Surgical treatment for severe visual compromised patients after pituitary apoplexy.
BACKGROUND
Pituitary apoplexy is a rare neurovascular insult. Early surgical decompression is the most effective treatment, especially for rapid deterioration of visual acuity or for altered consciousness. The timing of rapidly expanded mass was strongly related to the treatment outcome.


METHODS
Thirteen patients who presented with severe visual defect after pituitary apoplexy were enrolled retrospectively. Six patients without severe underlying diseases were considered non-complicated and were treated early. Another seven patients who received delayed treatment after medical problems were stabilized and/or conservative management failed were considered to be complicated. The visual acuity of each individual eye was evaluated and organized into six grades based on visual acuity. Twelve patients received transsphenoidal surgery and one craniotomy was performed for tumor removal.


RESULTS
The delay of surgical treatment was 3.5 days and 8.7 days in the two groups, respectively. Overall, 19 out of 26 eyes (73%) improved after surgery; 100% in non-complicated group and 50% in complicated group. The average grade of visual improvement was 2.66 vs. 0.71 by each individual eye, and the difference was statistically significant (P<0.000). The ratio of regained useful vision was significant in non-complicated patients (P<0.000). The incidence of requirement long-term hormone replacement was high in the complicated group (2/6 vs. 6/7). The resection rate was total in 8 patients, subtotal in 3, partial in 1, with one loss of image follow-up.


CONCLUSIONS
Early decompression significantly improved visual outcomes and the need for hormone replacement was minimal. We postulated old age, underlying malignant diseases, and coagulation disorders played the predisposing factors of poor outcome in these cases.
Chuang
Chi-Cheng
CC
Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
Chang
Chen-Nen
CN
Wei
Kuo-Chen
KC
Liao
Cheng-Chih
CC
Hsu
Peng-Wei
PW
Huang
Ying-Cheng
YC
Chen
Yao-Liang
YL
Lai
Li-Ju
LJ
Pai
Ping-Ching
PC
D000236:Adenoma / Q000150:complications / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000009:adverse effects; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010899:Pituitary Apoplexy / Q000150:complications* / Q000601:surgery*; D010902:Pituitary Gland / Q000098:blood supply / Q000473:pathology; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D015354:Vision, Low / Q000209:etiology* / Q000601:surgery*