gms | German Medical Science

Objective: Pituitary apoplexy is a rare disease with poor outcomes. The aim of this retrospective study is to determine the clinicopathological outcomes of a contemporary endoscopic series of patients with pituitary apoplexy. Results of a purely endoscopic transsphenoidal approach for pituitary apoplexy have not been examined in prior studies.

Method: Between September 1997 and December 2013, 729 cases of pituitary adenomas were operated using an endoscopic transphenoidal approach in the Department of Neurosurgery, Kocaeli University, Turkey. In this series, 25 (9 female, 16 male) patients with pituitary apoplexy underwent endoscopic transsphenoidal surgery.

Results: The age of the patients ranged from 23-82 years old, the mean age was 47.2. The average length of time from the ictus until surgery was 10.7 days. Twenty of 25 (80%) had inactive adenomas, 2 had acromegaly, 2 were prolactinomas and 1 was a ACTH adenoma. Headache was the most common presenting symptom (67%). A diminished level of consciousness was found in 11% of patients, a diminished visual acuity in 33% and ocular palsies in 42%. Eighty-three percent of the patients had hypopituitarism. In 15 patients, the predominant operative finding was hemorrhage with or without necrosis. 10 patients were found to have infarction alone. Visual fields and ophthalmoplegia improved after the operation in 85% and 100% of patients, respectively. Long-term hormone replacement therapy was necessary in 70% of patients. Diabetes insipidus was diagnosed in 16%.

Conclusions: Transphenoidal surgery is indicated in pituitary apoplexy patients with severe neuro-ophthalmic signs such as severely reduced visual acuity, severe and persistent or deteriorating visual field defects or a deteriorating level of consciousness, and hypothalamic dysfunction. The wide exposure provided by the endoscopic transphenoidal approach is found to lead to better results with early surgery for pituitary apoplexy.