Pituitary apoplexy in the aftermath of a SARS-CoV-2 infection: a case series from Amiens University Hospital.

Objective: Since the outbreak of the COVID-19 pandemic, several cases of pituitary apoplexy (PA) following a SARS-CoV-2 infection have been described in several countries. Here, we describe a case series of PA occurring in the aftermath of a SARS-CoV-2 infection to alert physicians about possible neuro-endocrinological damage caused by the virus that can lead to visual sequelae and hypopituitarism. Design and methods: We retrospectively identified all the adult patients treated at Amiens University Hospital between March 2020 and May 2021 for PA confirmed by cerebral imaging and following an RT-PCR-confirmed SARS-CoV-2 infection. Results: Eight cases (six women, two men) occurred between March 2020 and May 2021 and were reviewed in this study. The mean age at diagnosis was 67.5 ± 9.8 years. Only one patient had a 'known' non-functional pituitary macroadenoma. The most common symptom of PA was a sudden headache. Brain imaging was typical in all cases. Only two patients required decompression surgery, whereas the others were managed conservatively. The clinical outcome was favorable for all patients but without recovery of their pituitary deficiencies. There was no diabetes insipidus. Conclusion: This case series, the largest in the literature, reinforces the strength, consistency, and coherence of the association between SARS-CoV-2 infection and PA. Our study provides support for the hypothesis that SARS-CoV-2 may be a new precipitating factor for PA. It is essential that practitioners be alerted about possible pituitary disease due to the virus so that such patients are recognized and appropriately managed, hence improving their prognosis.

A matched comparison of outcomes between percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for the treatment of lumbar disc herniation: a 2-year retrospective cohort study.

BACKGROUND CONTEXT: Although open lumbar microdiscectomy (OLMD) is considered to be the gold standard method for discectomy, recent progress in endoscopic spinal surgery has increased the popularity of percutaneous endoscopic lumbar discectomy (PELD) for this indication. However, one of the main drawbacks of PELD is incomplete decompression, especially at the start of the surgeon's learning curve. The functional outcomes of PELD and OLMD in patients matched for age, hernia level, and hernia location have not previously been compared. PURPOSE: To compare OLMD with PELD in terms of the clinical outcome and the time to recovery. STUDY DESIGN: Retrospective, matched cohort study. PATIENT SAMPLE: Data of all patients who underwent elective spinal surgery between January 2015 and June 2017 were extracted from the local database. OUTCOME MEASURES: Clinical outcomes were assessed using a 0-to-10 visual analogue scale (VAS) for lower back pain (LBP) and leg pain were scored before surgery and at postoperative day 1 and at each follow-up visit (3, 12, and 24 months), the Oswestry Disability Index (ODI: 0%-100%), the length of hospital stay, time to resumption of work, recurrence of Lumbar disc herniation, procedure failures, and complications. METHODS: The participants were matched for age, disc level, and location of the herniated disk (central and paracentral vs. far-lateral). The participants' mean±standard deviation age was 47.09±12.55 (range: 28-70). We compared the various clinical outcomes between the two groups to identify which procedure had better immediate and long-term functional outcomes. The differences in mortality and occurrence of postoperative complications were also compared in patients with PELD versus controls. RESULTS: Fifty-eight patients were enrolled (29 with PELD and 29 with OLMD). Both groups reported significant reductions in LBP and leg pain (p<0.01) postoperatively and an improvement in the ODI at 24 months postsurgery. The intergroup difference in the VAS for LBP at 1 day and 3 months was statistically significant (1.48 vs. 3.5, and 1.62 vs. 2.72, respectively; p=0.01 and 0.026, respectively) but the intergroup difference in the ODI was not. The mean length of hospital stay and the time to resumption of work were significantly shorter in the PELD group than in the OLMD group (2.55 vs. 3.21 days, and 4.45 vs. 6.62 weeks, respectively; p=0.037 and 0.01, respectively. There were no significant intergroup differences in terms of complications, recurrence, or procedure failures. CONCLUSIONS: Both PELD and OLMD can provide equivalent, satisfactory outcomes. However, PELD demonstrated several potential advantages, including more rapid recovery and lower LBP early on. Further large-scale, randomized studies with long-term follow-up are now warranted.

A Novel, Hybrid, Stereotactic Approach (Radiosurgery and Dual Ommaya Reservoirs) for the Treatment of Mixed (Polycystic and Solid) Craniopharyngioma.

BACKGROUND: Craniopharyngioma is a difficult entity to treat, which is particularly true for mixed craniopharyngioma (i.e., a mixture of both solid and cystic components). The present case report illustrates a minimally invasive, two-component, stereotactic treatment approach as an alternative to standard microsurgery. CASE DESCRIPTION: A 38-year-old patient presented with progressive intracranial hypertension followed by pan-hypopituitarism, deterioration of the visual field, and cognitive impairment. Brain MRI revealed hydrocephalus and a suprasellar mixed solid and polycystic lesion that was suggestive of craniopharyngioma. Using a robot-assisted, stereotactic treatment approach, we combined the installation of catheters for 2 Ommaya reservoirs with 5-fraction CyberKnife radiosurgery of the solid tumor. The high intracranial pressure and visual field deterioration resolved completely. A partial improvement in endocrine function was noted, and the patient returned to work 6 weeks after surgery. CONCLUSION: A combined, robot-assisted, stereotactic approach to the treatment of mixed (solid and polycystic) craniopharyngioma is a safe alternative to microsurgery. Further studies including larger numbers of patients will be needed to assess the long-term efficacy and morbidity and mortality rates associated with this approach.