2026 Poster Presentations
P031: FROM DETECTION TO INTERVENTION: ONE INSTITUTION'S EXPERIENCE IN ASSESSING WORKFLOW EFFICIENCY IN ANTERIOR SKULL BASE MASS DIAGNOSIS AND MANAGEMENT
Mark Liu, MD; Doreen Lam, MD; Troy Woodard; Raj Sindwani; Varun R Kshettry; Pablo F Recinos; Christopher Roxbury; Cleveland Clinic Foundation
Background: Management of anterior skull base masses (ASBMs) requires a multidisciplinary approach for optimal outcomes. ASBMs can be incidentally found or have multiple different presenting symptoms, many of which are nonspecific, including headaches, vision changes and nasal congestion. Once patients with ASBMs are diagnosed, it is critical that the turnaround time to treatment is expedited to prevent potentially irreversible sequelae. There is scant literature on systematically quantified metrics, such as time from initial presentation to diagnosis or treatment, and institutional performance is rarely reported.
Materials and Methods: A retrospective review was performed on all patients that underwent endoscopic anterior skull base surgery at a single institution from 2023 to 2024. The multidisciplinary anterior skull base team included neurosurgery, neurology, endocrinology, and otolaryngology among others. Our study only evaluated patients that underwent surgery. We aimed to characterize surgical treatment timelines by measuring time intervals between preoperative imaging, surgical requests, and surgery. Diagnostic timelines were also evaluated by assessing initial presenting symptoms, referring healthcare providers, preoperative diagnoses, and final pathology.
Results: Fifty patients were reviewed. The four most common presenting symptoms were vision changes (9, 18%), hypercortisolemia (9, 18%), headaches (9, 18%) and hyperprolactinemia (9, 18%). The most common preoperative diagnosis was pituitary macroadenoma (35, 70%), followed by pituitary microadenoma (7, 14%) and meningioma (4, 8%). 23 patients (46%) were first referred to neurosurgery, while 19 patients (38%) were first referred to endocrinology and 8 patients (16%) were referred concurrently to neurosurgery and endocrinology. 25 patients (50%) were diagnosed in our institution, while the other 25 patients (50%) were diagnosed at an outside facility. Of the ones diagnosed in our institution, the most common referral base was general endocrinology (7, 14%). Median time between preoperative imaging and definitive surgery was 3.5 days.
Discussion: The ability of a healthcare system to detect ASBMs in the general population and refer them appropriately and efficiently to the appropriate providers is critical. Additionally, the ability of a multidisciplinary anterior skull base team to expedite surgery for patients that require surgery is an important measure. Our data from a single institution demonstrates that patients with ASBMs have diverse initial presenting symptoms with multiple referring patterns, including many from outside our institution. Our data demonstrates there is a range of times between diagnostic imaging, decision for surgery, preoperative planning, and surgery. Assessing these metrics is critical to explore the many factors that contribute to treatment timing after multidisciplinary assessment of patients.
Conclusions: Despite advances in perioperative care, substantial delays can occur along the diagnostic pathway for patients with anterior skull base masses. Evaluating metrics in the patient referral pathway can help identify system-level bottlenecks and target quality improvement interventions that may accelerate care delivery and optimize outcomes.