Artikel
Outcome after subacute transsphenoidal surgery for pituitary apoplexy – preliminary results of a monocentric analysis
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Autoren
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Marcel Seiz-Rosenhagen
- Neurochirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Deutschland
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Marc Sebastian Walter
- Neurochirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Deutschland
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Dirk Michael Schulte
- Neurochirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Deutschland
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David Capper
- Abteilung für Neuropathologie, Pathologisches Institut Heidelberg, Klinische Kooperationseinheit DKFZ, Universität Heidelberg, Deutschland
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Alexander Lammert
- V. Medizinische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Deutschland
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: Pituitary apoplexy means acute hemorrhage or infarction of a pituitary adenoma with possible visual, oculomotor or endocrine disturbances. There is still controversy about the indication and especially the timing for surgery. We report our preliminary results of a prospective analysis of subacute surgery for pituitary apoplexy based on a single center experience.
Method: 17 consecutive patients with pituitary apoplexy were microsurgically operated via an endonasal transsphenoidal route between March 2013 and October 2014. Routine endocrine tests were performed pre- and postoperatively on day -1 and 5 as well as 4,12 and 26 weeks. Recovery of visual and oculomotor disturbancies was evaluated at dismission and 6-8 weeks postoperatively. 13 patients now passed the complete postoperative diagnostic work-up and their results can be presented.
Results: The patients' median age was 67 years (range 44-83, f:m 4:9). Median time from symptom to surgery was 13 days (range 3-107), median time from admission to surgery was 4 days (range 0-14). Patients' symptoms included headache (31.7%), visual impairment (53.8%), double vision (38%) and Addison crisis (30.8%). Mortality was 0%, 1 patient received a lumbar drainage for 7 days. There was no need for second surgery. Improvement and finally recovery of visual impairment and oculomotor palsy was seen in all patients so far. Neuro-endocrine deficiencies were found in all patients with partial pituitary impairment in 46%. Panhypopituitarism persisted in 2 patients. Recovery of pituitary function was associated with higher preoperative prolactin levels (mean 18 vs. 1,03ng/ml; p=0.0364).
Conclusions: The subacute surgical treatment for pituitary apoplexy leads to recovery of visual symptoms and neuroendocrine deficiencies without evidence for procedure-related morbidity and mortality. These preliminary results suggest that prolactin might be a good prognostic parameter for recovery of pituitary function.
