Long-term oncological outcomes after haemorrhagic apoplexy in pituitary adenoma managed operatively and non-operatively

• Published in: Acta neurochirurgica 2022-04, Vol.164 (4), p.1115-1123
• Main Authors: Budohoski, Karol P., Khawari, Sogha, Cavalli, Andrea, Quah, Boon L., Kolias, Angelos, Waqar, Mueez, Krishnan, Prahlad G., Lawes, Indu, Cains, Fiona, Arwyn-Jones, James, Su, Zhangjie, Gurnell, Mark, Powlson, Andrew, Donnelly, Neil, Tysome, James, Sharma, Rishi, Muthusamy, Brinda, Kearney, Tara, Robinson, Adam, Marcus, Hani J., Gnanalingham, Kanna, Karabatsou, Konstantina, Pathmanaban, Omar N., Sinha, Saurabh, Santarius, Thomas, Mannion, Richard, Kirollos, Ramez W.
• Format: Article
• Language: English
• Subjects: Acuity; Adenoma; Compression; Humans; Interventional Radiology; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Oculomotor nerve; Original Article - Pituitaries; Paralysis; Patients; Pituitaries; Pituitary; Pituitary Apoplexy - diagnostic imaging; Pituitary Apoplexy - surgery; Pituitary Neoplasms - complications; Pituitary Neoplasms - diagnostic imaging; Pituitary Neoplasms - surgery; Retrospective Studies; Stroke - complications; Surgery; Surgical Orthopedics; Treatment Outcome; Tumors; Visual perception
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-022-05119-8

Introduction Depending on severity of presentation, pituitary apoplexy can be managed with acute surgery or non-operatively. We aim to assess long-term tumour control, visual and endocrinological outcomes following pituitary apoplexy with special emphasis on patients treated non-operatively. Methods Multicentre retrospective cohort study. All patients with symptomatic pituitary apoplexy were included. Patients were divided into 3 groups: group 1: surgery within 7 days; group 2: surgery 7 days–3 months; group 3: non-operative. Further intervention for oncological reasons during follow-up was the primary outcome. Secondary outcome measures included visual and endocrinological function at last follow-up. Results One hundred sixty patients were identified with mean follow-up of 48 months ( n  = 61 group 1; n  = 34 group 2; n  = 64 group 3). Factors influencing decision for surgical treatment included visual acuity loss (OR: 2.50; 95% CI: 1.02–6.10), oculomotor nerve palsy (OR: 2.80; 95% CI: 1.08–7.25) and compression of chiasm on imaging (OR: 9.50; 95% CI: 2.06–43.73). Treatment for tumour progression/recurrence was required in 17%, 37% and 24% in groups 1, 2 and 3, respectively ( p  = 0.07). Urgent surgery (OR: 0.16; 95% CI: 0.04–0.59) and tumour regression on follow-up (OR: 0.04; 95% CI: 0.04–0.36) were independently associated with long-term tumour control. Visual and endocrinological outcomes were comparable between groups. Conclusion Urgent surgery is an independent predictor of long-term tumour control following pituitary apoplexy. However, 76% of patients who successfully complete 3 months of non-operative treatment may not require any intervention in the long term.