Third, Fourth, and Sixth Cranial Nerve Palsies in Pituitary Apoplexy

• Type of Material: Article
• Authors: Rabih Hage, Emory University; Sheila R. Eshraghi, Emory University; Nelson Oyesiku, Emory University; Adriana Ioachimescu, Emory University; Nancy Newman, Emory University; Valerie Biousse, Emory University; Beau Bruce, Emory University
• Language: English
• Date: 2016-10
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Elsevier Inc.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.wneu.2016.07.026
• Title of Journal or Parent Work: World Neurosurgery
• ISSN: 1878-8750
• Volume: 94
• Start Page: 447
• End Page: 452
• Grant/Funding Information: Dr. Hage received research grants from the Philippe Foundation (NYC, USA), the “Club de Neuro-Ophtalmologie Francophone” (Paris, France) and the “Faculté de Médecine des Antilles et de la Guyane” (bourse année-recherche).; Dr. Bruce receives research support form the NIH/NEI (K23-EY019341).; This work was supported in part by an unrestricted departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc., New York and by National Institutes of Health/National Eye Institute (NIH/NEI) core grant P30-EY006360 (both to the Department of Ophthalmology, Emory University School of Medicine).
• Keywords: Cranial nerve palsy; SERIES; CLINICAL-FEATURES; Life Sciences & Biomedicine; Pituitary apoplexy; Diplopia; TRANSSPHENOIDAL SURGERY; Clinical Neurology; Surgery; ADENOMAS; Science & Technology; Neurosciences & Neurology; Pituitary adenoma; OUTCOMES; EXPERIENCE; TUMORS; MANAGEMENT; HEMORRHAGE
• Research Categories: Biology, Neuroscience; Health Sciences, Epidemiology; Health Sciences, Opthamology

Abstract

Background Pituitary apoplexy (PA) often presents with acute headache and neuro-ophthalmic manifestations, including ocular motility dysfunction (OMD) from cranial nerve palsies (CNPs). Our goal was to describe the epidemiology and outcomes of OMD in a large, single-center series of patients with PA. Methods We conducted a retrospective chart review of all patients with PA seen in our pituitary center between January 1995 and December 2012. Presenting neuro-ophthalmic, endocrine, and radiologic data, as well as neuro-ophthalmology follow-up data, were collected. Results We identified 235 patients with PA, 59 of whom (25%) had OMD. Twenty-seven of those 59 patients underwent neuro-ophthalmic evaluation. Preoperatively, 23 of these 27 patients had unilateral OMD, 18 (78%) with a single CNP and 5 (22%) with multiple CNPs. Bilateral OMD was present in 4 of the 27 patients. Postoperatively, 24 of the 27 patients with OMD had follow-up (median duration, 7 months; interquartile range [IQR], 3–17 months). At the last postoperative follow-up, 7 of these 24 patients (29%) had OMD (5 unilateral, 2 bilateral). OMD resolved in 3 of the 24 patients (12%) within 1 month, in 13 of 21 patients (62%) within 6 months (3 lost to follow-up), and in 17 of 19 patients (89%) within 1 year (2 lost to follow-up). Surgery was performed at ≤14 days after presentation in 16 of 18 (89%) resolved cases and in 4 of 6 (67%) unresolved cases. Patients with OMD were more likely than those without OMD to have larger tumors (2.6 vs. 2.0 cm; P < 0.001), panhypopituitarism (31% vs. 14%; P = 0.005), and necrosis (58% vs. 37%; P = 0.03). Conclusions OMD from CNPs is common in PA, occurring in one-quarter of patients, and is frequently associated with certain radiologic, endocrinologic, and pathological features. The prognosis is excellent, with 90% of cases of OMD resolving by 1 year after early pituitary surgery.