Journal of Neuro-Oncology

, Volume 80, Issue 1, pp 39–47 | Cite as

Surgical treatment for severe visual compromised patients after pituitary apoplexy

  • Chi-Cheng Chuang
  • Chen-Nen Chang
  • Kuo-Chen Wei
  • Cheng-Chih Liao
  • Peng-Wei Hsu
  • Ying-Cheng Huang
  • Yao-Liang Chen
  • Li-Ju Lai
  • Ping-Ching Pai
Clinical–Patient Studies



Pituitary apoplexy is a rare neurovascular insult. Early surgical decompression is the most effective treatment, especially for rapid deterioration of visual acuity or for altered consciousness. The timing of rapidly expanded mass was strongly related to the treatment outcome.


Thirteen patients who presented with severe visual defect after pituitary apoplexy were enrolled retrospectively. Six patients without severe underlying diseases were considered non-complicated and were treated early. Another seven patients who received delayed treatment after medical problems were stabilized and/or conservative management failed were considered to be complicated. The visual acuity of each individual eye was evaluated and organized into six grades based on visual acuity. Twelve patients received transsphenoidal surgery and one craniotomy was performed for tumor removal.


The delay of surgical treatment was 3.5 days and 8.7 days in the two groups, respectively. Overall, 19 out of 26 eyes (73%) improved after surgery; 100% in non-complicated group and 50% in complicated group. The average grade of visual improvement was 2.66 vs. 0.71 by each individual eye, and the difference was statistically significant (P<0.000). The ratio of regained useful vision was significant in non-complicated patients (P<0.000). The incidence of requirement long-term hormone replacement was high in the complicated group (2/6 vs. 6/7). The resection rate was total in 8 patients, subtotal in 3, partial in 1, with one loss of image follow-up.


Early decompression significantly improved visual outcomes and the need for hormone replacement was minimal. We postulated old age, underlying malignant diseases, and coagulation disorders played the predisposing factors of poor outcome in these cases.


Pituitary adenoma Pituitary apoplexy Visual defect Legal blindness Hormone replacement 


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Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Chi-Cheng Chuang
    • 1
  • Chen-Nen Chang
    • 1
  • Kuo-Chen Wei
    • 1
  • Cheng-Chih Liao
    • 1
  • Peng-Wei Hsu
    • 1
  • Ying-Cheng Huang
    • 1
  • Yao-Liang Chen
    • 2
  • Li-Ju Lai
    • 3
    • 5
  • Ping-Ching Pai
    • 4
    • 5
  1. 1.Department of NeurosurgeryChang Gung Memorial Hospital, Chang Gung UniversityTaipeiTaiwan
  2. 2.Department of RadiologyChang Gung Memorial Hospital, Chang Gung UniversityTaipeiTaiwan
  3. 3.Department of OphthalmologyChang Gung Memorial Hospital, Chang Gung UniversityTaipeiTaiwan
  4. 4.Department of Radiation OncologyChang Gung Memorial Hospital, Chang Gung UniversityTaoyuan HsienTaiwan R.O.C.
  5. 5.Graduate Institute of Clinical Medical SciencesChang Gung Memorial Hospital, Chang Gung UniversityTaipeiTaiwan

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