Stylianos Pikis1, Adomas Bunevicius1, Jason Sheehan2. 1. Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, 22908, USA. 2. Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, 22908, USA. jsheehan@virginia.edu.
Abstract
PURPOSE: To evaluate the incidence of internal carotid artery (ICA) stenosis and cerebrovascular accident in a series of patients treated with stereotactic radiosurgery (SRS) for recurrent or residual pituitary adenoma. METHODS: All patients treated with single fraction SRS in our institution for recurrent or residual non-functioning-, growth hormone- and ACTH-secreting pituitary adenomas were retrospectively identified and reviewed. A comprehensive literature review to identify studies reporting on ICA steno-occlusive disease following SRS for pituitary adenomas and compare the risks of carotid stenosis and ischemic stroke in the SRS treated group to the general population figures. RESULTS: 528 patients [312 women and 216 men; median age at SRS 46 years old (range 12-80 years)] treated with SRS at our institution met study inclusion criteria. Mean clinical and radiologic follow-ups were 68.87 (SD ± 43.29) and 55.99 months (SD ± 38.03), respectively, and there were no clinically evident cerebral ischemic events noted. Asymptomatic, post-SRS, ICA stenosis occurred in two patients. A total of eight patients with ICA steno-occlusive disease following pituitary adenoma radiosurgery have been reported. Two of them suffered from ischemic stroke with however excellent recovery. CONCLUSION: As compared to the general population, SRS for pituitary adenomas does not seem to confer appreciable increased risk for ICA steno-occlusive disease and ischemic stroke. However, post-SRS radiation vessel injuries do occur and physicians should be aware about this rare event. Prompt identification and management according to current guidelines are essential to prevent ischemic strokes.
PURPOSE: To evaluate the incidence of internal carotid artery (ICA) stenosis and cerebrovascular accident in a series of patients treated with stereotactic radiosurgery (SRS) for recurrent or residual pituitary adenoma. METHODS: All patients treated with single fraction SRS in our institution for recurrent or residual non-functioning-, growth hormone- and ACTH-secreting pituitary adenomas were retrospectively identified and reviewed. A comprehensive literature review to identify studies reporting on ICA steno-occlusive disease following SRS for pituitary adenomas and compare the risks of carotid stenosis and ischemic stroke in the SRS treated group to the general population figures. RESULTS: 528 patients [312 women and 216 men; median age at SRS 46 years old (range 12-80 years)] treated with SRS at our institution met study inclusion criteria. Mean clinical and radiologic follow-ups were 68.87 (SD ± 43.29) and 55.99 months (SD ± 38.03), respectively, and there were no clinically evident cerebral ischemic events noted. Asymptomatic, post-SRS, ICA stenosis occurred in two patients. A total of eight patients with ICA steno-occlusive disease following pituitary adenoma radiosurgery have been reported. Two of them suffered from ischemic stroke with however excellent recovery. CONCLUSION: As compared to the general population, SRS for pituitary adenomas does not seem to confer appreciable increased risk for ICA steno-occlusive disease and ischemic stroke. However, post-SRS radiation vessel injuries do occur and physicians should be aware about this rare event. Prompt identification and management according to current guidelines are essential to prevent ischemic strokes.
Authors: Jason P Sheehan; Robert M Starke; David Mathieu; Byron Young; Penny K Sneed; Veronica L Chiang; John Y K Lee; Hideyuki Kano; Kyung-Jae Park; Ajay Niranjan; Douglas Kondziolka; Gene H Barnett; Stephen Rush; John G Golfinos; L Dade Lunsford Journal: J Neurosurg Date: 2013-04-26 Impact factor: 5.115
Authors: Jason P Sheehan; Ajay Niranjan; Jonas M Sheehan; John A Jane; Edward R Laws; Douglas Kondziolka; John Flickinger; Alex M Landolt; Jay S Loeffler; L Dade Lunsford Journal: J Neurosurg Date: 2005-04 Impact factor: 5.115
Authors: Giorgio Spatola; Laura Frosio; Marco Losa; Antonella Del Vecchio; Martina Piloni; Pietro Mortini Journal: Rep Pract Oncol Radiother Date: 2016-09-28