title: Endoscopic Endonasal Transsphenoidal Treatment of Pituitary Apoplexy: Outcomes in a Series of 20 Patients.
abstract: OBJECTIVE
  Pituitary apoplexy is a rare clinical entity and few cases treated with an endonasal endoscopic approach (EEA) have been reported. We report our experience of treating pituitary apoplexy using an EEA approach.
  
  
  METHODS
  We performed a retrospective chart review on all the patients who underwent EEA skull base and pituitary surgery between December 2003 and March 2012 performed by the senior authors (THS and VKA) and identified patients with pituitary apoplexy. The extent of resection was determined volumetrically and the visual and endocrine outcome was evaluated.
  
  
  RESULTS
  From a total of 488 skull base surgeries, there were 241 pituitary cases, of which 20 had apoplexy. The most common presenting symptoms included headaches (80%), endocrinopathy (95%), and visual symptoms (60%). Surgery was performed within 24 hours in 15% of patients, and > one month after ictus in 40% due to late referral. Gross-total resection (GTR) was achieved in 18 (90%) patients. There was one (5%) postoperative cerebrospinal fluid (CSF) leak treated with lumbar drainage. Of 12 patients with preoperative visual disturbances, seven had improvements. For those patients with visual field cuts, only 33.3% showed improvement. There was no postoperative visual deterioration. Two patients developed new transient postoperative diabetes insipidus (DI) but there was no new permanent DI. The mean duration of follow-up was 22 months (range: 6 days - 72 months).
  
  
  CONCLUSIONS
  The endoscopic endonasal transsphenoidal approach is an effective modality to treat pituitary apoplexy with a high rate of GTR and minimal risk. Delayed surgery may result in lower rates of visual field defect improvement.
authors.affiliation: Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York.
authors.forename: Tong
authors.initials: T
authors.lastname: Yang
authors.affiliation: Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York.
authors.forename: Fatema
authors.initials: F
authors.lastname: Bayad
authors.affiliation: Otolaryngology, Weill Cornell Medical College, New York Presbyterian Hospital, New York.
authors.forename: Madeleine R
authors.initials: MR
authors.lastname: Schaberg
authors.affiliation: Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York.
authors.forename: Dimigtri
authors.initials: D
authors.lastname: Sigounas
authors.affiliation: Otolaryngology, Weill Cornell Medical College, New York Presbyterian Hospital, New York.
authors.forename: Gurston
authors.initials: G
authors.lastname: Nyquist
authors.affiliation: Radiology, Division of Neuroradiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York.
authors.forename: Gregory
authors.initials: G
authors.lastname: Bonci
authors.affiliation: Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York.
authors.forename: Kunal
authors.initials: K
authors.lastname: Patel
authors.affiliation: Radiology, Division of Neuroradiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York.
authors.forename: Apostolos John
authors.initials: AJ
authors.lastname: Tsiouris
authors.affiliation: Department of Otorhinolaryngology, Weill Cornell Medical College, New York Presbyterian Hospital, New York.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Anand
authors.affiliation: Weill Cornell Brain and Spine Center, Weill Cornell Medical College, New York Presbyterian Hospital, New York.
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
keywords: endoscopic endonasal transsphenoidal; hormone replacement; pituitary adenoma; pituitary apoplexy; visual defect