Analysis of Surgical Results of Pituitary Adenomas

From June, 1989 to December, 1993, 162 patients were diagnosed as a pituitary adenoma and treated by a surgical procedure. These patients were analyzed in terms of preoperative and postoperative hormonal level, grade, stage, size and treatment modalities. The results were as follows:1) The ratio of male versus female was 1:2.1. Female was predominant in twenties and thirties and male in forties. 2) The incidence of prolactinoma was 37.6% and non-functioning adenoma 37.1%, acromegaly 16.0%, Cushing's disease 5.6%. Marked female preponderence was noticed in prolactinoma and Cushing's disease. 3) The incidence of microadenoma in Cushing's disease was higher than the other tumor types. 4) The remission rate of prolactinoma was 54.1% and acromegaly 69.2%, Cushing's disease 66.7% and it was not correlated with tumor type. 5) Preoperative hormonal level was not correlated with grade, stage and size. 6) In prolactinoma, the remission rate was correlated with grade, stage, preoperative prolactin level, but not with size. 7) In acromegaly, the remission rate was correlated with grade, stage, but not with size and preoperative growth hormone level. 8) In Cushing's disease, the remission rate was not correlated with grade, stage, size and preoperative ACTH level. 9) The residual mass was noticed in 44.5% of patients and correlated with grade, stage and size. 10) The treatment modalities were surgery, surgery/bromocriptine, surgery/radiation therapy(including gamma knife surgery), surgery/bromocriptine/radiation therapy. Although surgery had the best treatment result, it had the lower preoperative hormonal level than the other treatment cases.

Stereotactic Gamma Knife Radiosurgery for the Treatment of Angiographically Occult Vascular Malformations(AOVMs)

In recent years, an increasing number of patient with AOVMs have been recognized using MRI. When an AOVM is located in a region associated with an unacceptable surgical risk, stereotactic radiosurgery offers an alternative treatment. We treated 21 patients with AOVM using gamma knife radiosurgery from June, 1990 to December, 1993 at Asan Medical Center. The indications for radiosurgery were as follows:1) Patients who had episodes of hemorrhage from a lesion that had the characteristic images of AOVM in MRI. 2) Patients who had seizures and the focus of these seizures corresponded to the lesions. 3) Patients were excluded if the lesions were located superficially or were accessible to microsurgery. Nine patients presented with hemorrhages and twelve with seizures. The marginal dose was ranged from 10 to 25 Gy at or above the 50% isodose line. Of eight patients followed 12 months or less after radiosurgery, two patients had improved neurologic deficits and one had decreased the seizure frequency with mediciation. Among seven patients followed 12-24 months, MRI showed a reduction of the lesion in one patient and no change in five patients. One patient had perifocal edema. In two patients with seizures, one patient was seizure free without medication and one patient was controlled with medication. In six patients between 24 and 44 months, two patients had smaller lesions and three patients had perifocal edema. Among four patients who had seizures, one patient was seizure free without medication and three had decreased the seizure frequency with medication. Postoperative complications developed two patients, but one patient showed improvement of neurologic deficits after a short period of steroid medication. Stereotactic radiosurgery offers a treatment to a selective patients with intracranial AOVMs.

Cytogenetic analysis of meningiomas

Cytogenetic analysis of 4 cases of meningiomas from 3 male and 1 female patients is reported. One of male patients suffered from neurofibromatosis type 2. Histologically, the meningiomas were meningotheliomatous (1), transitional (2), and psammomatous (1). Chromosomal abnormalities were found in all cases with a karyotype 45,XY,-22, 45,XY,-16, 45,XX,-2, and 45,XY,t (15p;22q), respectively. Monosomy of chromosome 22 was detected only in the patient with neurofibromatosis type 2. These cytogenetic analysis demonstrates that variable clonal karyotype aberrations exist in meningiomas.