Surgical versus non-surgical treatment for pituitary apoplexy: A systematic review and meta-analysis

Tu, Ming; Lü, Qin; Zhu, Penglei; Zheng, Wenjie

doi:10.1016/j.jns.2016.09.047

Cited by 54 publications

(33 citation statements)

References 14 publications

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“…Historically, this condition was considered a neurosurgical emergency with immediate corticosteroid administration, surgical sellar decompression, hemorrhage evacuation, and tumor resection. Most agree that patients presenting with acute onset altered consciousness, and severe and/or progressive visual dysfunction and/or diplopia from cranial neuropathy, warrant rapid endonasal transsellar surgical decompression, with bony sellar decompression, and microsurgical resection of the adenoma, hemorrhage, and necrosis. Endoscopic sellar decompression and adenoma resection has been shown to improve vision in nearly 75% of patients with low rates of complications and low rates of new endocrinopathy .…”

Section: Intradural Tumorsmentioning

confidence: 99%

“…Although surgery was previously held as the standard of care in the management of pituitary apoplexy, there has been a trend toward more conservative management, especially in less symptomatic patients . Nonsurgical management has been successfully employed in carefully selected patients presenting with pituitary apoplexy, particularly those with only mild, nonprogressive ophthalmologic findings, and without alterations in mental status . Mild endocrinopathy has also been shown to improve with steroid treatment, more likely in the setting of pituitary infarction alone than with overt hemorrhage .…”

Section: Intradural Tumorsmentioning

confidence: 99%

“…Nonsurgical management has been successfully employed in carefully selected patients presenting with pituitary apoplexy, particularly those with only mild, nonprogressive ophthalmologic findings, and without alterations in mental status . Mild endocrinopathy has also been shown to improve with steroid treatment, more likely in the setting of pituitary infarction alone than with overt hemorrhage . It is important to note, however, that many patients have a more subacute and progressive presentation, and may develop delayed visual disturbance requiring surgical decompression .…”

Section: Intradural Tumorsmentioning

confidence: 99%

“…Mild endocrinopathy has also been shown to improve with steroid treatment, more likely in the setting of pituitary infarction alone than with overt hemorrhage . It is important to note, however, that many patients have a more subacute and progressive presentation, and may develop delayed visual disturbance requiring surgical decompression . As with most conditions, careful preoperative evaluation and patient selection are paramount to good outcomes.…”

Section: Intradural Tumorsmentioning

confidence: 99%

“…No RCTs have been performed between surgical and medical management of pituitary apoplexy, such that most studies are subject to retrospective and patient selection bias. As a result, existing reviews have failed to demonstrate a significant difference in visual or endocrine outcomes between surgical and conservative management of pituitary apoplexy . As always, careful patient selection is essential in the management of pituitary apoplexy, and urgent surgical decompression is advocated in the setting of decreased consciousness, severe visual or hormonal dysfunction, and a nonsurgical approach may be taken in those cases of mild and subacute presentations, with close monitoring and hormonal supplementation as needed (see Table ).…”

Section: Intradural Tumorsmentioning

confidence: 99%

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ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

160

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Section: Intradural Tumorsmentioning

confidence: 99%

Section: Intradural Tumorsmentioning

confidence: 99%