Acute Hemorrhagic Apoplectic Pituitary Adenoma: Endoscopic Management, Surgical Outcomes, and Complications.
OBJECTIVE
To assess safety and effectiveness of endoscopic transsphenoidal surgery (ETS) for acute hemorrhagic apoplectic pituitary adenoma.


METHODS
Eighty nine patients with hemorrhagic apoplectic pituitary tumor undergoing endoscopic transsphenoidal surgery were included into a retrospective chart of this study. Charts were reviewed for patient age, sex, presentation, lesion size, surgical procedure, extent of resection, clinical outcome, and surgical complications.


RESULTS
Seventy eight (87.7%) patients achieved total resection, 9 (10.1%) had subtotal resection, and 2 (2.2%) patients had partial resection; no patient experienced insufficient resection. After surgery, 65 (90.3%) of 72 patients who had visual acuity deterioration preoperatively normalized and improved significantly; the rate for remission of visual field was 87.7%. All other acute symptoms, such as severe headache, nausea, vomiting, alteration of mental status, and loss of consciousness, vanished postoperatively. Twenty eight (90.4%) of 31 patients with active secreting adenoma had hormonal remission based on endocrinological evaluation. Three (3.4%) patients incurred CSF leakage which was managed with lumbar drainage. Nine (10.1%) patients incurred transient DI postoperatively, and 2 (2.2%) of them developed permanent DI. Seven (7.9%) patients developed hypopituitarism which was treated with replacement therapy of hormone. One (1.1%) experienced craniotomy for intracranial hemorrhage and died from severe surgical complications postoperatively. There were no patients of meningitis or carotid artery injury.


CONCLUSIONS
Early detection and emergent endoscopic transsphenoidal surgery provided a safe and effective surgical option for hemorrhagic apoplectic pituitary tumor with a low morbidity and mortality.
*Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Science Research Institute, Shandong University †Department of Neurosurgery, The Third People's Hospital of Jinan, Jinan, Shandong, China ‡Department of Neurology, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, China §Private Practice, Bakersfield, CA.
Rucai
R
Zhan
Yanxin
Y
Zhao
Timothy M
TM
Wiebe
Xingang
X
Li
D049913:ACTH-Secreting Pituitary Adenoma / Q000601:surgery; D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000601:surgery; D065634:Cerebrospinal Fluid Leak / Q000209:etiology; D015331:Cohort Studies; D003919:Diabetes Insipidus / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology; D020300:Intracranial Hemorrhages / Q000209:etiology; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D010899:Pituitary Apoplexy / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012449:Safety; D016896:Treatment Outcome; D055815:Young Adult