Joao Paulo Almeida1, Miguel Marigil Sanchez2, Claire Karekezi2, Nebras Warsi2, Rodrigo Fernández-Gajardo3, Jyoti Panwar4, Alireza Mansouri2, Suganth Suppiah2, Farshad Nassiri2, Romina Nejad2, Walter Kucharczyk4, Rowena Ridout5, Andrei F Joaquim6, Fred Gentili2, Gelareh Zadeh2. 1. Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Neurology, State University of Campinas (UNICAMP), Campinas, Brazil. Electronic address: jpaulocavalcante@yahoo.com.br. 2. Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. 3. Department of Neurological Sciences, University of Chile, Santiago, Chile. 4. Department of Radiology, University of Toronto, Toronto, Ontario, Canada. 5. Division of Endocrinology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. 6. Division of Neurosurgery, Department of Neurology, State University of Campinas (UNICAMP), Campinas, Brazil.
Abstract
OBJECTIVE: Pituitary apoplexy is associated with visual, cranial nerve, and endocrine dysfunction. In this article, the results of surgical and conservative management of pituitary apoplexy in a single center are evaluated and a review of the literature is presented. METHODS: A retrospective analysis was made of patients with pituitary apoplexy who underwent surgery or conservative management at our center between January 2007 and June 2017. Surgery was typically selected for patients who presented with acute deterioration of visual status and/or level of consciousness. Patients with no visual field deficit and those who had medical contraindications to undergo a surgical procedure because of previous comorbidities typically had conservative treatment. Baseline characteristics and clinical and radiologic outcomes were reviewed. A review of the literature (1990-2018) was performed according to PRISMA guidelines. Studies comparing the results of conservative and surgical management were identified. Visual, cranial nerve, and endocrine outcomes and tumor recurrence were analyzed. RESULTS: Forty-nine patients (73.1%) were managed surgically and 18 (26.9%) conservatively. After careful case selection, patients underwent surgical or conservative treatment. Patients who underwent conservative treatment had fewer visual deficits. At diagnosis, visual deficit (38.8% vs. 75.5%; P = 0.008) and cranial nerve palsy (27.7% vs. 51%; P = 0.058) were less common in the conservative group. Conservative and surgical treatments had similar visual and cranial nerve improvement rates (75% vs. 58.3%, P = 0.63 and 75% vs. 69.2%, P = 1.0, respectively). In the conservative group, tumor shrinkage was observed in 76.4% of cases. The systematic review retrieved 11 studies. No significant difference between conservative and surgical treatment for clinical outcomes (visual field recovery, odds ratio [OR], 1.45; 95% confidence interval [CI], 0.72-2.92; cranial nerve recovery, OR, 2.30; 95% CI, 0.93-5.65; and hypopituitarism, OR, 1.05; 95% CI, 0.64-1.74) or tumor recurrence (OR, 0.68; 95% CI, 0.20-2.34) was observed. CONCLUSIONS: A tailored approach to pituitary apoplexy, one that does not include an absolute need for surgery, is appropriate. Conservative management is appropriate in selected patients presenting without visual deficits.
OBJECTIVE:Pituitary apoplexy is associated with visual, cranial nerve, and endocrine dysfunction. In this article, the results of surgical and conservative management of pituitary apoplexy in a single center are evaluated and a review of the literature is presented. METHODS: A retrospective analysis was made of patients with pituitary apoplexy who underwent surgery or conservative management at our center between January 2007 and June 2017. Surgery was typically selected for patients who presented with acute deterioration of visual status and/or level of consciousness. Patients with no visual field deficit and those who had medical contraindications to undergo a surgical procedure because of previous comorbidities typically had conservative treatment. Baseline characteristics and clinical and radiologic outcomes were reviewed. A review of the literature (1990-2018) was performed according to PRISMA guidelines. Studies comparing the results of conservative and surgical management were identified. Visual, cranial nerve, and endocrine outcomes and tumor recurrence were analyzed. RESULTS: Forty-nine patients (73.1%) were managed surgically and 18 (26.9%) conservatively. After careful case selection, patients underwent surgical or conservative treatment. Patients who underwent conservative treatment had fewer visual deficits. At diagnosis, visual deficit (38.8% vs. 75.5%; P = 0.008) and cranial nerve palsy (27.7% vs. 51%; P = 0.058) were less common in the conservative group. Conservative and surgical treatments had similar visual and cranial nerve improvement rates (75% vs. 58.3%, P = 0.63 and 75% vs. 69.2%, P = 1.0, respectively). In the conservative group, tumor shrinkage was observed in 76.4% of cases. The systematic review retrieved 11 studies. No significant difference between conservative and surgical treatment for clinical outcomes (visual field recovery, odds ratio [OR], 1.45; 95% confidence interval [CI], 0.72-2.92; cranial nerve recovery, OR, 2.30; 95% CI, 0.93-5.65; and hypopituitarism, OR, 1.05; 95% CI, 0.64-1.74) or tumor recurrence (OR, 0.68; 95% CI, 0.20-2.34) was observed. CONCLUSIONS: A tailored approach to pituitary apoplexy, one that does not include an absolute need for surgery, is appropriate. Conservative management is appropriate in selected patients presenting without visual deficits.
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: Marta Araujo-Castro; Eider Pascual-Corrales; Alberto Acitores Cancela; Sara García Duque; Luis Ley Urzaiz; Víctor Rodríguez Berrocal Journal: Endocrine Date: 2020-08-12 Impact factor: 3.633
Authors: Rafael Martinez-Perez; Michael W Kortz; Benjamin W Carroll; Daniel Duran; James S Neill; Gustavo D Luzardo; Marcus A Zachariah Journal: World Neurosurg Date: 2021-06-12 Impact factor: 2.104