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Abstract：
Introduction Pituitary apoplexy commonly presents with visual and hormonal deficits. While traditionally regarded as an emergency, there have been increasing trends toward conservative management. Our institutional practice consists of early surgery; therefore, we reviewed our series evaluating vision outcomes, hormone function, and complications compared with the present literature. Methods We retrospectively reviewed our institution\'s medical records to identify pituitary apoplexy patients who were treated via the endoscopic endonasal approach by a single neurosurgeon (senior author). We recorded basic demographics, radiographic and operative features, and preoperative and postoperative vision and hormone status. Univariate and multivariate statistical analyses were performed. Pooled data analysis of visual outcomes in the current literature using Bayesian inference was performed. Results We identified 44 patients with histologically confirmed pituitary apoplexy treated by endoscopic transsphenoidal decompression; 77% were treated within 24 hours of presentation. Total 45% had cranial nerve (CN) palsy, 36% anopsia, and 20% had visual acuity deficits. Postoperatively, 100% of CN palsies improved, 81% of anopsias improved, and 66.7% of visual acuity deficits improved. Long-lasting panhypopituitarism (25%) and hypothyrodism (22%) were common. Cavernous sinus involvement predicted residual tumor ( p = 0.006). Pooled Bayesian inference showed 30% improvement in vision outcomes with surgical management compared with medical management with a number needed to treat of 3.3. Conclusion Early surgery for pituitary apoplexy was associated with excellent visual outcomes and the need for long-term hormone replacement is common. Cavernous sinus involvement is an independent predictor of residual tumor. Pooled statistical analysis favors aggressive surgical management of apoplexy for improved visual outcomes.
摘要：
简介垂体中风通常表现为视觉和荷尔蒙缺陷。虽然传统上被认为是紧急情况，保守管理的趋势越来越大。我们的机构实践包括早期手术；因此，我们回顾了我们评估视力结果的系列，激素功能，和并发症与现有文献相比。方法我们回顾性回顾了我们机构的医疗记录，以确定由一名神经外科医生（资深作者）通过鼻内镜入路治疗的垂体卒中患者。我们记录了基本的人口统计,射线照相和手术特征，术前和术后视力和激素状态。进行单变量和多变量统计分析。使用贝叶斯推断对当前文献中的视觉结果进行汇总数据分析。结果我们确定了44例经内镜经蝶入路减压治疗的经组织学证实的垂体卒中患者；77％的患者在出现后24小时内得到治疗。共有45％的人患有颅神经（CN）麻痹，36%的患者,20%有视力缺陷。术后,100%的CN麻痹得到改善,81％的肛门改善，66.7%的视力缺陷有所改善。长期的全垂体功能减退（25％）和甲状腺功能减退（22％）是常见的。海绵窦受累预测肿瘤残留(p=0.006)。合并贝叶斯推断显示，与医疗管理相比，手术管理的视力结果改善了30％，需要治疗的数量为3.3。结论垂体卒中的早期手术与良好的视力结果相关，并且需要长期的激素替代是常见的。海绵窦受累是肿瘤残留的独立预测因素。汇总统计分析有利于中风的积极手术治疗，以改善视力。
