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J Neurol Surg B Skull Base 2022; 83(S 02): e1-e6
DOI: 10.1055/s-0040-1722668
Original Article

Recovery of Cranial Nerve Deficits in Patients Presenting with Pituitary Apoplexy: A Case Series

Mohammed Alahmari
1   Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
,
Fahad Alkherayf 
2   Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
3   The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
,
Andrea Lasso
1   Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
3   The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
,
Fatmahalzahra Banaz
4   Department of Otolaryngology Head and Neck Surgery, King Abdulaziz Hospital, Ministry of Health, Jeddah, Saudi Arabia
,
Sepideh Mohajeri
1   Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
,
Pourya Masoudian
1   Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
,
Andre Lamothe
1   Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
,
Charles Agbi
2   Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
,
Lisa Caulley
1   Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
3   The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
,
Mohammad Alshardan
2   Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
,
Shaun Kilty 
1   Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
3   The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
5   Dr. S. Kilty Medicine Prof. Corp., Ottawa, Ontario, Canada
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Abstract

Background Pituitary apoplexy (PA) is a rare complication of pituitary tumors that can present with a myriad of symptoms, including sudden onset cranial nerve deficits. After patient stabilization and hormone replacement, surgical decompression is often recommended. The timing of surgical decompression remains controversial. In this case series, we describe our institutional experience pertaining to the cranial nerve recovery in patients who underwent endoscopic endonasal transsphenoidal (EETS) surgery for PA while evaluating outcome based on tumor stage using the suprasellar infrasellar parasellar anterior posterior (SIPAP) classification.

Design Present study is a single-institution retrospective cohort.

Methods A retrospective review of all EETS cases for pituitary tumor resection between November 2009 and August 2018. Queries of the hospital database were completed by trained personnel to identify cases of PA treated using the EETS approach. Baseline characteristics, tumor type, endocrine data, and SIPAP classification based on preoperative magnetic resonance imaging (MRI) and operation characteristics were extracted from medical records. Postoperative results were extracted for the duration of the follow-up period available for each patient.

Results Fifteen cases of PA were identified. Patient follow-up period was a mean of 30 months. The cranial nerve deficits present at admission were visual deficit (33%); unilateral third nerve palsy (47%) and unilateral sixth nerve palsy (27%). No fourth nerve palsies were observed. Following EETS, 60% of patients with preoperative visual deficit had normal visual fields. For those with third and sixth nerve palsies preoperatively, 43 and 75%, respectively, had return to normal function postoperatively. SIPAP tumor characteristics were not related to postoperative cranial nerve recovery.

Conclusion In this series of surgically treated patients with pituitary apoplexy, all cranial nerve deficits normalized or improved following surgery. The tumor SIPAP classification was not associated with patient outcome. Though in a small series, the presented results suggest surgical treatment is beneficial for these patients.

Keywords

pituitary apoplexy - cranial nerve deficit - pituitary adenoma


Publication History

Received: 06 May 2020

Accepted: 01 November 2020

Article published online:
21 January 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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