48973 Hippocampal Dosimetry and Neurocognitive Functions in Sellar and Parasellar Lesions Treated With Gamma Knife Radiosurgery

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INTRODUCTION: Gamma Knife radiosurgery (GKRS) is an effective treatment for benign tumors in the sellar, parasellar, and suprasellar regions. However, radiation exposure to the hippocampus, a critical structure for memory and cognitive functions, may lead to neurocognitive decline. Identifying optimal dosimetric thresholds is crucial for balancing tumor control with cognitive preservation. METHODS: This prospective study included 41 patients who underwent GKRS. Neurocognitive assessments, including memory tests, were performed pre-treatment and at six months post-treatment. Hippocampal dosimetry parameters (D40, D100, Dmin, Dmax, Dmean) were analyzed and correlated with cognitive outcomes. Pearson correlation analysis was used to assess associations between radiation dose and cognitive function, while receiver operating characteristic (ROC) analysis was conducted to determine optimal dose thresholds predictive of cognitive decline. Additional factors, including demographic variables and hippocampal volumes, were incorporated into the analysis. RESULTS: A significant correlation was observed between hippocampal radiation dose and neurocognitive function. Pearson correlation analysis revealed that exceeding threshold doses correlated with declines in Story Immediate Recall (r = -0.26, p = 0.018) and Visual Immediate Recall (r = -0.23, p = 0.033). ROC analysis identified optimal dosimetric cutoffs for preserving cognitive function, with thresholds of D40 ≤ 2.5 Gy, D100 ≤ 2.4 Gy, Dmin ≤ 0.7 Gy, Dmax ≤ 5.7 Gy, and Dmean ≤ 2.4 Gy. Younger age and higher education levels were associated with better cognitive resilience. CONCLUSIONS: Our findings emphasize the importance of hippocampal protection in GKRS. The identified dose thresholds may be more effective in preserving neurocognitive function than current recommendations. These results support refining GKRS strategies and re-evaluating clinical guidelines to minimize cognitive impairment.

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