Long-term oncological outcomes after haemorrhagic apoplexy in pituitary adenoma managed operatively and non-operatively

Budohoski, Karol P.; Khawari, Sogha; Cavalli, Andrea; Quah, Boon Leong; Kolias, Angelos; Waqar, Mueez; Krishnan, Prahlad G.; Lawes, Indu; Cains, Fiona; Arwyn-Jones, James; Su, Zhangjie; Gurnell, Mark; Powlson, Andrew S; Donnelly, Neil; Tysome, James R.; Sharma, Rishi; Muthusamy, Brinda; Kearney, Tara; Robinson, Adam; Marcus, Hani J.; Gnanalingham, Kanna; Karabatsou, Konstantina; Pathmanaban, Omar; Sinha, Saurabh; Santarius, Thomas; Kirollos, Ramez

doi:10.1007/s00701-022-05119-8

Cited by 9 publications

(1 citation statement)

References 24 publications

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“…Our observed rates of the long-term recovery of CNDs mirror the estimations of several previous series [ 21 , 22 , 23 , 24 , 25 ]. However, whereas some have reported improved visual recovery with early surgery [ 26 , 27 , 28 ], this association was not reflected in our data. It is possible that early surgery could have exacerbated vision loss in this cohort, but we propose instead that early surgical patients presented with more severe vision loss that resolved at a lower rate, as multivariate analysis confirmed blindness to be independently associated with persistent deficit.…”

Section: Discussioncontrasting

confidence: 98%

Surgery for Pituitary Tumor Apoplexy Is Associated with Rapid Headache and Cranial Nerve Improvement

et al. 2022

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Pituitary tumor apoplexy (PTA) classically comprises sudden-onset headache, loss of vision, ophthalmoparesis, and decreased consciousness. It typically results from hemorrhage and/or infarction within a pituitary adenoma. Presentation is heterologous, and optimal management is debated. The time course of recovery of cranial nerve deficits (CNDs) and headaches is not well established. In this study, a retrospective series of consecutive patients with PTA managed at a single academic institution over a 22-year period is presented. Headaches at the time of surgery were more severe in the early and subacute surgical cohort and improved significantly within 72 h postoperatively (p < 0.01). At one year, 90% of CNDs affecting cranial nerves (CNs) 3, 4, and 6 had recovered, with no differences between early (<4 d), subacute (4–14 d), and delayed (>14 d) time-to-surgery cohorts. Remarkably, half recovered within three days. In total, 56% of CN2 deficits recovered, with the early surgery cohort including more severe deficits and recovering at a lower rate (p = 0.01). No correlation of time-to-surgery and rapidity of recovery of CNDs was observed (p = 0.65, 0.72). Surgery for PTA is associated with rapid recovery of CNDs in the early, subacute, and delayed time frames, and with rapid headache improvement in the early and subacute time frames in 50% or more of patients.

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Section: Discussioncontrasting

confidence: 98%

Surgery for Pituitary Tumor Apoplexy Is Associated with Rapid Headache and Cranial Nerve Improvement

et al. 2022

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Comparing neuroendocrine recovery between surgical and conservative management in pituitary apoplexy patients: a propensity score-matched analysis

Saktiwarawat,

Tunthanathip,

Oearsakul

et al. 2024

Neurosurg Rev

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Background: Pituitary apoplexy is a rare and potentially life-threatening clinical syndrome. Patients may present with severe neuro-ophthalmologic or endocrine symptoms. Current evidence is unclear whether conservative or surgical management leads to the best neuroendocrine outcomes. This study aimed to compare neuroendocrine outcomes between surgical and conservative treatments in a single center. Methods: Cases of patients with pituitary apoplexy who received transsphenoidal surgery or conservative management in Songklanagarind Hospital between January 1, 2005 and December 31, 2022 were retrospectively reviewed. A propensity score matching method was used to adjust bias from treatment selection (surgery or conservative treatment). Differences in visual acuity, visual eld, cranial nerve, and endocrine outcomes between the surgical and conservative treatment groups were analyzed using logistic regression analysis.Results: This study included 127 patients, with 98 and 29 patients in the surgical and the conservative treatment group, respectively. The optimal matching method was used for propensity score matching.Compared to the conservative group, the surgically treated patients had a signi cantly higher rate of visual eld recovery (odds ratio (OR): 12.89, P = 0.007). However, there were no statistical differences in the recovery rate of preoperative visual acuity, cranial nerve, and endocrine de cits between the groups.Conclusions: Transsphenoidal surgery was associated with a higher rate of visual eld recovery when compared to the conservative treatment for pituitary apoplexy patients. Careful selection of appropriate treatment based on the patient's presentation and neuroendocrine status will result in the best outcomes while avoiding unnecessary surgical intervention.

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The role of intervention timing and treatment modality in visual recovery following pituitary apoplexy: a systematic review and meta-analysis

Brown,

Patel,

Gendreau

et al. 2024

J Neurooncol

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Introduction Pituitary apoplexy has historically been considered an emergent condition that necessitates surgical intervention when there is acute symptomatic onset. This potentially serious condition often occurs in the setting of an underlying adenoma, cystic lesion, or other sellar mass. When these mass lesions hemorrhage within the confined space of the sella turcica, the pituitary gland is subjected to hemorrhagic ischemia. Furthermore, critical neurovasculature in close proximity to the sella can sustain collateral damage. In the present study, we investigate whether early versus delayed surgical intervention (in terms of three timelines: before versus after 48 h, 72 h, and 7 days, respectively) results in differences in visual outcomes for patients experiencing pituitary apoplexy with acute onset neurological and/or neuro-opthalmic symptoms. Furthermore, we compare the efficacy of surgical decompression versus expectant management of this condition. Methods Accordingly, we queried the PubMed, Scopus, and Embase databases in adherence to PRISMA guidelines. Quantitative meta-analysis was performed according to the Mantel–Haenszel method and forest plots were generated using Review Manager v5.4. P-values < 0.05 were defined as the threshold for statistical significance. Results Twenty-nine studies remained eligible for review following initial search and screen, including 16 studies describing the role of intervention timing and 15 studies comparing intervention modality. Most patients presented with a visual deficit, and all patients underwent surgery – most commonly via the endoscopic endonasal (EEA) approach. Two hundred and twenty patients were included in the sub-analysis for the 7-day cutoff point. Furthermore, 81 patients underwent surgical decompression of the sella prior to 48 h, and 32 patients underwent surgical decompression between 48–72 h following presentation. Almost all patients exhibited improved vision post-decompression, including 19/19 patients (100%) in the post-72-h cohort. On meta-analysis using the Mantel–Haenszel method, there was a significant difference in vision outcomes in favor of patients who underwent surgical decompression before 7 days as compared to after seven days (OR 5.88, 95% CI [1.77, 19.60], I2 = 0%, p < 0.01). In a separate sub-analysis, there was a total of 288 patients across 15 studies comparing surgical versus conservative management of pituitary apoplexy. These management options proved equivocal on meta-analysis (p > 0.05). Conclusion In the present study, timing of surgical intervention for pituitary apoplexy was predictive of visual function recovery only at the 7-day timepoint, as has been reported by previous studies. Ultimately, this suggests that pituitary apoplexy involving severe visual deficits or altered mental status is best addressed within the first seven days post-presentation, and that both surgery and conservative management can offer similar outcomes. When apoplexy is suspected, IV corticosteroids should be administered independent of acuity or severity to prevent secondary adrenal crisis. Subsequently, for patients presenting without severe visual or other neurological deficits, expectant management is recommended. Management should be patient-specific and dependent upon the severity of symptoms present at onset.

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Long-term oncological outcomes after haemorrhagic apoplexy in pituitary adenoma managed operatively and non-operatively

Cited by 9 publications

References 24 publications

Surgery for Pituitary Tumor Apoplexy Is Associated with Rapid Headache and Cranial Nerve Improvement

Surgery for Pituitary Tumor Apoplexy Is Associated with Rapid Headache and Cranial Nerve Improvement

Comparing neuroendocrine recovery between surgical and conservative management in pituitary apoplexy patients: a propensity score-matched analysis

The role of intervention timing and treatment modality in visual recovery following pituitary apoplexy: a systematic review and meta-analysis

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