Timing of Surgical Intervention in Patients with Pituitary Apoplexy and Cranial Nerves Deficits: Single-Center Experience

Background: Pituitary tumors account for up to 15% of all intracranial tumors, 90% of which are adenomas. One of the rare but urgent presentations of a pituitary tumor is pituitary apoplexy (PA). Typically, patients with PA present emergently with a symptom cluster that may include sudden severe headache, nausea, vomiting, and new-onset impairment of the visual acuity with or without visual field defect. Occasionally, these patients may exhibit other cranial nerve palsies. These manifestations are due to the sudden increase of the tumor size caused by intratumor hemorrhage and/or infarction. Usually, hypopituitarism develops as a result of gland ischemia. After patient stabilization and hormonal replacement, surgical decompression is often recommended with controversy on the timing of intervention. In this case series, we describe our experience regarding the cranial nerve recovery in patients with pituitary apoplexy following the endoscopic endonasal transsphenoidal (EETS).