Endoscopic Endonasal Surgery for Treatment of Pituitary Apoplexy: 16 Years of Experience in a Specialized Pituitary Center

World Neurosurg. 2017 Dec:108:137-142. doi: 10.1016/j.wneu.2017.08.131. Epub 2017 Sep 1.

Abstract

Objective: Symptomatic pituitary apoplexy is a rare but life-threatening condition caused by sudden hemorrhage or infarction of a pituitary adenoma. In the current study, we aim to evaluate the clinical presentation, management, and clinical outcomes in a cohort of patients who were treated for this condition in our center in the last 16 years.

Methods: We performed a retrospective analysis of all patients who underwent endoscopic endonasal surgery for treatment of symptomatic pituitary apoplexy between 2001 and 2016 in our center.

Results: A total of 39 patients were included in the study, mean age of 54.9 years (range, 18-70 years) and mean follow-up 5.1 years (range, 0.6-16 years). Most of the patients had nonfunctioning adenomas (32 patients). Headache (89%), visual impairment (79%), and hypopituitarism (86%) were the most common preoperative findings. Surgical treatment led to gross total resection in 31 patients (79.4%). During follow-up, visual fields and oculomotor improvement was observed in 23 (74.1%) and 21 (67.7%) of the patients, respectively. Intractable headache also improved in all patients. Hypopituitarism was present in 77% of patients after surgery. In this series, no cerebrospinal fluid leak, vascular injury, or infection was observed. There was no postoperative mortality.

Conclusions: The endoscopic endonasal transsphenoidal approach is an effective modality to treat pituitary apoplexy with a high rate of success and minimal risk in selected cases. Although reversion of preoperative visual deficits is often observed, hormonal deficits tend to persist, and require long-term hormonal therapy, even after successful endoscopic endonasal surgical resection.

Keywords: Apoplexy; Endonasal; Endoscopy; Pituitary; Surgery.

MeSH terms

  • Adenoma / complications
  • Adenoma / surgery*
  • Adolescent
  • Adult
  • Aged
  • Cerebrospinal Fluid Leak / epidemiology
  • Female
  • Humans
  • Hypopituitarism / epidemiology
  • Male
  • Middle Aged
  • Nasal Cavity
  • Natural Orifice Endoscopic Surgery / methods*
  • Neuroendoscopy / methods*
  • Pituitary Apoplexy / etiology
  • Pituitary Apoplexy / surgery*
  • Pituitary Neoplasms / complications
  • Pituitary Neoplasms / surgery*
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Sphenoid Bone
  • Surgical Wound Infection / epidemiology
  • Vascular System Injuries / epidemiology
  • Young Adult