Hemorrhagic pituitary macroadenoma: characteristics, endoscopic endonasal transsphenoidal surgery, and outcomes.
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.
Zhang
Xiang
X
Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, People's Republic of China. xzhang@fmmu.edu.cn
Zhang
Wei
W
Fu
Luo-an
LA
Cheng
Jin-xiang
JX
Liu
Bo-lin
BL
Cao
Wei-dong
WD
Fei
Zhou
Z
Zhang
Jian-ning
JN
Liu
Wei-ping
WP
Zhen
Hai-ning
HN
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