Apoplejía hipofisaria: análisis de una serie de 14 casos operados por vía endoscópica endonasal.

Abstract

Objective. To present a series of cases of pituitary apoplexy (PA) that underwent endonasal endoscopic surgery and analyze the results.

Material. We retrospectively reviewed all consecutive cases of PA who underwent surgery between January 2013 and December 2019 in both Neurosurgery Departments. Endocrinological, visual, pathological, surgical outcomes and complications related to the procedure  were evaluated.

Results. Fourteen patients with PA were included, 11 (78.5%) were male and the mean age was 55.5 years. Twelve (85.7%) patients presented with visual field defects and 5 (35.1%) with cranial nerve palsies. Eleven (78.5%) were macroadenomas and 3 (21.4%) were giant adenomas; according to the Knosp grade, there were 4 (28.5%) invasive adenomas and 10 (71.4%) non-invasive. All underwent surgery within 48 hours of hospital admission and all exhibited visual improvement in the postoperative period. Eight (57.1%) patients were admitted with panhypopituitarism, without postoperative improvement. 8 (57.1%) total resections were achieved, 3 (21.4%) subtotal and 3 (21.4%) partial. Complications were 1 epistaxis, 1 syndrome of inappropriate antidiuretic hormone release and 1 death in the late postoperative period.

Conclusions. Endoscopic endonasal surgery is an effective and safe alternative to treat PA. In our series we obtained improvement in visual field defects and cranial nerve palsies in all cases; conversely, the endocrine deficits persisted, requiring hormonal replacement treatment. Multidisciplinary teamwork is critical for the management of this entity.