LAUSR

BACKGROUND The management of pituitary apoplexy, caused by acute hemorrhage and/or infarction of a pituitary adenoma, is debated. OBJECTIVE Analyze clinical characteristics of patients undergoing endoscopic endonasal approaches (EEA) for pituitary apoplexy. METHODS A retrospective review of patients undergoing EEA from 2012-2018 at our institution for pituitary apoplexy diagnosed clinically and with imaging/pathological findings. Analysis included demographics, symptoms, neuroendocrine deficits, neuroimaging, complications, symptom resolution and follow-up details. RESULTS Fifty patients (mean age 53 years) were included. Preoperative symptoms included headache (86%), vision loss (62%) and cranial nerve (CN) paresis (40%). Mean tumor diameter was 2.7 cm and extrasellar extension was observed in 96% of tumors. 28 tumors were hemorrhagic (76%), 24 were necrotic (65%), and 13 (35%) had both features. MRI 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 cases, partially improved in 11%, and remained unchanged in 17% of cases. 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%), transient postoperative vision loss requiring reoperation (n=1, 4%). Endocrinopathies improved in 21% of patients, panhypopituitarism persisted in 48% and developed in 6% of patients. Mean follow-up time was 26 months; two patients demonstrated recurrence. CONCLUSIONS EEA for pituitary apoplexy is effective in rapidly improving headache and visual symptoms. Although neuro-ophthalmic deficits often improve over time, panhypopituitarism persists in the majority of patients following surgical resection.; Abbreviations List: EEA: endoscopic endonasal approach , CN: cranial nerve, MRI: magnetic resonance imaging, GH: growth hormone, ACTH: adrenocorticotropic hormone, DDAVP: Desmopressin, ANA: anti-nuclear antibodies, DVT/PE: deep vein thrombosis/pulmonary embolism, NFPA: nonfunctional pituitary adenoma, CSF: cerebrospinal fluid, DI: diabetes insipidus , TSS: transsphenoidal surgery.