Abstract
Abstract INTRODUCTION Neurosurgeons are, at times, called upon to help manage cancer patients with intractable, progressive pain towards the end of life when the common treatment modalities including high dose narcotics become ineffective. Various neurosurgical interventions, either destructive or neuromodulatory in nature, can offer quality of life enhancement to palliative care. METHODS Gamma Knife radiosurgery was performed focusing on the anterior pituitary gland. RESULTS >7 patients presenting with a variety of metastatic cancer diagnoses in intractable pain were given 200gy of focused cobalt 60 energy to the anterior pituitary with significant improvements in all patients chronic, intractable pain which greatly helped their end of life experience. Patient survival time ranged from 3 months to 2 years. No patient developed pituitary insufficiency. One patient underwent autopsy histologic evaluation of the pituitary gland. No patient developed visual disturbances. CONCLUSION Pituitary ablation for metastatic bony cancer via alcohol injection has been around for years but infrequently thought of as a current treatment. Gamma Knife radiosurgery is a noninvasive method of partial pituitary ablation without signficant side effects.
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