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Radiation-Induced Ocular Motor Cranial Nerve Palsies in Patients With Pituitary Tumor

Vaphiades, Michael S DO; Spencer, Sharon A MD; Riley, Kristen MD; Francis, Courtney MD; Deitz, Luke MD; Kline, Lanning B MD

doi: 10.1097/WNO.0b013e31820eb7bc
Original Contribution
Japanese Abstract

Background: Radiation therapy is often used in the treatment of pituitary tumor. Diplopia due to radiation damage to the ocular motor cranial nerves has been infrequently reported as a complication in this clinical setting.

Methods: Retrospective case series of 6 patients (3 men and 3 women) with pituitary adenoma, all of whom developed diplopia following transsphenoidal resection of pituitary adenoma with subsequent radiation therapy. None had evidence of tumor involvement of the cavernous sinus.

Results: Five patients developed sixth nerve palsies, 3 unilateral and 2 bilateral, and in 1 patient, a sixth nerve palsy was preceded by a fourth cranial nerve palsy. One patient developed third nerve palsy. Five of the 6 patients had a growth hormone-secreting pituitary tumor with acromegaly. Following transsphenoidal surgery in all 6 patients (2 had 2 surgeries), 4 had 2 radiation treatments consisting of either radiosurgery (2 patients) or external beam radiation followed by radiosurgery (2 patients).

Conclusions: Patients with pituitary tumors treated multiple times with various forms of radiation therapy are at risk to sustain ocular motor cranial nerve injury. The prevalence of acromegalic patients in this study reflects an aggressive attempt to salvage patients with recalcitrant growth hormone elevation and may place the patient at a greater risk for ocular motor cranial nerve damage.

Departments of Ophthalmology (MSV, CF, LD, LBK), Neurology (MSV), Neurosurgery (MSV, KR), and Radiation Oncology (SAS), University of Alabama, Birmingham, Alabama.

Supported in part by an unrestricted grant from the Research to Prevent Blindness, Inc, New York, NY.

The authors report no financial conflicts of interest related to this article.

Address correspondence to Michael S. Vaphiades, DO, Department of Ophthalmology, University of Alabama, Suite 601, 700 South 18th Street, Birmingham, AL 35233; E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.