PMC4450501_01
(a) Initial gadolinium-enhanced MRI showing irregular-shaped pituitary macroadenoma with multiple cyst formations invading the cavernous sinus, completely encasing the right ICA. (b) Preoperative MRA indicating no abnormal findings (right oblique projection)
SNI-6-279-g001.jpg
PMC4450501_01_SNI-6-279-g001.jpg
F1
Magnetic resonance imaging (MRI) demonstrated a 5.0 x 5.3 cm pituitary tumor projecting toward the suprasellar region with encasement of both ICAs [Figure 1a]. Preoperative magnetic resonance angiography (MRA) indicated that the cavernous segments of both ICAs were normal [Figure 1b].
(a) Dosimetry of the GKS procedure. The marginal dose to the tumor margin was 15 Gy at the 50% isodose curve. (b) Isodose lines on the dosimetry planning showing the dose received by the intracavernous segment of the ICA, retrospectively (red line = 20-22 Gy isodose line, yellow line = 15 Gy isodose line)
SNI-6-279-g002.jpg
PMC4450501_01_SNI-6-279-g002.jpg
F2
The marginal dose to the tumor margin was 15 Gy at the 50% isodose curve [Figure 2a]. The irradiated dose of the cavernous segment of the right ICA was 20-22 Gy, retrospectively [Figure 2b].
Five years postradiosurgical MRI and MRA. (a) Nonenhanced MRI demonstrating a remarkable reduction of the tumor volume. (b) MRA indicating severe stenosis and disappearance at the distal portion of the intracavernous segment of the right ICA (right oblique projection)
SNI-6-279-g003.jpg
PMC4450501_01_SNI-6-279-g003.jpg
F3
Five years after the GKS, the MRA demonstrated severe stenosis of the cavernous segment of the right ICA with a remarkable reduction of the residual pituitary adenoma [Figure 3].
Pretreatment and posttreatment right ICA angiograms. The pretreatment angiogram indicating severe stenosis in the cavernous segment of the ICA (a, arrowhead). A microguidewire was advanced through the stenotic lesion and into the supraclinoid segment of the ICA. Inflation of a contrast-filled gateway PTA balloon (b, arrowhead) within the stenotic cavernous segment of the ICA dilated the vessel lumen, improving flow (c, arrowhead)
SNI-6-279-g004.jpg
PMC4450501_01_SNI-6-279-g004.jpg
F4
Posttreatment angiography showed improvement in vessel diameter [Figure 4].
Angiogram of the right common carotid artery showing slight restenosis of cavernous segment of the ICA (arrowhead) one year after the treatment
SNI-6-279-g005.jpg
PMC4450501_01_SNI-6-279-g005.jpg
F5
Angiography 1 year after the PTA indicated slight restenosis of target lesion [Figure 5]; the patient remained asymptomatic.