Cranial nerves palsy in pituitary apoplexy outcome post emergent surgery

Authors

  • ALI ABD-ALMER JWAD COLLEGE OF MEDICINE

DOI:

https://doi.org/10.28922/qmj.2023.19.1.1-3

Keywords:

Pituitary apoplexy, cranial nerve palsy, pituitary adenoma

Abstract

Introduction:
pituitary apoplexy (PA), an uncommon clinical condition brought on by rapid bleeding or infarction. The primary symptom, a sudden, severe headache, is occasionally accompanied by vision abnormalities or ocular palsy.
Aim of the study :
to assess the benefit of an emergent trans sphenoidal approach and its results, as well as the deficit of cranial nerves other than the optic nerve in the recovery from pituitary apoplexy.
Patient and methods
A prospective study of cranial nerve deficit in pituitary apoplexy and their prognosis in patients with apoplexy followed up on 16 patients from 2018 to 2020 who had cranial nerve deficits throughout their hospital stays and for up to two years following release.
Results :
Oculomotor nerve intracavernous segment has more predilection to involve in pituitary apoplexy cavernous invasion in our study we include other cranial nerves to expel the presenting oculomotor nerve palsy in comprise to other cranial nerves and even with mixed cranial nerve involvement, the cranial nerve involvement and cavernous extension and the volume of tumor effect additional compression on cranial nerve. Only one patient with 3rd cranial nerve palsy and one patient with mixed palsy is not recovered after six-month postoperative fellows while the majority retrieve their function during 1st three months.
Conclusion:
Patients with pituitary apoplexy who experienced ocular motility dysfunction due to cranial nerve palsies had favorable prognoses.
Keywords: Pituitary apoplexy, cranial nerve palsy, pituitary adenoma

References

1. Rovit RL, Fein JM. Pituitary apoplexy: a review and reappraisal. J Neurosurg. 1972;37(3):280–288.
2. Mohr G, Hardy J. Hemorrhage, necrosis, and apoplexy in pituitary adenomas. Surg Neurol. 1982;18(3):181–189.
3. Ebersold MJ, Laws ER, Scheithauer BW, Randall RV. Pituitary apoplexy is treated by transsphenoidal surgery. A clinicopathological and immunocytochemical study. J Neurosurg. 1983;58(3):315–320.
 4. Hernandez A, Angeles Del Real M, Aguirre M, Vaamonde J, Gudin M, Ibanez R. Pituitary apoplexy: a transient benign presentation mimicking mild subarachnoid hemorrhage with negative angiography. Eur J Neurol. 1998;5(5):499–501.
5. Nawar RN, AbdelMannan D, Selman WR, Arafah BM. Pituitary tumor apoplexy: a review. J Intensive Care Med. 2008;23(2):75–90. 
6. Cardoso ER, Peterson EW. Pituitary apoplexy: a review. Neurosurgery. 1984;14(3):363–373. 
7. Agrawal D, Mahapatra AK. Visual outcome of blind eyes in pituitary apoplexy after transsphenoidal surgery: a series of 14 eyes. Surg Neurol. 2005;63(1):42–46. 
8. Kaplan B, Day AL, Quisling R, Ballinger W. Hemorrhage into pituitary adenomas. Surg Neurol. 1983;20(4):280–287. 
9. Onesti ST, Wisniewski T, Post KD. Clinical versus subclinical pituitary apoplexy: presentation, surgical management, and outcome in 21 patients. Neurosurgery. 1990;26(6):980–986. 
10. Tsitsopoulos P, Andrew J, Harrison MJ. Pituitary apoplexy and hemorrhage into adenomas. Postgrad Med J. 1986;62(729):623–626. 
11. Pelkonen R, Kuusisto A, Salmi J, et al. Pituitary function after pituitary apoplexy. Am J Med. 1978;65(5):773–778. 
12. Suri A, Narang KS, Sharma BS, Mahapatra AK. Visual outcome after surgery in patients with suprasellar tumors and preoperative blindness. J Neurosurg. 2008;108(1):19–25. 
13. Zhang X, Fei Z, Zhang W, et al. Emergency transsphenoidal surgery for hemorrhagic pituitary adenomas. Surg Oncol. 2007;16(2):115–120. 
14. Woo HJ, Hwang JH, Hwang SK, Park YM. Clinical outcome of cranial neuropathy in patients with pituitary apoplexy. J Korean Neurosurg Soc. 2010;48(3):213–218. 
15. Bills DC, Meyer FB, Laws ER, et al. A retrospective analysis of pituitary apoplexy. Neurosurgery. 1993;33(4):602–608. 
16. Semple PL, Webb MK, de Villiers JC, Laws ER. Pituitary apoplexy. Neurosurgery. 2005;56(1):65–72. 
17. Kim SH, Lee KC, Kim SH. Cranial nerve palsies accompanying pituitary tumor. J Clin Neurosci Off J Neurosurg Soc Australas. 2007;14(12):1158–1162.
18. Kobayashi H, Kawabori M, Terasaka S, Murata J, Houkin K. A possible mechanism of isolated oculomotor nerve palsy by apoplexy of pituitary adenoma without cavernous sinus invasion: a report of two cases. Acta Neurochir. 2011;153(12):2453–2456. 
19. Bujawansa S, Thondam SK, Steele C, et al. Presentation, management and outcomes in acute pituitary apoplexy: a large single-center experience from the United Kingdom. Clin Endocrinol. 2014;80(3):419–424.
20. Jho DH, Biller BMK, Agarwalla PK, Swearingen B. Pituitary Apoplexy: Large Surgical Series with Grading System. World Neurosurg. 2014;82(5):781–790.
21. Verrees M, Arafah BM, Selman WR. Pituitary tumor apoplexy: characteristics, treatment, and outcomes. Neurosurg Focus. 2004;16(4):E6. 
22. Jho DH, Biller BMK, Agarwalla PK, Swearingen B. Pituitary Apoplexy: Large Surgical Series with Grading System. World Neurosurg. 2014;82(5):781–790.

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2023-06-30

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