{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:01:55Z","timestamp":1790186515229,"version":"4.1.0"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Radiological progression occurs in 50%\u201360% of residual nonfunctioning pituitary adenomas (NFPAs). Stereotactic radiosurgery (SRS) is a safe and effective management option for residual NFPAs, but there is no consensus on its optimal timing. This study aims to define the optimal timing of SRS for residual NFPAs.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This retrospective, multicenter study involved 375 patients with residual NFPAs managed with SRS. The patients were divided into adjuvant (ADJ; treated for stable residual NFPA within 6 months of resection) and progression (PRG) cohorts (treated for residual NFPA progression). Factors associated with tumor progression and clinical deterioration were analyzed.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Following propensity-score matching, each cohort consisted of 130 patients. At last follow-up, tumor control was achieved in 93.1% of patients in the ADJ cohort and in 96.2% of patients in the PRG cohort (HR 1.6, 95% CI 0.55\u20134.9, p = 0.37). Hypopituitarism was associated with a maximum point dose of &gt; 8 Gy to the pituitary stalk (HR 4.5, 95% CI 1.6\u201312.6, p = 0.004). No statistically significant difference was noted in crude new-onset hypopituitarism rates (risk difference [RD] = \u22120.8%, p &gt; 0.99) or visual deficits (RD = \u22122.3%, p = 0.21) between the two cohorts at the last follow-up. The median time from resection to new hypopituitarism was longer in the PRG cohort (58.9 vs 29.7 months, p = 0.01).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>SRS at residual NFPA progression does not appear to alter the probability of tumor control or hormonal\/visual deficits compared with adjuvant SRS. Deferral of radiosurgical management to the time of radiological progression could significantly prolong the time to radiosurgically induced pituitary dysfunction. A lower maximum point dose (&lt; 8 Gy) to the pituitary stalk portended a more favorable chance of preserving pituitary function after SRS.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.10.jns221873","type":"journal-article","created":{"date-parts":[[2022,11,18]],"date-time":"2022-11-18T12:13:43Z","timestamp":1668773623000},"page":"1662-1668","source":"Crossref","is-referenced-by-count":17,"title":["Adjuvant versus on-progression Gamma Knife radiosurgery for residual nonfunctioning pituitary adenomas: a matched-cohort analysis"],"prefix":"10.3171","volume":"138","author":[{"given":"Georgios","family":"Mantziaris","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stylianos","family":"Pikis","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Chytka","sequence":"additional","affiliation":[{"name":"Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Li\u0161\u010d\u00e1k","sequence":"additional","affiliation":[{"name":"Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimball","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darrah","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selcuk","family":"Peker","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yavuz","family":"Samanci","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shray K.","family":"Bindal","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Niranjan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Dade","family":"Lunsford","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupinder","family":"Kaur","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renu","family":"Madan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjul","family":"Tripathi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhiraj J.","family":"Pangal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben A.","family":"Strickland","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Zada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Marie","family":"Langlois","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Universit\u00e9 de Sherbrooke, Centre de recherch\u00e9 du CHUS, Sherbrooke, Qu\u00e9bec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Mathieu","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Universit\u00e9 de Sherbrooke, Centre de recherch\u00e9 du CHUS, Sherbrooke, Qu\u00e9bec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald E.","family":"Warnick","sequence":"additional","affiliation":[{"name":"Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zayda","family":"Minier","sequence":"additional","affiliation":[{"name":"Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herwin","family":"Speckter","sequence":"additional","affiliation":[{"name":"Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyuan","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rithika","family":"Kormath Anand","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason P.","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Clin Endocrinol (Oxf)","first-page":"377","article-title":"Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK)","volume":"72","author":"Fernandez A","year":"2010","unstructured":"Fernandez A, Karavitaki N, Wass JAH. 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