Emergency endoscopic surgery for pituitary apoplexy presenting as cerebral infarction in a limited resources condition: A case report

He Van Dong; Dat Tran; Hung Thanh Chu; Anh Hoang Pham; Xuan Thanh Nguyen; Ha Dai Duong

doi:10.1016/j.ijscr.2021.106015

Emergency endoscopic surgery for pituitary apoplexy presenting as cerebral infarction in a limited resources condition: A case report

Int J Surg Case Rep. 2021 Jun:83:106015. doi: 10.1016/j.ijscr.2021.106015. Epub 2021 May 26.

Authors

He Van Dong¹, Dat Tran¹, Hung Thanh Chu², Anh Hoang Pham³, Xuan Thanh Nguyen¹, Ha Dai Duong⁴

Affiliations

¹ Department of Neurosurgery I, Viet Duc University Hospital, Hanoi, Viet Nam.
² Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam. Electronic address: hungchu94@hmu.edu.vn.
³ Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam; Department of Neurosurgery I, Viet Duc University Hospital, Hanoi, Viet Nam.
⁴ Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam; Department of Neurosurgery I, Viet Duc University Hospital, Hanoi, Viet Nam. Electronic address: duongdaiha@hmu.edu.vn.

Abstract

Introduction and importance: Pituitary apoplexy is defined as a sudden onset of neurologic deficit due to infarction or hemorrhage of the pituitary tumor. We report a case of emergency endoscopic surgery for pituitary apoplexy presenting as cerebral infarction due to ICA compression in a limited resources condition.

Case presentation: A 38-year-old female presented with acute onset of severe headache, decreased level of consciousness, decreased visual acuity bilaterally, aphasia, and right hemiparesis. Computed tomography angiography showed a hyperdense sellar mass with stenosis of the left ICA. The patient underwent emergent endoscopic transsphenoidal surgery for sellar decompression.

Clinical discussion: The epidermiology, presentation and diagnosis and strategy of treatments as well as their outcomes were discussed.

Conclusion: Pituitary apoplexy should be taken into consideration in a patient with increasing headache and neuro-ophthalmic symptoms. Pituitary apoplexy presenting as cerebral infarction is rare. The aim of surgery in emergency setting was sellar decompression. Endoscopic transsphenoidal surgery was an effective treatment.

Keywords: Cerebral infarction; Endoscopic transsphenoidal surgery; Pituitary adenoma; Pituitary apoplexy.