• Dhiraj J Pangal, Kelsi Chesney, Zoe Memel, Phillip A Bonney, Ben A Strickland, John Carmichael, Mark Shiroishi, Jason Liu Chia-Shang CS Department of Radiology, Keck School of Medicine of University of Southern California, Los Angeles, California, USA., and Gabriel Zada.
• Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
• World Neurosurg. 2020 May 1; 137: e366-e372.

BackgroundThe management of pituitary apoplexy, caused by acute hemorrhage and/or infarction of a pituitary adenoma, is debated.ObjectiveTo analyze clinical characteristics of patients undergoing endoscopic endonasal approaches (EEAs) for pituitary apoplexy.MethodsA retrospective review of patients at our institution from 2012 to 2018 undergoing EEA for pituitary apoplexy diagnosed clinically and with imaging/pathologic findings. Analysis included demographics, symptoms, neuroendocrine deficits, neuroimaging, complications, symptom resolution, and follow-up details.ResultsFifty patients (mean age, 53 years) were included. Preoperative symptoms included headache (86%), vision loss (62%), and cranial nerve paresis (40%). Mean tumor diameter was 2.7 cm and extrasellar extension was observed in 96% of tumors. Twenty-eight tumors were hemorrhagic (76%), 24 were necrotic (65%), and 13 (35%) had both features. Magnetic resonance imaging showed gross total resection in 58% of patients. Headache and vision loss improved in 87% and 86% of presenting patients. Cranial nerve paresis resolved in 72% of patients, partially improved in 11%, and remained unchanged in 17%. There were no deaths or carotid artery injuries. Surgical complications included postoperative cerebrospinal fluid leak (n = 4, 8%), epistaxis (n = 2, 4%), postoperative abscess (n = 1, 2%), and transient postoperative vision loss requiring reoperation (n = 1, 4%). Endocrinopathies improved in 21% of patients and panhypopituitarism persisted in 48% and developed in 6% of patients. Mean follow-up time was 26 months; 2 patients experienced recurrence.ConclusionsEEA for pituitary apoplexy is effective in rapidly improving headache and visual symptoms. Although neuro-ophthalmic deficits often improve over time, panhypopituitarism persists in most patients after surgical resection.Copyright © 2020. Published by Elsevier Inc.

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