Advertisement

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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Pituitary adenoma Pituitary apoplexy Visual defect Legal blindness Hormone replacement 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Semple PL, Webb MK, de Villiers JC, Laws ER Jr (2005) Pituitary apoplexy. Neurosurgery 56:65–72PubMedGoogle Scholar
  2. 2.
    Verrees M, Arafah BM, Selman WR (2004) Pituitary tumor apoplexy: characteristics, treatment, and outcomes. Neurosurg Focus 16:E6PubMedCrossRefGoogle Scholar
  3. 3.
    Lee CC, Cho AS, Carter WA (2000) Emergency department presentation of pituitary apoplexy. Am J Emerg Med 18:328–331PubMedCrossRefGoogle Scholar
  4. 4.
    Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA (1999) Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol (Oxf) 51:181–188CrossRefGoogle Scholar
  5. 5.
    da Motta LA, de Mello PA, de Lacerda CM, Neto AP, da Motta LD, Filho MF (1999) Pituitary apoplexy. Clinical course, endocrine evaluations and treatment analysis. J Neurosurg Sci 43:25–36PubMedGoogle Scholar
  6. 6.
    Wakai S, Fukushima T, Teramoto A, Sano K (1981) Pituitary apoplexy: its incidence and clinical significance. J Neurosurg 55:187–193PubMedGoogle Scholar
  7. 7.
    Bauer M, Lang C, Patzelt D (2001) Sudden death due to pituitary apoplexy. Leg Med (Tokyo) 3:183–186Google Scholar
  8. 8.
    Bills DC, Meyer FB, Laws ER Jr, Davis DH, Ebersold MJ, Scheithauer BW, Ilstrup DM, Abboud CF (1993) A retrospective analysis of pituitary apoplexy. Neurosurgery 33:602–608PubMedGoogle Scholar
  9. 9.
    Peter M, De Tribolet N (1995). Visual outcome after transsphenoidal surgery for pituitary adenomas. Br J Neurosurg 9:151–157Google Scholar
  10. 10.
    Agrawal D, Mahapatra AK (2005) Visual outcome of blind eyes in pituitary apoplexy after transsphenoidal surgery: a series of 14 eyes. Surg Neurol 63:42–46PubMedCrossRefGoogle Scholar
  11. 11.
    Robinson JL (1972) Sudden blindness with pituitary tumors. Report of three cases. J Neurosurg 36:83–85PubMedGoogle Scholar
  12. 12.
    Chanson P, Lepeintre JF, Ducreux D (2004) Management of pituitary apoplexy. Expert Opin Pharmacother 5:1287–1298PubMedCrossRefGoogle Scholar
  13. 13.
    Ebersold MJ, Laws ER Jr, Scheithauer BW, Randall RV (1983) Pituitary apoplexy treated by transsphenoidal surgery. A clinicipathological and immunocytochemical study. J Neurosurg 58:315–320PubMedCrossRefGoogle Scholar
  14. 14.
    Cardoso ER, Peterson EW (1984) Pituitary apoplexy: a review. Neuosurgery 14:363–373CrossRefGoogle Scholar
  15. 15.
    Dokmetas HS, Selcuklu A, Colak R, Unluhizarci K, Bayram F, Kelestimur F (1999) Pituitary apoplexy probably due to TRH and GnRH stimulation tests in a patient with acromegaly. J Endocrinol Invest 22:698–700PubMedGoogle Scholar
  16. 16.
    Wiesmann M, Gliemroth J, Kehler U, Missler U (1999) Pituitary apoplexy after cardiac surgery presenting as deep coma with dilated pupils. Acta Anaesthesiol Scand 43:236–238PubMedCrossRefGoogle Scholar
  17. 17.
    Meek EN, Butterworth J, Kon ND, Zvara DA, Ash GE Jr, Martin TJ (1998) Pituitary apoplexy following mitral valve repair. Anesthesiology 89:1580–1582PubMedCrossRefGoogle Scholar
  18. 18.
    Cohen A, Kishore K, Wolansky L, Frohman L (2004) Pituitary apoplexy occurring during large volume liposuction surgery. J␣Neuroophthalmol 24:31–33PubMedGoogle Scholar
  19. 19.
    Acar F, Mertol T (2004) Pituitary apoplexy following laparascopic choleocystectomy. Acta Neurochir (Wien) 146:1275–1276CrossRefGoogle Scholar
  20. 20.
    Yahagi N, Nishikawa A, Matsui S, Komoda Y, Sai Y, Amakata Y (1992) Pituitary apoplexy following cholecystectomy. Anaesthesia 47:234–236PubMedGoogle Scholar
  21. 21.
    Liu JK, Nwagwu C, Pikus HJ, Couldwell WT (2001) Laparoscopic anterior lumbar interbody fusion precipitating pituitary apoplexy. Acta Neurochir (Wien) 143:303–306CrossRefGoogle Scholar
  22. 22.
    Willamowicz AS, Houlden RL (1999) Pituitary apoplexy after anticoagulation for unstable angina. Endocr Pract 5:273–276PubMedGoogle Scholar
  23. 23.
    Korotinsky S, Smadja P, Goland S, Somin M, Attali M, Zhornicky T, Malnick SD (2002) Pituitary apoplexy after administration of heparin and isosorbide dinitrate. South Med J 95:469–470PubMedGoogle Scholar
  24. 24.
    Fuchs S, Beeri R, Hasin Y, Weiss AT, Gotsman MS, Zahger D (1998) Pituitary apoplexy as a first manifestation of pituitary adenomas following intensive thrombolytic and antithrombotic therapy. Am J Cardiol 81:110–111PubMedCrossRefGoogle Scholar
  25. 25.
    Biousse V, Newman NJ, Oyesiku NM (2001) Precipitating factors in pituitary apoplexy. J Neurol Neurosurg Psychiatry 71:542–545PubMedCrossRefGoogle Scholar
  26. 26.
    Shou XF, Li SQ, Wang YF, Zhao Y, Jia PF, Zhou LF (2005) Treatment of pituitary adenomas with a transsphenoidal approach. Neurosurgery 56:249–256PubMedCrossRefGoogle Scholar
  27. 27.
    Maccagnan P, Macedo CL, Kayath MJ, Nogueira RG, Abucham J (1995) Conservative management of pituitary apoplexy: a prospective study. J Clin Endocrinol Metab 80:2190–2197PubMedCrossRefGoogle Scholar
  28. 28.
    Laws ER, Jane JA Jr (2005) Neurosurgical approach to treating pituitary adenomas. Growth Horm IGF Res 15(Suppl A):S36–41PubMedCrossRefGoogle Scholar
  29. 29.
    Chuang CC, Chen YL, Pai PC (2006) A giant intracavernous carotid artery aneurysm embedded in pituitary macroadenoma presenting with pituitary apoplexy. Cerebrovasc Dis 21:142–144PubMedCrossRefGoogle Scholar
  30. 30.
    Wick B, Schor CM (1984) A comparison of the Snellen chart and S-chart for visual acuity in amblyopia. J Am Optom Assoc 55:359–361PubMedGoogle Scholar
  31. 31.
    Cook MW, Levin LA, Joseph MP, Pinczower EF (1996) Traumatic optic neuropathy. A meta-analysis. Arch Otolaryngol Head Neck Surg 122:389–392PubMedGoogle Scholar
  32. 32.
    Pandit JC (1994) Testing acuity vision in general practice: reaching recommended standard. BMJ 309:1408PubMedGoogle Scholar
  33. 33.
    Lubina A, Olchovsky D, Berezin M, Ram Z, Hadani M, Shimon I (2005) Management of pituitary apoplexy: clinical experience with 40 patients. Acta Neurochir (Wien) 147:151–157CrossRefGoogle Scholar
  34. 34.
    Ayuk J, McGregor EJ, Mitchell RD, Gittoes NJ (2004) Acute management of pituitary apoplexy – surgery or conservative management? Clin Endocrinol (Oxf) 61:747–752CrossRefGoogle Scholar
  35. 35.
    Laws ER Jr, Ebersold MJ (1982) Pituitary apoplexy – an endocrine emergency. World J Surg 6:686–688PubMedCrossRefGoogle Scholar

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

Personalised recommendations