Evaluation of the efficacy and outcome of endoscopic endonasal trans-sphenoidal surgery for treatment of pituitary apoplexy

Abstract

Background Pituitary apoplexy (PA) is a very serious clinical syndrome with serious long-term effects. It can be managed either conservatively or surgically depending on the presentation and co-morbidities of each case. Aim Is to evaluate the outcome of the endoscopic trans-sphenoidal approach in the treatment of patients with PA and to evaluate its safety and efficacy. Patients and methods This is a combined retrospective and prospective study on 14 patients with PA who underwent endoscopic endonasal trans-sphenoidal surgery. The analysis included demographics, risk factors, symptoms, neuro-endocrinal deficits, neuroimaging, complications, and outcomes. Results 14 patients (mean age was 47.21) were included. Preoperative symptoms included headache (100%), ocular mobility (78.6%), and visual deficits (92.9%). Radiological findings showed that (21.4%) were necrotic only, while (78.6%) were both necrotic and hemorrhagic. 100% of patients had resolved headache. (23.1%), (61.5%), and (15.4%) of patients had recovered, partially improved, and no change in visual acuity respectively. (72.7%) had recovered extraocular palsies, (18.2%) were partially improved, and (9.1%) had no change in extraocular palsies. (23.1%), (46.2%), and (30.8%) had recovered, partially improved, and no change in hormonal functions, respectively. (76.9%) needed long-term replacement therapy. (7.1%) had partial tumor resection, (57.1%) had subtotal resection, (35.7%) had gross total resection, and (100%) had tumor regression and no recurrence. Conclusion Endoscopic endonasal trans-sphenoidal surgery is a safe and effective treatment for PA with excellent neurological outcome, good visual outcome, low rates of complications, and recurrence. However, it has Poor hormonal outcomes.