{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T13:17:33Z","timestamp":1782739053481,"version":"3.54.5"},"reference-count":39,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,5,3]],"date-time":"2025-05-03T00:00:00Z","timestamp":1746230400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Introduction: The group of so-called \u201csellar-region masses\u201d consists of a heterogeneous group of neoplasms and tumor-mimicking lesions, whose differential diagnosis may be challenging due to the overlapping of clinical and radiological features, which can be found both in \u201ccommon\u201d and \u201cuncommon\u201d lesions. The choice of a correct treatment strategy is still arduous and requires histological analysis. Gamma Knife Radiosurgery (GKRS) has already been reported as a safe and effective treatment in these cases. The objective of this study is to evaluate single-center pre-operative data, post-operative outcomes, and long-term follow-up in patients treated with GKRS for unusual sellar tumors. Methods: We retrospectively identified and analyzed nine patients treated with GKRS from 2004 to 2015, according to a standard protocol. Lesions consist of hypothalamic hamartoma (HH), Rathke\u2019s cleft cist (RCC), Langerhans cell histiocytosis (LCH), spindle cell oncocytoma (SCO), choroid plexus papilloma (CPP), and ossifying fibroma (OF). The diagnosis was histologically confirmed in six patients that underwent surgery, while in three patients, diagnosis was based on characteristic clinical and radiological findings (two HH and one RCC). Pre-operative and post-operative data were retrieved from medical archives, and long-term follow-up was obtained through clinical and neuroradiological periodic examination. Results: In our series, all the \u201crare\u201d sellar lesions treated, had a successful radiographic and clinical response in a medium-long follow-up period. Conclusions: The long-term follow-up results suggest that GKRS is a safe and effective treatment in rare sellar lesions, with very low toxicity. To the best of our knowledge, this report represents the largest series of unusual sellar lesions treated with GKRS in a single high-volume center, suggesting that GKRS might be an effective non-invasive adjuvant treatment option. Further studies and a larger number of patients are needed to confirm if residuals of these rare sellar lesions might regress on their own without treatment or if other non-invasive treatments could be as effective as GKRS.<\/jats:p>","DOI":"10.3390\/cancers17091564","type":"journal-article","created":{"date-parts":[[2025,5,4]],"date-time":"2025-05-04T20:09:14Z","timestamp":1746389354000},"page":"1564","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Role of Gamma Knife Surgery in the Treatment of Rare Sellar Neoplasms: A Report of Nine Cases"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1464-0522","authenticated-orcid":false,"given":"Michele","family":"Longhi","sequence":"first","affiliation":[{"name":"Departmental Unit of Stereotaxis, Department of Neurosciences, Hospital Trust of Verona, 37126 Verona, Italy"},{"name":"Unit of Neurosurgery B, Department of Neurosciences, Hospital Trust of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Lavezzo","sequence":"additional","affiliation":[{"name":"Vertebral Surgery Service, San Lorenzo Hospital-AULSS Berica, 36078 Valdagno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7086-1920","authenticated-orcid":false,"given":"Valeria","family":"Barresi","sequence":"additional","affiliation":[{"name":"Unit of Neuropathology, Fondazione IRCSS Carlo Besta, 20021 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Bulgarelli","sequence":"additional","affiliation":[{"name":"Departmental Unit of Stereotaxis, Department of Neurosciences, Hospital Trust of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"D\u2019Amico","sequence":"additional","affiliation":[{"name":"Departmental Unit of Stereotaxis, Department of Neurosciences, Hospital Trust of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Lombardo","sequence":"additional","affiliation":[{"name":"Departmental Unit of Stereotaxis, Department of Neurosciences, Hospital Trust of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Zivelonghi","sequence":"additional","affiliation":[{"name":"Unit of Medical Physics, Department of Diagnostics and Public Health, Hospital Trust of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo Maria","family":"Polloniato","sequence":"additional","affiliation":[{"name":"Unit of Medical Physics, Department of Diagnostics and Public Health, Hospital Trust of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8536-5794","authenticated-orcid":false,"given":"Giuseppe Kenneth","family":"Ricciardi","sequence":"additional","affiliation":[{"name":"Unit of Neuroradiology, Department of Diagnostics and Public Health, Hospital Trust of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Sala","sequence":"additional","affiliation":[{"name":"Unit of Neurosurgery B, Department of Neurosciences, Hospital Trust of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Musumeci","sequence":"additional","affiliation":[{"name":"Unit of Neurosurgery A, Department of Neurosciences, Hospital Trust of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giampietro","family":"Pinna","sequence":"additional","affiliation":[{"name":"Unit of Neurosurgery A, Department of Neurosciences, Hospital Trust of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1842-8051","authenticated-orcid":false,"given":"Antonio","family":"Nicolato","sequence":"additional","affiliation":[{"name":"Departmental Unit of Stereotaxis, Department of Neurosciences, Hospital Trust of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.clineuro.2016.08.011","article-title":"The sellar and suprasellar region: A \u201chideaway\u201d of rare lesions. Clinical aspects, imaging findings, surgical outcome and comparative analysis","volume":"149","author":"Petrakakis","year":"2016","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/S0889-8529(05)70058-X","article-title":"Differential diagnosis of sellar masses","volume":"28","author":"Freda","year":"1999","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.ecl.2007.10.003","article-title":"Rare sellar lesions","volume":"37","author":"Glezer","year":"2008","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.5858\/2002-126-1174-DEOCAD","article-title":"Differential expression of cytokeratins 8 and 20 distinguishes craniopharyngioma from rathke cleft cyst","volume":"126","author":"Xin","year":"2002","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.3171\/2021.12.JNS212108","article-title":"Stereotactic radiosurgery for Rathke\u2019s cleft cysts: An international multicenter study","volume":"137","author":"Kondziolka","year":"2022","journal-title":"J. Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"E81","DOI":"10.1002\/hed.24811","article-title":"Radiotherapy for juvenile ossifying fibroma of the maxillary sinus: Case report and literature review","volume":"39","author":"Strickler","year":"2017","journal-title":"Head Neck"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1093\/jnen\/nlz044","article-title":"Very Unusual Sellar\/Suprasellar Region Masses: A Review","volume":"78","author":"Abushamat","year":"2019","journal-title":"J. Neuropathol. Exp. Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"191","DOI":"10.4103\/1793-5482.185067","article-title":"Ectopic Choroid Plexus Papilloma","volume":"13","author":"Khade","year":"2018","journal-title":"Asian J. Neurosurg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"517","DOI":"10.3171\/2018.4.JNS18211","article-title":"Spindle cell oncocytoma of the pituitary gland","volume":"131","author":"Cote","year":"2019","journal-title":"J. Neurosurg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1097\/01.rmr.0000224685.83629.18","article-title":"Nonadenomatous tumors of the pituitary and sella turcica","volume":"16","author":"Huang","year":"2005","journal-title":"Top. Magn. Reson. Imaging TMRI"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e01412","DOI":"10.1002\/brb3.1412","article-title":"Hypothalamic hamartomas in adulthood: Clinical spectrum and treatment outcome-A unicenter experience","volume":"9","author":"Manzanares","year":"2019","journal-title":"Brain Behav."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1007\/s00381-006-0139-y","article-title":"Epilepsy related to hypothalamic hamartomas: Surgical management with special reference to gamma knife surgery","volume":"22","author":"Scavarda","year":"2006","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.spen.2007.03.005","article-title":"Gamma knife surgery for epilepsy related to hypothalamic hamartomas","volume":"14","author":"Scavarda","year":"2007","journal-title":"Semin. Pediatr. Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1212\/WNL.0000000000012773","article-title":"Hypothalamic Hamartomas: Evolving Understanding and Management","volume":"97","author":"Cohen","year":"2021","journal-title":"Neurology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"106624","DOI":"10.1016\/j.eplepsyres.2021.106624","article-title":"Epileptic hypothalamic hamartomas impact of topography on clinical presentation and radiosurgical outcome","volume":"173","author":"Hamdi","year":"2021","journal-title":"Epilepsy Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1111\/epi.16896","article-title":"Long-term cognitive outcome after radiosurgery in epileptic hypothalamic hamartomas and review of the literature","volume":"62","author":"Hamdi","year":"2021","journal-title":"Epilepsia"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1007\/s10072-024-07946-2","article-title":"MRgFUS disconnection surgery for hypothalamic hamartoma-related epilepsy: Case report and literature review","volume":"46","author":"Ricciardi","year":"2025","journal-title":"Neurol. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1111\/epi.13760","article-title":"Gamma Knife radiosurgery for hypothalamic hamartoma preserves endocrine functions","volume":"58","author":"Castinetti","year":"2017","journal-title":"Epilepsia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.ejpn.2016.05.008","article-title":"Neurological complications after gamma-knife radiosurgery for hypothalamic hamartoma","volume":"20","author":"Oikonomopoulou","year":"2016","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_20","first-page":"e2968","article-title":"CyberKnife\u00ae Radiosurgery as First-line Treatment for Catastrophic Epilepsy Caused by Hypothalamic Hamartoma","volume":"10","author":"Romanelli","year":"2018","journal-title":"Cureus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.wneu.2021.03.047","article-title":"Role of Stereotactic Radiosurgery in Intracranial Histiocytosis: A Systematic Review of Literature of an Emerging Modality for Localized Disease","volume":"150","author":"Tripathi","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.clineuro.2012.07.004","article-title":"Pituitary stalk Langerhans cell histiocytosis treated with CyberKnife radiosurgery","volume":"115","author":"Hong","year":"2013","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e13853","DOI":"10.1097\/MD.0000000000013853","article-title":"Isolated hypothalamic-pituitary langerhans\u2019 cell histiocytosis in female adult: A case report","volume":"98","author":"Tan","year":"2019","journal-title":"Medicine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1038\/nrendo.2011.12","article-title":"Management of Cushing disease","volume":"7","author":"Tritos","year":"2011","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.wneu.2020.09.090","article-title":"Salvage Gamma Knife Stereotactic Radiosurgery for Recurrent Intracranial Langerhans Cell Histiocytosis: A 36-Year Saga","volume":"144","author":"Faramand","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1007\/s10143-024-02742-0","article-title":"Rathke\u2019s cleft cysts: From pathophysiology to management","volume":"47","author":"Aydin","year":"2024","journal-title":"Neurosurg. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1093\/neuros\/nyz523","article-title":"Stereotactic Radiation as Salvage Therapy for Recurrent Rathke Cleft Cysts","volume":"87","author":"Agarwalla","year":"2020","journal-title":"Neurosurgery"},{"key":"ref_28","first-page":"841","article-title":"Ossifying fibroma of the ethmoid sinus: Report of a rare case and review of literature","volume":"16","author":"Mohsenifar","year":"2011","journal-title":"J. Res. Med. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1007\/s12105-021-01350-4","article-title":"Ossifying Fibromas of the Head and Neck Region: A Clinicopathological Study of 45 Cases","volume":"16","author":"Nagar","year":"2022","journal-title":"Head Neck Pathol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"38","DOI":"10.25259\/SNI_182_2023","article-title":"Ossifying fibroma of the ethmoid and sphenoid sinuses: A report of a rare case and literature review","volume":"15","author":"Azab","year":"2024","journal-title":"Surg. Neurol. Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e197","DOI":"10.1016\/j.wneu.2021.02.051","article-title":"A Comprehensive Study of Spindle Cell Oncocytoma of the Pituitary Gland: Series of 6 Cases and Meta-Analysis of 85 Cases","volume":"149","author":"Hasegawa","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1007\/s12022-022-09703-7","article-title":"Overview of the 2022 WHO Classification of Pituitary Tumors","volume":"33","author":"Asa","year":"2022","journal-title":"Endocr. Pathol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s11060-019-03231-x","article-title":"Single-fraction stereotactic radiosurgery for spindle cell oncocytoma: Preliminary experience and systematic review of the literature","volume":"144","author":"Oushy","year":"2019","journal-title":"J. Neurooncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"139","DOI":"10.4103\/1793-5482.153501","article-title":"Choroid plexus papilloma","volume":"12","author":"Sethi","year":"2017","journal-title":"Asian J. Neurosurg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s11060-008-9531-7","article-title":"Primary choroid plexus papilloma of the sellar region","volume":"88","author":"Ma","year":"2008","journal-title":"J. Neurooncol."},{"key":"ref_36","first-page":"1050","article-title":"Not So Benign: A Rare Atypical Ectopic Choroid Plexus Papilloma","volume":"6","author":"Patel","year":"2021","journal-title":"J. Ophthalmol. Vis. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"S116","DOI":"10.4103\/2152-7806.176132","article-title":"Treatment of epidermoid tumors with gamma knife radiosurgery: Case series","volume":"7","author":"Vasquez","year":"2016","journal-title":"Surg. Neurol. Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"744","DOI":"10.3171\/2016.1.JNS152860","article-title":"Stereotactic radiosurgery for intracranial hemangiopericytomas: A multicenter study","volume":"126","author":"Lee","year":"2017","journal-title":"J. Neurosurg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1007\/s40618-019-01158-8","article-title":"Primary sellar melanocytoma: Pathological, clinical and treatment review","volume":"43","author":"Albano","year":"2020","journal-title":"J. Endocrinol. Investig."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/9\/1564\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:26:52Z","timestamp":1760030812000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/9\/1564"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,3]]},"references-count":39,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["cancers17091564"],"URL":"https:\/\/doi.org\/10.3390\/cancers17091564","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,3]]}}}