Clinical Outcome of Cranial Neuropathy in Patients with Pituitary Apoplexy

OBJECTIVE: Pituitary apoplexy (PA) is described as a clinical syndrome characterized by sudden headache, vomiting, visual impairment, and meningismus caused by rapid enlargement of a pituitary adenoma. We retrospectively analyzed the clinical presentation and surgical outcome in PA presenting with cranial neuropathy. METHODS: Twelve cases (3.3%) of PA were retrospectively reviewed among 359 patients diagnosed with pituitary adenoma. The study included 6 males and 6 females. Mean age of patients was 49.0 years, with a range of 16 to 74 years. Follow-up duration ranged from 3 to 20 months, with an average of 12 months. All patients were submitted to surgery, using the transsphenoidal approach (TSA). RESULTS: Symptoms included abrupt headache (11/12), decreased visual acuity (12/12), visual field defect (11/12), and cranial nerve palsy of the third (5/12) and sixth (2/12). Mean height of the mass was 29.0 mm (range 15-46). Duration between the ictus and operation ranged from 1 to 15 days (mean 7.0). The symptom duration before operation and the recovery period of cranial neuropathy correlated significantly (p = 0.0286). TSA resulted in improvement of decreased visual acuity in 91.6%, visual field defect in 54.5%, and cranial neuropathy in 100% at 3 months after surgery. CONCLUSION: PA is a rare event, complicating 3.3% in our series. Even in blindness following pituitary apoplexy cases, improvement of cranial neuropathy is possible if adequate management is initiated in time. Surgical decompression must be considered as soon as possible in cases with severe visual impairment or cranial neuropathy.

Posterior Fossa Tumors in Children

The authors reviewed retrospectively the records of 27 cases of posterior fossa tumor in patients below the age of 60 among the 387 brain tumor cases admitted to Kyungpook University Hospital during the last 10 years. The posterior fossa tumors were 34.2% of the total 79 cases of pediatric brain tumors. The most frequently involved age group was 6~8 years. Headache(40.7%) and vomiting(37.0%) were the most common initial presenting symptoms. Cerebellar signs, Cranial nerve palsy and motor weakness were found in 66.7%, 9.6% and 11.1% of the cases respectively. Cerebellar midline was the most frequently involved site(63.0%). In order of frequency, the pathological diagnoses were medulloblastoma, ependymoma, primitive neuroectodermal tumor(PNET), and astrocytoma. Hydrocephalus was noted in 70.4%, and shunt surgery was done in 28.6%. Surgery followed by radiation therapy was used in most of the cases.