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Asymptomatic internal carotid artery occlusion after gamma knife radiosurgery for pituitary adenoma: Report of two cases and review of the literature
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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[[ce:hsp sp="0.25"/]]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.
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[[ce:hsp sp="0.25"/]]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.
Keywords
Pituitary adenoma; Gamma knife radiosurgery; Internal carotid artery occlusion; Growth hormone
About this articleTitle
Asymptomatic internal carotid artery occlusion after gamma knife radiosurgery for pituitary adenoma: Report of two cases and review of the literature
Journal
Reports of Practical Oncology and Radiotherapy
Issue
Pages
555-559
Published online
2016-11-01
DOI
10.1016/j.rpor.2016.09.006
Bibliographic record
Rep Pract Oncol Radiother 2016;21(6):555-559.
Keywords
Pituitary adenoma
Gamma knife radiosurgery
Internal carotid artery occlusion
Growth hormone
Authors
Giorgio Spatola
Laura Frosio
Marco Losa
Antonella del Vecchio
Martina Piloni
Pietro Mortini