WM, JO, AM-S have made substantial

contributions to patients sample collection. IM has made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data, drafting the manuscript and revising it critically for important intellectual content. He has also given final approval of the version to be published.”
“Background Pituitary adenomas are common lesions and represent 20% of all primary brain tumors[1, 2]. The epidemiological studies BIRB 796 mouse have demonstrated that nearly 20% of the general population harbor pituitary adenomas[3, 4]. Pituitary adenomas are broadly classified into two groups[5]. In the first category are those that secrete excess amounts of normal pituitary hormones and present with a variety of clinical Volasertib purchase syndromes depending on the types of hormones secreted. Meanwhile, some macroadenoma may present with pressure symptoms, often increase in size if untreated, and in some rare cases they may cause symptoms related to mass

effect in which the optic nerves and chiasm are compressed[6, 7]. The second category of pituitary adenomas is nonfunctioning adenomas that do not secrete any known biologically active pituitary hormones. Patients can also suffer hypopituitarism secondary CBL-0137 purchase to compression of the normal functioning pituitary gland[8]. In the treatment of pituitary adenomas the goal is to remove the tumor mass or arrest further growth and when present normalize hormonal hypersecretion. Transsphenoidal surgery is established as one of the most reliable treatment modalities. This modern microsurgical technique can reduce tumor mass to protect surrounding structures from potential compression, and achieve the endocrinological cure of the symptoms caused by hormone secreting tumors. Long term tumor control rates after transsphenoidal excision alone vary from 50 to 80%[9]. However, in some cases, many patients are already in poor physical condition caused by extended production of the excess pituitary hormones, and general anesthesia itself sometimes brings a certain risk for them. Also, they

often show invasion to surrounding structures including cavernous sinus. And for these types of pituitary adenomas, incomplete tumor resection or recurrence as a result of tumor invasion into Cyclooxygenase (COX) surrounding structures is quite common[10]. In recent years, gamma knife radiosurgery(GKRS) has emerged as an important treatment modality in the management of secretory pituitary adenomas with its high efficacy. Radiosurgical treatment may deliver a high dose to the adenomas with high accuracy and may not influence the nearby neural structures to induce neurological defect[11]. Recently, more and more reports have detailed treatment results for secretory pituitary adenomas with GKRS, and there have been a number of reports of GKRS as a primary treatment for secretory pituitary adenomas[12].