title: Hemorrhagic pituitary macroadenoma: characteristics, endoscopic endonasal transsphenoidal surgery, and outcomes.
abstract: OBJECTIVE
  This study aims to assess the effect of endoscopic endonasal transsphenoidal surgery (EETSS) of hemorrhagic pituitary macroadenoma (HPMA).
  
  
  METHODS
  We retrospectively reviewed 52 cases with HPMA collected from the Xijing Hospital from April 1995 to April 2009. There were 39 males and 13 females, ranging in age from 18 to 79 years (average 51.6 years). Patients presented with headache or acute ophthalmological symptoms after adenoma hemorrhage. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed pituitary macroadenoma with hemorrhage in all cases. Twenty-eight adenomas showed marked suprasellar extension, 19 showed moderate extension, and another 5 showed slight extension. All patients were promptly treated by emergency EETSS, usually within 24 h after hospitalization.
  
  
  RESULTS
  Total removal of tumor was achieved in 46 cases (88.5%), and subtotal removal in 6 cases (11.5%). Postoperative radiotherapy and reoperation of the tumor were required in five patients with either residual or relapsed tumors. Follow-up ranged from 8 to 93 months (mean 41.6 months) for 43 cases. Visual acuity and visual field recovery and improvement was recorded in 92.1% and 94.3% of patients who had preoperative visual symptoms, respectively.
  
  
  CONCLUSIONS
  The majority of macroadenomas are hemorrhagic, and they often occur in middle-aged, male subjects. Detection by imaging in the setting of pituitary apoplexy accurately predicts the nature of the apoplectic process and helps to guide the type and timing of surgery. Early EETSS is the most effective therapy and significantly improves visual outcomes and systemic conditions.
authors: Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, People's Republic of China. xzhang@fmmu.edu.cn
authors: Xiang
authors: X
authors: Zhang
authors: Wei
authors: W
authors: Zhang
authors: Luo-an
authors: LA
authors: Fu
authors: Jin-xiang
authors: JX
authors: Cheng
authors: Bo-lin
authors: BL
authors: Liu
authors: Wei-dong
authors: WD
authors: Cao
authors: Zhou
authors: Z
authors: Fei
authors: Jian-ning
authors: JN
authors: Zhang
authors: Wei-ping
authors: WP
authors: Liu
authors: Hai-ning
authors: HN
authors: Zhen
mesh_terms: D000236:Adenoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006470:Hemorrhage / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery*; D044583:Neuroendoscopy; D019635:Neurosurgical Procedures; D010911:Pituitary Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000601:surgery*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult