title: The impact of surgical timing on visual outcome in pituitary apoplexy: Literature review and case illustration.
abstract: BACKGROUND
  Neuro-ophthalmologic signs are common clinical manifestations of pituitary apoplexy. Managing sudden visual loss is critical for achieving a good outcome. The timing of pituitary surgery remains controversial. In fact, various points of view have been reported in the literature.
  
  
  METHODS
  We reviewed the impact of surgical intervention timing on visual outcome. The surgical intervention time was classified as urgent, early, intermediate, and late interventions based on the literature review. We report a case of a 40-year-old male patient who presented with headache and sudden visual loss for 3 days. He was diagnosed with pituitary apoplexy and had transnasal-transsphenoidal resection. Three days later, he achieved a complete recovery of his vision.
  
  
  RESULTS
  This paper is an addition to several studies that favor early surgical decompression of pituitary fossa for apoplexy cases with severe neuro-ophthalmologic involvement. There is an increasing trend for early surgical intervention for pituitary apoplexy in the literature, especially for severe visual deterioration.
  
  
  CONCLUSIONS
  The visual outcome appears to be better in early intervention as compared to late. Nevertheless, good visual recovery is also seen in late surgical intervention.
authors.affiliation: Department of Neurosciences, Division of Neurosurgery, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia; Alfaisal University, College of Medicine, Riyadh 11533, Saudi Arabia.
authors.forename: Arif
authors.initials: A
authors.lastname: Abdulbaki
authors.affiliation: Department of Neurosciences, Division of Neurosurgery, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia; Alfaisal University, College of Medicine, Riyadh 11533, Saudi Arabia.
authors.forename: Imad
authors.initials: I
authors.lastname: Kanaan
keywords: Pituitary apoplexy; transsphenoidal surgery; visual outcome