To determine the tumor control rates and endocrinological responses after stereotactic radiosurgery for pituitary adenomas, we reviewed our experience in 65 patients (40 men, 25 women) treated in the Gamma Knife during the last 4 years. The mean age was 41.6 years (range 19–69 years). 43 patients had endocrinologically active tumors (20 growth hormone-secreting, 19 prolactin-secreting and 4 ACTH-secreting adenomas). 22 had nonfunctioning adenomas. 39 patients had a macroadenoma and 26 patients had a microadenoma. 33 patients underwent Gamma Knife radiosurgery for recurrent or residual tumors after microsurgery. 50 patients have had follow-up neuroimaging studies and/or hormonal evaluation. The follow-up period was 25.5 months (range 3 to 54 months). The margin of the tumor was incorporated within the 50 to 90% isodose. The mean number of isocenters was 3.8 and the mean marginal dose was 25.4 Gy (range 15 to 36 Gy). 27 out of 40 patients (65.7%) showed decreased tumor volume to less than 50% of the initial volume. In 17 out of 38 patients (44.7%) with endocrinologically active tumors, the hormonal level fell to within the normal range. Two patients had delayed complications: in one case there was pituitary insufficiency and in the other a visual disturbance. Gamma Knife radiosurgery seems to be effective adjuvant therapy for pituitary adenoma in selected cases. More long-term follow-up is required to evaluate the efficacy and side effects further.

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For trigeminal neuralgia patients with advanced age, MVD showed advantages in immediately relieving the pain. However, in overall, GKRS was preferable, despite the delayed pain relief, due to the lower rate of surgical complications that arise owing to the old age.

OBJECTIVE Abnormal lateral spread response (LSR) is a typical finding in facial electromyography (EMG) in patients with hemifacial spasm (HFS). Although intraoperative monitoring of LSR has been widely used during microvascular decompression (MVD), the prognostic value of this monitoring is still debated. The purpose of this study was to determine whether such monitoring exhibits prognostic value for the alleviation of LSR after treatment of HFS. METHODS Between January 2009 and December 2013, a total of 582 patients underwent MVD for HFS with intraoperative EMG monitoring at Kyung Hee University Hospital. The patients were categorized into 1 of 2 groups according to the presence of LSR at the conclusion of surgery (Group A, LSR free; Group B, LSR persisting). Patients were assessed for the presence of HFS 1 day, 6 months, and 1 year after surgery. Various parameters, including age, sex, symptom duration, offending vertebral artery, and offending perforating artery, were evaluated for their influence on surgical and electrophysiological results. RESULTS Overall, HFS was alleviated in 455 (78.2%) patients 1 day after MVD, in 509 (87.5%) patients 6 months after MVD, and in 546 (93.8%) patients 1 year after MVD. Patients in Group B were significantly younger than those in Group A (p = 0.022). Patients with a symptom duration of less than 1 year were significantly more likely to be classified in Group A than were patients whose symptoms had persisted for longer than 10 years (p = 0.023); however, analysis of the entire range of symptom durations did not reveal a significant effect (p = 0.132). A comparison of Groups A and B according to follow-up period revealed that HFS recovery correlated with LSR alleviation over a shorter period, but the same was not true of longer periods; the proportions of spasm-free patients were 80.6% and 71.1% (p = 0.021), 89.4% and 81.9% (p = 0.022), and 93.5% and 94.6% (p = 0.699) 1 day, 6 months, and 1 year after surgery in Groups A and B, respectively. CONCLUSIONS Although intraoperative EMG monitoring during MVD was beneficial for identifying the offending vessel and suggesting the most appropriate surgical end point, loss of LSR did not always correlate with long-term HFS treatment outcome. Because the HFS cure rate improved over time, revision might be considered for persistent LSR when follow-up has been performed for more than 1 year and the spasm remains despite adequate decompression.

Each type of tumor had different characteristics with respect to the induction of hemifacial spasm; therefore, it is suggested that neurosurgeons, who are planning surgeries both for the purposes of relieving hemifacial spasm and removal of cerebellopontine angle tumor, should thoroughly prepare appropriate approaches and specific dissecting strategies according to each causative lesion.