Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Visual Outcome after Transsphenoidal Surgery in Patients with Pituitary Apoplexy

  • Seuk, Ju-Wan (Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine) ;
  • Kim, Choong-Hyun (Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine) ;
  • Yang, Moon-Sul (Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine) ;
  • Cheong, Jin-Hwan (Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine) ;
  • Kim, Jae-Min (Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine)
  • Received : 2010.08.10
  • Accepted : 2011.05.30
  • Published : 2011.06.28
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Abstract

Objective : Pituitary apoplexy is one of the most serious life-threatening complications of pituitary adenoma. The purpose of this study is to investigate the visual outcome after early transsphenoidal surgery for the patients with pituitary apoplexy. Methods : We retrospectively reviewed the 31 patients with pituitary apoplexy who were admitted due to acute visual acuity or field impairment and treated by transsphenoidal surgery. Five patients were excluded because of the decreased conscious level. The visual acuity of each individual eye was evaluated by Snellen's chart Visual fields were also checked using automated perimetry. To compare the visual outcome according to the surgical timing, we divided the patients into 2 groups. The first group, 21 of the patients have been undertaken transsphenoidal approach (TSA) within at least 48 hours after admission. The second group included 8 patients who have been undertaken TSA beyond 48 hours. All patients were monitored at least 12 months after surgery. Results : Patients were 21 males and 8 females (M : F=2.6 : 1) with the mean age of 42.4 years. Among the enrolled 29 patients, 26 patients presented with decreased visual acuity and 23 patients revealed the defective visual field respectively. Postoperatively, improvement in the visual acuity was seen in 15 patients (83.3%) who underwent surgery within the first 48 hours of presentation, as compared to those in whom surgery was delayed beyond 48 hours (n=5; 62.5%) (p=0.014). Improvement in the visual field deficits was observed in 15 (88.2%) of patients who had been operated on within the first 48 hours of presentation, as compared to those in whom surgery was delayed beyond 48 hours (n=3; 50.0%) (p=0.037). Conclusion : This study suggests that rapid transsphenoidal surgery is effective to recover the visual impairment in patients with pituitary apoplexy. If there are associated abnormalities of visual acuity or visual fields in patients with hemorrhagic pituitary apoplexy, early neurosurgical intervention within 48 hours should be also required to recover visual impairment.

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References

  1. Agrawal D, Mahapatra AK : Visual outcome of blind eyes in pituitary apoplexy after transsphenoidal surgery : a series of 14 eyes. Surg Neurol 63 : 42-46; discussion 46, 2005 https://doi.org/10.1016/j.surneu.2004.03.014
  2. Arafah BM, Harrington JF, Madhoun ZT, Selman WR : Improvement of pituitary function after surgical decompression for pituitary tumor apoplexy. J Clin Endocrinol Metab 71 : 323-328, 1990 https://doi.org/10.1210/jcem-71-2-323
  3. Bills DC, Meyer FB, Laws ER Jr, Davis DH, Ebersold MJ, Scheithauer BW, et al. : A retrospective analysis of pituitary apoplexy. Neurosurgery 33 : 602-608; discussion 608-609, 1993 https://doi.org/10.1227/00006123-199310000-00007
  4. Biousse V, Newman NJ, Oyesiku NM : Precipitating factors in pituitary apoplexy. J Neurol Neurosurg Psychiatry 71 : 542-545, 2001 https://doi.org/10.1136/jnnp.71.4.542
  5. Bonicki W, Kasperlik-Zaluska A, Koszewski W, Zgliczynski W, Wislawski J : Pituitary apoplexy : endocrine, surgical and oncological emergency. Incidence, clinical course and treatment with reference to 799 cases of pituitary adenomas. Acta Neurochir (Wien) 120 : 118-122, 1993 https://doi.org/10.1007/BF02112028
  6. Brougham M, Heusner AP, Adams RD : Acute degenerative changes in adenomas of pituitary body; with special reference to pituitary apoplexy. J Neurosurg 7 : 421-439, 1950 https://doi.org/10.3171/jns.1950.7.5.0421
  7. Cardoso ER, Peterson EW : Pituitary apoplexy : a review. Neurosurgery 14 : 363-373, 1984 https://doi.org/10.1227/00006123-198403000-00021
  8. Chanson P, Lepeintre JF, Ducreux D : Management of pituitary apoplexy. Expert Opin Pharmacother 5 : 1287-1298, 2004 https://doi.org/10.1517/14656566.5.6.1287
  9. Chuang CC, Chang CN, Wei KC, Liao CC, Hsu PW, Huang YC, et al. : Surgical treatment for severe visual compromised patients after pituitary apoplexy. J Neurooncol 80 : 39-47, 2006 https://doi.org/10.1007/s11060-006-9148-7
  10. da Motta LA, de Mello PA, de Lacerda CM, Neto AP, da Motta LD, Filho MF : Pituitary apoplexy. Clinical course, endocrine evaluations and treatment analysis. J Neurosurg Sci 43 : 25-36, 1999
  11. Deb S : Clinical significance of pituitary apoplexy. J Indian Med Assoc 96 : 302-303, 307, 1998
  12. Ebersold MJ, Laws ER Jr, Scheithauer BW, Randall RV : Pituitary apoplexy treated by transsphenoidal surgery. A clinicopathological and immunocytochemical study. J Neurosurg 58 : 315-320, 1983 https://doi.org/10.3171/jns.1983.58.3.0315
  13. Epstein S, Pimstone BL, De Villiers JC, Jackson WP : Pituitary apoplexy in five patients with pituitary tumours. Br Med J 2 : 267-270, 1971 https://doi.org/10.1136/bmj.2.5756.267
  14. Fraioli B, Esposito V, Palma L, Cantore G : Hemorrhagic pituitary adenomas : clinicopathological features and surgical treatment. Neurosurgery 27 : 741-747; discussion 747-748, 1990 https://doi.org/10.1227/00006123-199011000-00011
  15. Kim JK, Park BJ, Cho KT, Lee SK, Cho MK, Kim YJ : Surgical outcomes of pituitary apoplexy. J Korean Neurosurg Soc 38 : 450-455, 2005
  16. Lee JH, Kim JH, Moon KS, Joo SP, Lee JK, Kim SH : Pituitary apoplexy : surgical experience with 16 patients. J Korean Neurosurg Soc 42 : 83-88, 2007
  17. Maccagnan P, Macedo CL, Kayath MJ, Nogueira RG, Abucham J : Conservative management of pituitary apoplexy : a prospective study. J Clin Endocrinol Metab 80 : 2190-2197, 1995 https://doi.org/10.1210/jc.80.7.2190
  18. McFadzean RM, Doyle D, Rampling R, Teasdale E, Teasdale G : Pituitary apoplexy and its effect on vision. Neurosurgery 29 : 669-675, 1991 https://doi.org/10.1227/00006123-199111000-00005
  19. Mohanty S, Tandon PN, Banerji AK, Prakash B : Haemorrhage into pituitary adenomas. J Neurol Neurosurg Psychiatry 40 : 987-991, 1977 https://doi.org/10.1136/jnnp.40.10.987
  20. Onesti ST, Wisniewski T, Post KD : Clinical versus subclinical pituitary apoplexy : presentation, surgical management, and outcome in 21 patients. Neurosurgery 26 : 980-986, 1990 https://doi.org/10.1227/00006123-199006000-00010
  21. Rajasekaran S, Vanderpump M, Baldeweg S, Drake W, Reddy N, Lanyon M, et al. : UK guidelines for the management of pituitary apoplexy. Clin Endocrinol (Oxf) 74 : 9-20, 2011 https://doi.org/10.1111/j.1365-2265.2010.03913.x
  22. Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA : Classical pituitary apoplexy : clinical features, management and outcome. Clin Endocrinol (Oxf) 51 : 181-188, 1999 https://doi.org/10.1046/j.1365-2265.1999.00754.x
  23. Robinson JL : Sudden blindness with pituitary tumors. Report of three cases. J Neurosurg 36 : 83-85, 1972 https://doi.org/10.3171/jns.1972.36.1.0083
  24. Rolih CA, Ober KP : Pituitary apoplexy. Endocrinol Metab Clin North Am 22 : 291-302, 1993
  25. Rovit RL, Fein JM : Pituitary apoplexy : a review and reappraisal. J Neurosurg 37 : 280-288, 1972 https://doi.org/10.3171/jns.1972.37.3.0280
  26. Semple PL, De Villiers JC, Bowen RM, Lopes MB, Laws ER Jr : Pituitary apoplexy : do histological features influence the clinical presentation and outcome? J Neurosurg 104 : 931-937, 2006 https://doi.org/10.3171/jns.2006.104.6.931
  27. Shenkin HA : Relief of amblyopia in pituitary apoplexy by prompt surgical intervention. J Am Med Assoc 159 : 1622-1624, 1955 https://doi.org/10.1001/jama.1955.02960340042010
  28. Sibal L, Ball SG, Connolly V, James RA, Kane P, Kelly WF, et al. : Pituitary Apoplexy : a Review of Clinical Presentation, management and Outcome in 45 Cases. Pituitary 7 : 157-163, 2004 https://doi.org/10.1007/s11102-005-1050-3
  29. Symon L, Mohanty S : Haemorrhage in pituitary tumours. Acta Neurochir (Wien) 65 : 41-49, 1982 https://doi.org/10.1007/BF01405440
  30. Verrees M, Arafah BM, Selman WR : Pituitary tumor apoplexy : characteristics, treatment, and outcomes. Neurosurg Focus 16 : E6, 2004
  31. Wakai S, Fukushima T, Teramoto A, Sano K : Pituitary apoplexy : its incidence and clinical significance. J Neurosurg 55 : 187-193, 1981 https://doi.org/10.3171/jns.1981.55.2.0187
  32. Zhang X, Fei Z, Zhang W, Cao WD, Liu WP, Zhang JN, et al. : Emergency transsphenoidal surgery for hemorrhagic pituitary adenomas. Surg Oncol 16 : 115-120, 2007 https://doi.org/10.1016/j.suronc.2007.06.001

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