Long Term Effect of Gamma Knife Radiosurgery versus Surgical Excision on Pituitary Hormones in Patients with Non-Compressive Non-Functioning Pituitary Macro Adenomas: A Systematic Review

Abstract

Abstract Background Pituitary adenomas (PAs) are the second most common brain tumors comprise around 10%– 25% of all intracranial tumors of all primary brain tumors. Their clinical classification is defined on the basis of hormonal level into; Non-Functioning adenomas (68.8%) and Functioning ones (31.2%). Aim of the Work Aim of the work is to compare the surgical approach vs gamma knife radiosurgery for treatment of non-functioning pituitary macro adenomas in all age groups. We highlight the feasibility of each treatment modality and evaluate its advantages and limitations regarding hormonal outcomes. Patients and Methods We searched PubMed, Google scholar search engine, Cochrane database of systematic reviews, EMBASE and science Direct, using the following keywords “Pituitary adenoma/tumor, endoscopy or endoscopic, non-functioning pituitary adenoma, skull base surgery, gamma knife, stereotactic radiosurgery, hormonal effect ”. The mentioned databases were searched for studies published during period from 1 January 2000 to 1 September 2023. Results The total number of patients in included studies was 1237 patients. The mean age of patients was 56.55 years (range 54.2 - 59 years). The mean follow up duration of the included studies was 10.94 months (range 6 - 12.7) months. The mean tumor size was 29.03 mm (range 24.8 - 36.3) mm. All the surgical studies patients were treated using endoscopic trans sphenoidal approach. Basic study details and patient characteristics treated with Gamma Knife Radiosurgery (GKR). Again, all the included studies were retrospective in nature. The total number of patients treated in the GKR studies were 243 patients. Across all studies, 51.85% of patients were men, and the median age was 59.75 years (range: 50–69) Conclusion Endoscopic trans sphenoidal surgery and gamma knife radiosurgery are valid options as a treatment of non-functioning pituitary macro adenoma, however endoscopic transsphenoidal surgery offer better hormonal outcomes and less adverse effects when compared to gamma knife radiosurgery.