Journal of Clinical Case Reports

Two Cases of Late Recurrence after Gamma Knife Surgery for Non- Functioning Pituitary Adenoma Requiring Additional Radical Removal of Expanding Lesion with Endoscopic Trans-Sphenoidal Surgery

Abstract

Fumihiko Nishimura, Young-Su Park, Yasushi Motoyama, Yasuo Hironaka, Ichiro Nakagawa, Hiroshi Yokota, Kentaro Tamura, Ryosuke Matsuda, Yasuhiro Takeshima, Hiroyuki Nakase, Yasushi Nagatomo and Toshihide Tsuzuki

Objective: Gamma knife surgery is an important therapeutic strategy for treatment of a non-functioning pituitary adenoma, as it suppresses tumor growth. However, in rare cases, the lesion may unexpectedly re-grow after gamma knife surgery. This report presents such rare cases of late recurrence of sellar lesions. Case Description: Two cases of non-functioning pituitary adenomas underwent gamma knife surgery. Tumor re-growth occurred following radiation therapy in case 1 at 6 years after gamma knife surgery, while expanding radiation necrosis from the irradiated tumor appeared in case 2 at 8 years after gamma knife surgery. The cases required additional radical removal of the expanding lesion with endoscopic trans-sphenoidal surgery, resulting in successful total removal. Conclusion: A patient with a non-functioning pituitary adenoma should be carefully followed for a long period, even after undergoing gamma knife surgery, to examine for lesion re-growth. In such a case, it is important that the removal operation should be considered immediately to release the compression.