Gamma-knife radiosurgery for headache relief in a patient with pituitary metastasis

Abstract

Abstract Rationale: Pituitary metastasis is infrequent and has no pathognomonic symptoms. Surgical exploration is usually needed to establish the diagnosis and implement the appropriate therapy. Given that most affected patients are diagnosed in end-stage primary disease, the main aim of treatment for pituitary metastasis is to relieve symptoms. We report a case of pituitary metastasis in which gamma-knife radiosurgery (GRS) relieved headache pain that persisted after surgery for pituitary metastasis. Patient concerns: A 76-year-old man presented with severe headache. Diagnosis: Cranial magnetic resonance imaging demonstrated a pituitary mass invading the internal carotid artery and cavernous sinus. Interventions: All medical therapy for headache treatment failed. The patient underwent surgical resection via endoscopic endonasal transsphenoidal surgery but the tumor could only be partially resected because it adhered to vital structures. Postoperatively, headache persisted despite all attempted medical treatments. We performed GRS with the aim of resolving the severe headache. Outcomes: Ten days after GRS, the patient's headache had completely resolved. Lesson: Surgical decompression may not resolve headache in patients with pituitary metastasis. In such cases, it is important to recognize that GRS may provide rapid relief or resolution, as well as better quality of life, even though survival time may be limited.