2026 Poster Presentations
P147: POST-OPERATIVE ENDOCRINOLOGICAL OUTCOMES FOR PATIENTS UNDERGOING SURGERY FOR TUBERCULUM SELLAE MENINGIOMAS: CASE SERIES AND SYSTEMATIC REVIEW
Vratko Himic, MD; Jose Enrique Marino, MD; Alan Ho, BA; Vagif Kazimli, BS; Saisavat Phommavongsa, BS; Amy Wang, MD; Dagoberto Ordonez-Estevez, MD, PhD; Ashish Shah, MD; Ricardo Komotar, MD; Carolina Benjamin, MD; Michael E Ivan, MD, MBS; University of Miami
Introduction: The proximity of tuberculum sellae meningiomas (TSM) to the pituitary gland and the pituitary stalk confers particular risks to peri-operative endocrinological dysfunction. Given the intimate interaction of TSMs with surrounding vascular, optic and endocrinological structures, approach selection and extent of resection decisions are crucial. The burden of visual impairment and recurrence have been thoroughly studied before, with scoring systems developed; however, the rates of post-operative endocrinological dysfunction after TSM resection are less clear.
Objective: To compare the post-operative risk of endocrine dysfunction between the endonasal (EN) and transcranial (TC) approaches to TSM across an institutional patient cohort and the wider literature.
Methods: We conducted a decade-long retrospective review of TSM surgical cases in our institution, and recorded baseline pre-operative and operative characteristics, surgical approach (EN or TC) as well as pre- and post-operative endocrinological outcomes. We then searched Pubmed, Scopus and Embase databases from inception to December 2024. Studies with TSM resection and reported post-operative endocrinological outcomes were included. Random-effects meta-regression was used to compare new post-operative neuroendocrine dysfunction between EN and TC. Continuity corrected event rates were transformed to log-odds and variances. Between-study heterogeneity was assessed by Cochran’s Q and calculated between-study variance (τ²) via the DerSimonian–Laird method. Random-effects weights based on total variances were used in a weighted least-squares regression comparing log-odds of neuroendocrine dysfunction between EN and TC approaches. The effect of gross total resection (GTR) was similarly evaluated.
Results: At our institution 29 TSM (20 female, 69%) were identified from a total of 1198 meningioma cases (21 TC and 8 EN) across a decade-long period. Of these, 3 had pre-operative endocrine dysfunction (one DI, one hyperprolactinemia and one with anterior hypopituitarism), all of which resolved post-operatively. Only one patient developed new transient DI (after TC approach) (3.4% of total cohort), however, this resolved by discharge. GTR was achieved in 13/29 patients (45%). In the systematic review, across 14 studies, there were 446 patients with a median of 30.5 patients per study (IQR:24.25-34.25). The pooled mean age was 53.75±3.85 years. Studies by approach involved six EN, six TC, and two studies combining both approaches. EN patients had 1.85 times the odds of new post-operative endocrine dysfunction compared to TC patients; however, this was not statistically significant (95% CI:[-0.018-1.250], p=0.056, τ²=0.0000). The rate of GTR did not differ statistically and did not affect the odds risk (OR) of post-operative endocrinological dysfunction. The OR of permanent diabetes insipidus (DI) was significantly elevated in the EN cohort (OR=4.95, p=0.038, τ²=0.0026).
Conclusions: The EN approach to TSM may be associated with an increased risk of new post-operative permanent DI compared to TC approaches. When GTR was added as a variable, it did not modify this underlying OR. The overall odds of new post-operative endocrine dysfunction were comparable for both approaches.