TY - JOUR
T1 - Pituitary Apoplexy
T2 - Results of Surgical and Conservative Management Clinical Series and Review of the Literature
AU - Almeida, Joao Paulo
AU - Sanchez, Miguel Marigil
AU - Karekezi, Claire
AU - Warsi, Nebras
AU - Fernández-Gajardo, Rodrigo
AU - Panwar, Jyoti
AU - Mansouri, Alireza
AU - Suppiah, Suganth
AU - Nassiri, Farshad
AU - Nejad, Romina
AU - Kucharczyk, Walter
AU - Ridout, Rowena
AU - Joaquim, Andrei F.
AU - Gentili, Fred
AU - Zadeh, Gelareh
PY - 2019/10
Y1 - 2019/10
N2 - Objective: Pituitary apoplexy is associated with visual, cranial nerve, and endocrine dysfunction. In this article, the results of surgical and conservative management of pituitary apoplexy in a single center are evaluated and a review of the literature is presented. Methods: A retrospective analysis was made of patients with pituitary apoplexy who underwent surgery or conservative management at our center between January 2007 and June 2017. Surgery was typically selected for patients who presented with acute deterioration of visual status and/or level of consciousness. Patients with no visual field deficit and those who had medical contraindications to undergo a surgical procedure because of previous comorbidities typically had conservative treatment. Baseline characteristics and clinical and radiologic outcomes were reviewed. A review of the literature (1990–2018) was performed according to PRISMA guidelines. Studies comparing the results of conservative and surgical management were identified. Visual, cranial nerve, and endocrine outcomes and tumor recurrence were analyzed. Results: Forty-nine patients (73.1%) were managed surgically and 18 (26.9%) conservatively. After careful case selection, patients underwent surgical or conservative treatment. Patients who underwent conservative treatment had fewer visual deficits. At diagnosis, visual deficit (38.8% vs. 75.5%; P = 0.008) and cranial nerve palsy (27.7% vs. 51%; P = 0.058) were less common in the conservative group. Conservative and surgical treatments had similar visual and cranial nerve improvement rates (75% vs. 58.3%, P = 0.63 and 75% vs. 69.2%, P = 1.0, respectively). In the conservative group, tumor shrinkage was observed in 76.4% of cases. The systematic review retrieved 11 studies. No significant difference between conservative and surgical treatment for clinical outcomes (visual field recovery, odds ratio [OR], 1.45; 95% confidence interval [CI], 0.72–2.92; cranial nerve recovery, OR, 2.30; 95% CI, 0.93–5.65; and hypopituitarism, OR, 1.05; 95% CI, 0.64–1.74) or tumor recurrence (OR, 0.68; 95% CI, 0.20–2.34) was observed. Conclusions: A tailored approach to pituitary apoplexy, one that does not include an absolute need for surgery, is appropriate. Conservative management is appropriate in selected patients presenting without visual deficits.
AB - Objective: Pituitary apoplexy is associated with visual, cranial nerve, and endocrine dysfunction. In this article, the results of surgical and conservative management of pituitary apoplexy in a single center are evaluated and a review of the literature is presented. Methods: A retrospective analysis was made of patients with pituitary apoplexy who underwent surgery or conservative management at our center between January 2007 and June 2017. Surgery was typically selected for patients who presented with acute deterioration of visual status and/or level of consciousness. Patients with no visual field deficit and those who had medical contraindications to undergo a surgical procedure because of previous comorbidities typically had conservative treatment. Baseline characteristics and clinical and radiologic outcomes were reviewed. A review of the literature (1990–2018) was performed according to PRISMA guidelines. Studies comparing the results of conservative and surgical management were identified. Visual, cranial nerve, and endocrine outcomes and tumor recurrence were analyzed. Results: Forty-nine patients (73.1%) were managed surgically and 18 (26.9%) conservatively. After careful case selection, patients underwent surgical or conservative treatment. Patients who underwent conservative treatment had fewer visual deficits. At diagnosis, visual deficit (38.8% vs. 75.5%; P = 0.008) and cranial nerve palsy (27.7% vs. 51%; P = 0.058) were less common in the conservative group. Conservative and surgical treatments had similar visual and cranial nerve improvement rates (75% vs. 58.3%, P = 0.63 and 75% vs. 69.2%, P = 1.0, respectively). In the conservative group, tumor shrinkage was observed in 76.4% of cases. The systematic review retrieved 11 studies. No significant difference between conservative and surgical treatment for clinical outcomes (visual field recovery, odds ratio [OR], 1.45; 95% confidence interval [CI], 0.72–2.92; cranial nerve recovery, OR, 2.30; 95% CI, 0.93–5.65; and hypopituitarism, OR, 1.05; 95% CI, 0.64–1.74) or tumor recurrence (OR, 0.68; 95% CI, 0.20–2.34) was observed. Conclusions: A tailored approach to pituitary apoplexy, one that does not include an absolute need for surgery, is appropriate. Conservative management is appropriate in selected patients presenting without visual deficits.
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U2 - 10.1016/j.wneu.2019.07.055
DO - 10.1016/j.wneu.2019.07.055
M3 - Article
C2 - 31302273
AN - SCOPUS:85070320189
SN - 1878-8750
VL - 130
SP - e988-e999
JO - World Neurosurgery
JF - World Neurosurgery
ER -