Medizinische Universität Graz - Research portal
Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Hosmann, A; Micko, A; Frischer, JM; Roetzer, T; Vila, G; Wolfsberger, S; Knosp, E.
Multiple Pituitary Apoplexy-Cavernous Sinus Invasion as Major Risk Factor for Recurrent Hemorrhage.
World Neurosurg. 2019; 126:e723-e730
Doi: 10.1016/j.wneu.2019.02.138
Web of Science
PubMed
FullText
FullText_MUG
- Co-authors Med Uni Graz
- Wolfsberger Stefan
- Altmetrics:
- Dimensions Citations:
- Plum Analytics:
- Scite (citation analytics):
- Abstract:
- OBJECTIVE: Pituitary apoplexy is a rare but potentially life-threatening disorder that occurs in up to 10% of adenomas. Whereas risk factors for the initial hemorrhagic event are well described, there is minor knowledge on clinical symptomatic recurrent pituitary apoplexies. METHODS: At the Medical University of Vienna, 76 patients were surgically treated for clinical symptomatic pituitary apoplexy between 1990 and 2017. Four patients (5.3%) suffered multiple pituitary apoplexies after initial surgery. In this retrospective study, neuroradiologic images, clinical data, and intraoperative findings were reviewed for potential risk factors of multiple apoplexies in pituitary adenomas. RESULTS: Patients with multiple apoplexies had significantly higher Knosp grading on preoperative imaging (median grade 4), and more frequently observed cavernous sinus invasion intraoperatively (P = 0.01). Consequently, all cases with multiple pituitary apoplexies remained with residual adenoma postoperatively. In cases of residual tumor within the cavernous sinus, recurrent apoplexy occurred in 23.5% of patients. A tumor recurrence/residual was resected significantly earlier in patients with single apoplexy (median 2.2 years) than in patients with multiple apoplexies (median 5.4 years; P = 0.05). Multiple pituitary apoplexies caused significantly greater rates of ophthalmoplegia (75% vs. 14.1%; P = 0.01) and long-term hormone-replacement therapy was necessary in all cases. CONCLUSIONS: Cavernous sinus invasion and subtotal resection are high risk factors for multiple apoplexies in pituitary adenomas. Early treatment is recommended for residual tumor in the cavernous sinus to minimize the risk of recurrent apoplexy with subsequent worse clinical outcome.
- Find related publications in this database (using NLM MeSH Indexing)
- Adenoma - complications, surgery
- Adult - administration & dosage
- Aged - administration & dosage
- Cavernous Sinus - surgery
- Female - administration & dosage
- Hemorrhage - etiology, surgery
- Humans - administration & dosage
- Male - administration & dosage
- Middle Aged - administration & dosage
- Neurosurgical Procedures - administration & dosage
- Pituitary Apoplexy - complications, surgery
- Pituitary Neoplasms - complications, surgery
- Recurrence - administration & dosage
- Risk Factors - administration & dosage
- Treatment Outcome - administration & dosage
- Find related publications in this database (Keywords)
- Cavernous sinus
- Pituitary adenoma
- Pituitary apoplexy
- Transsphenoidal