Young-Hoon Kim1, Young Hyun Cho1, Seok Ho Hong1, Jeong Hoon Kim1, Min-Seon Kim2, Shin Kwang Khang3, Eun Jung Lee4, Kyuha Chong5, Chang Jin Kim6. 1. Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 2. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 3. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 4. Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Korea. 5. Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea. 6. Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: cjkim@amc.seoul.kr.
Abstract
OBJECTIVE: Pituitary apoplexy can cause severe neuro-ophthalmologic or endocrinologic sequelae, requiring timely treatment. The present study was performed to evaluate postoperative neurologic outcomes and to identify their risk factors in patients who underwent transsphenoidal surgery for pituitary apoplexy. METHODS: Forty-one consecutive patients with pituitary apoplexy who underwent transsphenoidal surgery were reviewed retrospectively. The initial rates of visual acuity (VA) decrease, visual field (VF) defect, and ocular palsy were 34.1%, 46.3%, and 68.3%, respectively. The median maximal diameter and tumoral volume was 2.6 cm (range, 2.0-4.6 cm) and 5.3 cm3 (range, 2.4-38.8 cm3), respectively. Seventeen patients (41.5%) underwent surgery within 7 days. The median follow-up duration was 45 months (range, 12-196 months). RESULTS: At the last follow-up, 62.9% (22/35) of patients had made a full recovery from preoperative neurologic deficits, with partial recovery observed in the remaining patients. The rates of improvement and full recovery from VA decrease were 92.9% and 57.1%, respectively; those from VF defect were 94.7% and 36.8%, respectively; and those from ocular palsy were 100.0% and 96.4%, respectively. On multivariate analysis, initial visual impairment score (≥20) was the only significant risk factor for postoperative neurologic sequelae (P < 0.001; odds ratio, 40.8). Surgical timing was not associated with postoperative neurological recovery (P = 0.733). CONCLUSIONS: Ocular palsy was fully recovered in 96.4% patients with pituitary apoplexy after transsphenoidal surgery. Initial visual impairment status was found to be more strongly associated with postoperative neurologic recovery than surgical timing.
OBJECTIVE:Pituitary apoplexy can cause severe neuro-ophthalmologic or endocrinologic sequelae, requiring timely treatment. The present study was performed to evaluate postoperative neurologic outcomes and to identify their risk factors in patients who underwent transsphenoidal surgery for pituitary apoplexy. METHODS: Forty-one consecutive patients with pituitary apoplexy who underwent transsphenoidal surgery were reviewed retrospectively. The initial rates of visual acuity (VA) decrease, visual field (VF) defect, and ocular palsy were 34.1%, 46.3%, and 68.3%, respectively. The median maximal diameter and tumoral volume was 2.6 cm (range, 2.0-4.6 cm) and 5.3 cm3 (range, 2.4-38.8 cm3), respectively. Seventeen patients (41.5%) underwent surgery within 7 days. The median follow-up duration was 45 months (range, 12-196 months). RESULTS: At the last follow-up, 62.9% (22/35) of patients had made a full recovery from preoperative neurologic deficits, with partial recovery observed in the remaining patients. The rates of improvement and full recovery from VA decrease were 92.9% and 57.1%, respectively; those from VF defect were 94.7% and 36.8%, respectively; and those from ocular palsy were 100.0% and 96.4%, respectively. On multivariate analysis, initial visual impairment score (≥20) was the only significant risk factor for postoperative neurologic sequelae (P < 0.001; odds ratio, 40.8). Surgical timing was not associated with postoperative neurological recovery (P = 0.733). CONCLUSIONS:Ocular palsy was fully recovered in 96.4% patients with pituitary apoplexy after transsphenoidal surgery. Initial visual impairment status was found to be more strongly associated with postoperative neurologic recovery than surgical timing.
Authors: Scott C Seaman; Mark C Dougherty; Mario Zanaty; Leslie A Bruch; Scott M Graham; Jeremy D W Greenlee Journal: J Neurol Surg B Skull Base Date: 2020-06-19
Authors: Mohammed Alahmari; Fahad Alkherayf; Andrea Lasso; Fatmahalzahra Banaz; Sepideh Mohajeri; Pourya Masoudian; Andre Lamothe; Charles Agbi; Lisa Caulley; Mohammad Alshardan; Shaun Kilty Journal: J Neurol Surg B Skull Base Date: 2021-01-21