Surgical intervention for binocular blindness in pituitary apoplexy

Abstract

PurposeBilateral blindness in patients with pituitary apoplexy is rare and infrequently studied. Visual outcomes after surgical decompression are unpredictable and predictors of favourable outcome not well defined. The purpose of this study was to determine whether vision can be salvaged in patients who present with bilateral blindness and what the time limit is before irreversible damage occurs. MethodsWe report a series of 5 patients who presented with bilateral blindness after pituitary apoplexy. Patients presented 1.5 to 15 days after losing complete vision. Four regained functional vision. All had endoscopic transsphenoidal decompression within 36 h of presentation. The 4 patients who had surgery within 7 days of ictus had recovery of functional vision. One patient presented late and was operated on day 15 post ictus, with no visual recovery. We review the literature regarding the incidence and outcome of bilateral blindness post-pituitary apoplexy and present the outcome of 52 patients from 1939 to 2011 who had surgical intervention. ResultsThere was an 80% recovery rate in the current series vs 0% from the historical comparison (p = 0.05). Surgical approach in the historical comparison was significant (p = 0.015). Median age and median time delay from ictus to surgery were not significant. ConclusionsFindings suggest that vision can be salvaged in patients who present with binocular blindness after pituitary apoplexy, especially if surgery is performed within the first 7 days of apoplexy. Even in delayed cases surgical decompression can be beneficial and should be performed to try and salvage functional vision.