Surgery for Pituitary Tumor Apoplexy Is Associated with Rapid Headache and Cranial Nerve Improvement

Round 1

Reviewer 1 Report

Thank you for reporting an informative study.

I think it would be better if the authors deal with and compare the complications between cohorts of three surgical durations.

Author Response

1. I think it would be better if the authors deal with and compare the complications between cohorts of three surgical durations.

 

This is an excellent point. We have modified the manuscript to include complications, and comparison between cohorts. We did not find any statistically significant differences between surgical cohorts.

 

Table 3. Complications

	Total	Operative Timeframe Cohort			p Value
		Early (<=72h)	Subacute (4d-14d)	Delayed (>14d)
Deep Vein Thrombosis	2 (3)	0 (0)	2 (7)	0 (0)	.29
Diabetes Insipidus	5 (8)	1 (7)	3 (11)	1 (5)	.78
Heparin Induced Thrombocytopenia	1 (2)	1 (7)	0 (0)	0 (0)	.17
Pneumonia	1 (2)	0 (0)	1 (3)	0 (0)	.55
Cerebrospinal Fluid Leak	10 (17)	2 (15)	5 (19)	3 (16)	.96
Death During Hospitalization	1 (2)	1 (7)	0 (0)	0 (0)	.17

Pearson’s χ2 test was used to test for differences between cohorts.

Reviewer 2 Report

The authors respectively analyzed the clinical data of the patients with pituitary tumours apoplexy (PTA) who underwent surgery for PTA at a single institution in a 22-year period, with aim to answer the question whether time-to-surgery correlates with more rapid resolution of headaches or CNDs. They demonstrated that no corelation of time-to-surgery and rapidity of recovery of CNDs was observed, however, surgery for PTA was related with rapid recovery of CNDs in the early, subacute, and delayed time frames, and 28 with rapid headache improvement in the early and subacute time frames in 50% or more of patients.

Major comments:

1.      As demonstrated in the manuscript: “Severe visual deficits in our series trended towards earlier surgical decompression”, therefore, the operation time might be affected by the clinical manifestations of the patients and some other factors, such as larger size of the tumour, the deficits of CN2, the bigger haematoma of the tumour, et al. It should be better to perform a propensity score matched analysis to control the confounding factors to obtain the reliable conclusions.

2.      You should compare the operation and conservative treatment group to get the conclusion that ”surgery for PTA was related with rapid recovery of CNDs”, however, no data regarding conservative treatment was presented.

3.      According to the presented date, you might compare the different outcome about the remission of headache and improvement of CNDs following control the confounding the factors.

Minor comments:

1.      Could you expand your method you used to evaluate the severity of headache?

2.      Could you present the number of the patients with necrosis?

3.      How did you classify the patients into three group: early treatment group (< 4 days), subacute treatment group (4-14 days) and delayed treatment group? Why did you use <4 days and >14 days as cutoffs?

4.      I was worried about that the size of the cohort was not large enough to obtain the reliable statistics results.

5.      Please revise the word  “2011 1”  in line 53.

Author Response

Please see attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

1.Because of small sample sizes and the uneven distribution of propensity scores, the authors could not perform the propensity matched analysis. I hope the authors should mention it in the limitation section.

2. No additional comments.

Author Response

Minor comments:

1. Because of small sample sizes and the uneven distribution of propensity scores, the authors could not perform the propensity matched analysis. I hope the authors should mention it in the limitation section.

Thank you for your review and comment. We have added a statement to this effect in the “limitations” paragraph within the discussion.