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

Autor: Budohoski KP; Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK., Khawari S; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK. sogha.khawari@nhs.net., Cavalli A; Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK., Quah BL; Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Manchester, UK., Kolias A; Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK., Waqar M; Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Manchester, UK., Krishnan PG; Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK., Lawes I; Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK., Cains F; Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Manchester, UK., Arwyn-Jones J; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK., Su Z; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK., Gurnell M; Department of Endocrinology, Cambridge University Hospitals, Cambridge, UK., Powlson A; Department of Endocrinology, Cambridge University Hospitals, Cambridge, UK., Donnelly N; Department of Otoloaryngology and Skull Base Surgery, Cambridge University Hospitals, Cambridge, UK., Tysome J; Department of Otoloaryngology and Skull Base Surgery, Cambridge University Hospitals, Cambridge, UK., Sharma R; Department of Otoloaryngology and Skull Base Surgery, Cambridge University Hospitals, Cambridge, UK., Muthusamy B; Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK., Kearney T; Department of Endocrinology, Salford Royal Hospital, Manchester, UK., Robinson A; Department of Endocrinology, Salford Royal Hospital, Manchester, UK., Marcus HJ; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK., Gnanalingham K; Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Manchester, UK., Karabatsou K; Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Manchester, UK., Pathmanaban ON; Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Manchester, UK., Sinha S; Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK., Santarius T; Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK., Mannion R; Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK., Kirollos RW; Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester, UK.
Jazyk: angličtina
Zdroj: Acta neurochirurgica [Acta Neurochir (Wien)] 2022 Apr; Vol. 164 (4), pp. 1115-1123. Date of Electronic Publication: 2022 Jan 18.
DOI: 10.1007/s00701-022-05119-8
Abstrakt: 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.
(© 2022. Crown.)
Databáze: MEDLINE
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