ABSTRACT
Objective: The diagnosis of hemorrhagic versus non-hemorrhagic pituitary apoplexy can be difficult as both the clinical presentation and radiographic appearance can be variable. Early identification and treatment of these patients is essential to prevent poor outcomes. This study identifies clinical characteristics of hemorrhagic and non-hemorrhagic pituitary apoplexy. Methods: 311 consecutive patients admitted with pituitary tumors were reviewed for clinical and radiographic evidence of pituitary apoplexy. Patient demographics, comorbidities, clinical presentation, tumor characteristics, surgical therapy, complications, and outcomes were analyzed for both groups. A cohort statistical analysis was performed using Chi square, Fisher exact test, and t-test. Results: Patients with hemorrhagic (n = 23, 57.5%) and non-hemorrhagic (n=17, 42.5%) pituitary apoplexy were similar except the hemorrhagic cohort was older (mean age 51.5 versus 40.6, p=0.03) and more hypertensive (n=16, p=0.03). Thirty-seven patients underwent surgical decompression for their pituitary apoplexy symptoms either through transcranial or endoscopic approach. There was no statistically significant difference between hemorrhagic (n=16, 43.2% endoscopic; n=4, 10.8% transcranial) and non-hemorrhagic (n=16, 43.2%, endoscopic; n=1, 2.7%, transcranial; p=0.22) apoplexy cohorts. Risks of post-operative complications were similar in both hemorrhagic (n=5: RR 1.13, 95% CI 0.59-2.1) and non-hemorrhagic cohorts (n=3: RR 0.84, 95% CI 0.31-2.3). Achievement of a good functional outcome as measured by modified Rankin scale better than 4 at last follow-up was not statistically different among cohorts (p = 0.74). Conclusions: Hemorrhagic and non-hemorrhagic pituitary apoplexy are similar clinical entities that require prompt surgical decompression of the optic apparatus and medical therapy aimed at treating acute adrenal insufficiency.
ABSTRACT
Aims: Kyphoplasty is a minimally invasive treatment used to reduce pain, restore vertebral height and improve mobility in patients with painful spinal VCF. Pain from vertebral compression fractures (VCF) comprises an important health issue with significant social and economic impact, particularly in elderly patients with osteoporosis where treatment options are limited. We assessed outcomes in patients with VCF who failed conservative management and underwent kyphoplasty. Study Design: Prospective and retrospective case series. Place and Duration of Study: At a single neurosurgical practice February 2003 and September 2012. Methodology: A total of 203 patients with 288 treated vertebral body fractures treated with kyphoplasty were enrolled. The Visual Analog Scale (VAS) was used to prospectively measure back pain before and after surgery. Pre and post operative disability and quality of life were retrospectively measured with the Roland Morris Disability Index (RMDI) and EuroQol 5-Domain scale (EQ5D), respectively, via patient survey. Pre and post-operative narcotic analgesic usage and incidence of subsequent fractures were recorded. Results: There was a statistically significant improvement (P < .001) in each of the assessed measures following surgery. The post-operative rate of narcotic use was reduced from 63% to 17%. Eight patients (4.2%) developed and underwent repair of an adjacent fracture with a mean time between surgeries of 461 days. Conclusion: Following kyphoplasty, patients experienced significant, rapid, and sustained reduction of back pain, improved quality of life, and reduced disability with a low complication rate. Timely repair of VCF is indicated, not only to prevent complications associated with prolonged inactivity but also for effective treatment of severe pain in the acute setting.