Vision Outcomes in Early versus Late Surgical Intervention of Pituitary Apoplexy: Meta-Analysis

Abstract

Background: Pituitary apoplexy (PA) is defined by hemorrhage and necrosis of the pituitary gland, often acute in onset, and frequently in the setting of an existing pituitary adenoma. Our objective was to conduct a meta-analysis of the available literature on vision outcomes following surgical intervention for PA on the basis of the timing from apoplexy to surgery (ATS).

Methods: A thorough literature search of the published English-language literature was performed in PubMed, Ovid, and Cochrane databases using the key words ("pituitary apoplexy") and ("surgery" or "vision") from database inception to August 2018 was conducted. The primary outcome variable evaluated using a binary random-effects model was vision recovery outcomes (metric: odds ratio).

Results: Of 234 articles found, 12 articles containing 200 patients met our eligibility criteria. The mean age was 46.1, with a male-to-female ratio of 2.9:1. A total of 86% of PA patients presented with visual deficits (ATS <7 days in 93 and >7 days in 79 patients). In patients with an ATS <7 days, 97.8% experienced visual recovery, compared with 84.8% with an ATS >7 days (odds ratio 2.6 [95% CI 0.94-7.31]; P value = 0.07).

Conclusions: Despite readily accepted guidelines provided by the United Kingdom advocating for early surgical intervention in PA, the rates of vision outcomes we report demonstrate >80% recovery for patients in both the early and late surgical intervention group. As such, conservative management may be warranted for early stabilization before surgical intervention in PA patients with respect to vision outcomes.

Keywords: Meta-analysis; Neurosurgery; Pituitary apoplexy; Timing; Vision.