Timing of Surgical Intervention in Patients with Pituitary Apoplexy and Cranial Nerves Deficits: Single-Center Experience
Notice bibliographique
Résumé
Background: Pituitary tumors account for up to 15% of all intracranial tumors, 90% of which are adenomas. One of the rare but urgent presentations of a pituitary tumor is pituitary apoplexy (PA). Typically, patients with PA present emergently with a symptom cluster that may include sudden severe headache, nausea, vomiting, and new-onset impairment of the visual acuity with or without visual field defect. Occasionally, these patients may exhibit other cranial nerve palsies. These manifestations are due to the sudden increase of the tumor size caused by intratumor hemorrhage and/or infarction. Usually, hypopituitarism develops as a result of gland ischemia. After patient stabilization and hormonal replacement, surgical decompression is often recommended with controversy on the timing of intervention. In this case series, we describe our experience regarding the cranial nerve recovery in patients with pituitary apoplexy following the endoscopic endonasal transsphenoidal (EETS). Study Design: Retrospective cohort, single-institutional study. Methods: Institutional REB approval was attained for a retrospective review of all EETS cases for pituitary tumor resection between November 2009 and August 2018. Queries of the hospital database were completed by medical records personnel to identify cases of pituitary tumor apoplexy treated using the EETS approach. Patient characteristics, tumor type, endocrine data, and operation characteristics were then extracted from medical records pertaining to patient baseline characteristics. Postoperative results were extracted for the duration of the follow-up period available for each patient. Results: A total of 15 cases of pituitary apoplexy were identified. Several cranial nerve deficits were present at admission. 33% of patients had a visual deficit; 47% had unilateral 3rd nerve palsy, and 27% had unilateral 6th nerve palsy. No patients had 4th nerve palsy. Following EETS, there was significant recovery for all cranial nerve deficits. Postoperatively, 60% of patients with preoperative visual deficit had normal visual fields and the other 40% showed improvement. For those with oculomotor nerve dysfunction preoperatively, 43% had returned to normal cranial nerve function, while 57% had improvement and abducens nerve palsy resolved in 75% postoperatively, while 25% demonstrated improvement. Conclusion: Based on this series, surgical treatment should be offered to patients presenting with cranial nerve deficit in the setting of pituitary apoplexy. In this series, all cranial nerve deficits either returned to normal or improved following surgery. Though a small series, the presented results are superior to those reported in the literature for conservative management. Publication History Article published online: 12 February 2021 © 2021. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».