Outcome in pituitary apoplexy patients, stratified by delay between symptom appearance and surgery: A single center retrospective analysis

There are surgical and conservative management strategies in pituitary apoplexy patients. The use of both methods may lead to delayed surgery in the treatment of pituitary apoplexy. The aim of this study was to evaluate the surgical indications and outcomes of a series of patients with pituitary apo...

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Bibliographic Details
Published in:Clinical neurology and neurosurgery 2021-11, Vol.210, p.106991-106991, Article 106991
Main Authors: CABUK, Burak, KAYA, Necdet Selim, POLAT, Caner, GEYIK, Abidin Murat, ICLI, Dilek, ANIK, Ihsan, CEYLAN, Savas
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Cerebral Hemorrhage - complications
Cerebral Hemorrhage - diagnostic imaging
Cerebral Hemorrhage - surgery
Coma
Consciousness
Diabetes
Endocrine outcome
Endoscopic surgery
Endoscopy
Female
Headache
Headache - diagnostic imaging
Headache - etiology
Headache - surgery
Headaches
Hemorrhage
Hormones
Humans
Magnetic resonance imaging
Male
Middle Aged
Motility
Neuroendoscopy - methods
Neuroendoscopy - trends
Neurosurgery
Pain
Paralysis
Patients
Pituitary
Pituitary adenoma
Pituitary apoplexy
Pituitary Apoplexy - diagnostic imaging
Pituitary Apoplexy - etiology
Pituitary Apoplexy - surgery
Retrospective Studies
Sphenoid Sinus - diagnostic imaging
Sphenoid Sinus - surgery
Statistical analysis
Surgery
Thyroid gland
Time-to-Treatment - trends
Treatment Outcome
Tumors
Vision Disorders - diagnostic imaging
Vision Disorders - etiology
Vision Disorders - surgery
Visual impairment
Young Adult
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Summary:There are surgical and conservative management strategies in pituitary apoplexy patients. The use of both methods may lead to delayed surgery in the treatment of pituitary apoplexy. The aim of this study was to evaluate the surgical indications and outcomes of a series of patients with pituitary apoplexy according to delay between surgery and symptom onset. A retrospective analysis was performed of 2711 cases with sellar pathologies treated with endoscopic transsphenoidal surgery in a single centre. Inclusion criteria were histopathological confirmation of haemorrhage or necrosis, acute onset and at least one of the following: symptoms of endocrine dysfunction; visual impairment; ophtalmoplegia; headache; or altered consciousness. Patients were divided into three groups based on the number of days from initial symptoms to surgery: early (1–7 day), delayed (8–21 days) and late (>21 day). The indication for and outcome of surgery was reviewed according to symptoms and timing of surgery. Ninety-one patients with pituitary apoplexy underwent surgery. The median time from ictus until surgery was 16 days (1–120 days). Headache was the most common presenting symptom. Visual impairment and ophtalmoplegia were found in 26.4% and 23.1% of patients, respectively. Surgical intervention was successful in treatment of headache in 82 (97,6%) patients. In patients in the early or delayed groups a significant improvement was found between pre- and post-operative headache, ocular palsy, visual impairment, and hormone deficiencies. Patients in the late group also had a significant improvement in headache and visual symptoms after surgery. Surgery was sufficient in headache, endocrine, and neuro-ophthalmic outcomes at first 21 days (early and delayed groups). Beyond 21 days (late group), surgery was not effective on recovery of pituitary function. •The role of surgery remains controversial in pituitary apoplexy patients with delay between symptom appearance and surgery.•Relationship between the timing of the pituitary surgery and clinical outcome were analysed in this study.•Surgery was an effective minimally invasive treatment for patients with apoplexy in early, delayed, or late admission.•A later surgical approach is a valid treatment option following initial conservative treatment that did not result in improvement.
ISSN:0303-8467
1872-6968
DOI:10.1016/j.clineuro.2021.106991