Bissonette; C A Jungreis; A H Maitz; J A Horton; R J Coffey Journal: J Neurosurg Date: 1991-10 Impact factor: 5.115
Authors: M P Marks; R L Delapaz; J I Fabrikant; K A Frankel; M H Phillips; R P Levy; D R Enzmann Journal: Radiology Date: 1988-08 Impact factor: 11.105