Pituitary Apoplexy

Surgical approach If surgical management is chosen, the transsphenoidal approach is almost always recommended, because it allows good decompression of the optic pathways and neuroanatomic structures in contact with the tumor, and because it is associated with low postoperative morbidity and mortality

Claire Briet; Sylvie Salenave; Jean-François Bonneville; Edward R. Laws; Philippe Chanson

2015

Scholarcy highlights

  • Surgical approach If surgical management is chosen, the transsphenoidal approach is almost always recommended, because it allows good decompression of the optic pathways and neuroanatomic structures in contact with the tumor, and because it is associated with low postoperative morbidity and mortality
  • In studies comparing the 2 strategies, visual acuity normalized after conservative management in 60%–100% of patients and improved in 25%, whereas visual field defects normalized in 50%– 100% of cases and improved in 25%
  • A computed tomography or magnetic resonance imaging scan confirms the diagnosis by revealing a pituitary tumor with hemorrhagic and/or necrotic components
  • Some authors advocate early transphenoidal surgical decompression for all patients, whereas others adopt a conservative approach for selected patients, namely those without visual acuity or field defects and with normal consciousness
  • If conservative treatment is chosen, careful monitoring of visual signs and symptoms is necessary, and surgical decompression is recommended if visual disorders do not improve or if they deteriorate
  • Clinical deterioration can be rapid and patients may not be able to be hospitalized for observation which may limit this approach

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