Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Neurology, State University of Campinas (UNICAMP), Campinas, Brazil.
Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
World Neurosurg. 2019 Oct;130:e988-e999. doi: 10.1016/j.wneu.2019.07.055. Epub 2019 Jul 11.
Pituitary apoplexy is associated with visual, cranial nerve, and endocrine dysfunction. In this article, the results of surgical and conservative management of pituitary apoplexy in a single center are evaluated and a review of the literature is presented.
A retrospective analysis was made of patients with pituitary apoplexy who underwent surgery or conservative management at our center between January 2007 and June 2017. Surgery was typically selected for patients who presented with acute deterioration of visual status and/or level of consciousness. Patients with no visual field deficit and those who had medical contraindications to undergo a surgical procedure because of previous comorbidities typically had conservative treatment. Baseline characteristics and clinical and radiologic outcomes were reviewed. A review of the literature (1990-2018) was performed according to PRISMA guidelines. Studies comparing the results of conservative and surgical management were identified. Visual, cranial nerve, and endocrine outcomes and tumor recurrence were analyzed.
Forty-nine patients (73.1%) were managed surgically and 18 (26.9%) conservatively. After careful case selection, patients underwent surgical or conservative treatment. Patients who underwent conservative treatment had fewer visual deficits. At diagnosis, visual deficit (38.8% vs. 75.5%; P = 0.008) and cranial nerve palsy (27.7% vs. 51%; P = 0.058) were less common in the conservative group. Conservative and surgical treatments had similar visual and cranial nerve improvement rates (75% vs. 58.3%, P = 0.63 and 75% vs. 69.2%, P = 1.0, respectively). In the conservative group, tumor shrinkage was observed in 76.4% of cases. The systematic review retrieved 11 studies. No significant difference between conservative and surgical treatment for clinical outcomes (visual field recovery, odds ratio [OR], 1.45; 95% confidence interval [CI], 0.72-2.92; cranial nerve recovery, OR, 2.30; 95% CI, 0.93-5.65; and hypopituitarism, OR, 1.05; 95% CI, 0.64-1.74) or tumor recurrence (OR, 0.68; 95% CI, 0.20-2.34) was observed.
A tailored approach to pituitary apoplexy, one that does not include an absolute need for surgery, is appropriate. Conservative management is appropriate in selected patients presenting without visual deficits.
垂体卒中与视力、颅神经和内分泌功能障碍有关。本文评估了单一中心垂体卒中的手术和保守治疗结果，并进行了文献复习。
对 2007 年 1 月至 2017 年 6 月期间在我院接受手术或保守治疗的垂体卒中患者进行回顾性分析。手术通常适用于视力状况和/或意识水平急性恶化的患者。无视野缺损的患者和由于先前合并症而有手术禁忌证的患者通常接受保守治疗。回顾了基线特征、临床和影像学结果。根据 PRISMA 指南对文献（1990-2018 年）进行了综述。确定了比较保守和手术治疗结果的研究。分析了视力、颅神经和内分泌结果以及肿瘤复发情况。
49 例（73.1%）患者接受了手术治疗，18 例（26.9%）患者接受了保守治疗。经过仔细的病例选择，患者接受了手术或保守治疗。接受保守治疗的患者视力缺损较少。在诊断时，保守组的视力缺损（38.8% vs. 75.5%；P=0.008）和颅神经麻痹（27.7% vs. 51%；P=0.058）较少见。保守治疗和手术治疗的视力和颅神经改善率相似（75% vs. 58.3%，P=0.63 和 75% vs. 69.2%，P=1.0）。在保守组中，76.4%的病例观察到肿瘤缩小。系统评价检索到 11 项研究。保守治疗和手术治疗在临床结局（视野恢复，比值比[OR]，1.45；95%置信区间[CI]，0.72-2.92；颅神经恢复，OR，2.30；95%CI，0.93-5.65；和垂体功能减退，OR，1.05；95%CI，0.64-1.74）或肿瘤复发（OR，0.68；95%CI，0.20-2.34）方面均无显著差异。
对垂体卒中采用量身定制的方法，不一定需要手术，是合适的。对于没有视力缺损的患者，保守治疗是合适的。
