Q: I underwent an excision of pituitary adenoma six months back and got my MRI scans repeated last week. There is a small nodule left in my right cavernous. My growth hormones are still on the higher side. The doctors have advised me to undergo a similar endoscopic surgery I went before. I have heard of gamma knife radiosurgery through some doctors who told me that it can be more effective and result oriented than endoscopic surgery. I also want to know where these surgeries are conducted and how much could be the approximate expenditure? Does it have any side effects?

A:The chance of being cured depends upon the type, size and location of the tumour and the expertise of the surgeon. The complete surgical removal of macroadenoma depends upon whether it has grown into the cavernous sinus, bone, or neighbouring tissue. If it has not grown into these areas, a surgical cure can often be achieved. If tumour has grown into an area where it is not possible or safe for the surgeon to operate, it may not be surgically curable. Radiation therapy may be required to control further growth. Gamma knife (stereotactic radiosurgery) delivers focused radiation beams to match the tumour precisely with the aid of brain imaging techniques and no scalpel is involved. Its advantage is that surrounding, healthy tissue receives minimal radiation compared to the tumour. It may be used with external-beam radiation, especially for tumours in deep or sensitive areas of the brain, where surgical removal is dangerous. It is usually done as an outpatient procedure. The main disadvantage is that its effect is not immediate and may take months or years to be fully effective and it cannot be used for tumours very close to important nerves, such as those needed for vision. It still is, however, most often recommended when surgery has not been successful. The facility will be available at most major hospitals in the metros, which have a full-fledged department of Neurosurgery. The cost will be variable depending on the type of hospital, room charges, doctor fee etc.