# Gamma Knife Radiosurgery: An Adjuvant Therapy for Primary Sellar Paraganglioma

## TL;DR

Gamma Knife radiosurgery is an effective adjuvant therapy for primary sellar paraganglioma after partial surgical removal.

## Contribution

This case study demonstrates the efficacy of Gamma Knife radiosurgery as an adjuvant treatment for primary sellar paraganglioma.

## Key findings

- A TC-TS surgical approach allowed partial resection of a highly vascular sellar paraganglioma.
- Gamma Knife radiosurgery stabilized residual tumor growth two years post-treatment.
- SP should be considered in the differential diagnosis of pituitary diseases.

## Abstract

Sellar paraganglioma (SP) is a rare benign tumor, usually treated by surgery. SPs are lobulated, firm, adherent, and highly vascular, allowing mostly partial resection. We present the case of a 52-year-old man diagnosed with primary SP, treated with a transcranial-transsphenoidal (TC-TS) surgical approach, followed by adjuvant Gamma Knife stereotactic radiosurgery (GKSR). The tumor has an extra-pituitary origin, with a sellar-suprasellar, right cavernous sinus extension that encroached the bilateral optic nerve and anterior cerebral artery. Histopathology confirmed SP with a Zellballen pattern. Despite postoperative tumor growth observed at four and 10 months, a stable residual tumor was noted at a follow-up two years after GKSR. SP is diagnosed mainly in middle age or in adolescent males. The TC-TS approach offers a bidirectional view that allows greater resection by minimizing blind spots, thus reducing complications. Similar to the paragangliomas of other sites, the efficacy of GKSR was observed for primary SP. SP is a rare differential diagnosis of pituitary diseases; however, it should be considered. After surgical resection of primary SP, GKSR is observed as an effective adjuvant therapy.