Pituitary function after endonasal surgery for nonadenomatous parasellar tumors: Rathke's cleft cysts, craniopharyngiomas, and meningiomas.
BACKGROUND
Transsphenoidal surgery for parasellar nonadenomatous lesions has the possibility to either improve or worsen pituitary hormonal function. Herein we present the rates and risk factors of new hormonal failure and recovery in patients undergoing surgery for either an RCC, craniopharyngioma, or tuberculum sella meningioma.


METHODS
All consecutive patients treated over an 8-year period by endonasal surgery for an RCC, craniopharyngioma, or tuberculum sella meningioma were analyzed. Patients treated with prior sellar radiotherapy were excluded. Preoperative and postoperative pituitary hormonal status was determined. Patient characteristics, tumor size, intraoperative and postoperative events, and extent of tumor resection were correlated with new or resolved hypopituitarism.


RESULTS
In total, 50 patients with an RCC, 18 with a craniopharyngioma and 13 with tuberculum sellae meningioma, were analyzed. New anterior pituitary failure and permanent DI occurred as follows: in RCCs, 6% and 2%; in craniopharyngiomas, 31% and 39%; and in meningiomas, 9% and 0%. Overall, improved hormonal function occurred in 57% of patients with an RCC including recovery of one or more anterior axes in 9 (41%) of 22 patients and resolution of hyperprolactinemia in 12 (67%) of 18 patients; no patients with a craniopharyngioma or meningioma had resolution of hypopituitarism. Younger age was predictive of hormonal recovery in patients with an RCC (P = .026).


CONCLUSIONS
New hypopituitarism after transsphenoidal surgery occurs in approximately one third of patients with a craniopharyngioma and in less than 10% of patients with an RCC or suprasellar meningioma. Hormonal function improves in the majority of patients undergoing drainage of an RCC but is unlikely to occur after removal of a craniopharyngioma or suprasellar meningioma.
Dusick
Joshua R
JR
Division of Neurosurgery, University of California at Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA.
Fatemi
Nasrin
N
Mattozo
Carlos
C
McArthur
David
D
Cohan
Pejman
P
Wang
Christina
C
Swerdloff
Ronald S
RS
Kelly
Daniel F
DF
D000293:Adolescent; D000328:Adult; D000368:Aged; D020863:Central Nervous System Cysts / Q000378:metabolism / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D003397:Craniopharyngioma / Q000378:metabolism / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000378:metabolism / Q000601:surgery*; D008579:Meningioma / Q000378:metabolism / Q000601:surgery*; D008875:Middle Aged; D010901:Pituitary Function Tests; D010902:Pituitary Gland / Q000503:physiopathology*; D010908:Pituitary Hormones, Anterior / Q000378:metabolism; D010909:Pituitary Hormones, Posterior / Q000378:metabolism; D010911:Pituitary Neoplasms / Q000378:metabolism / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
D010908:Pituitary Hormones, Anterior; D010909:Pituitary Hormones, Posterior