LBMON173 Non-functioning Seller Masses: Tumor Types, Surgical Management And Course Over Time
Authors: Alhadlaq Omar , Alnassar Anhar A , Alsuhaibani Rawan H , AlQuraa Reem , Abothenain Fayha , Afeef Ahmed Bin , Altwaijry Yasser A , Alzahrani Ali S 
Published: November 2022

Introduction

Pituitary adenomas (PA) are common. However, not all sellar tumors are PA. The specific diagnosis of a sellar mass can be difficult. Although there is abundant literature on PA, other types of sellar masses are not well described. In particular, their course over time and response to therapy are not well known. In this study, our objectives were to review non-functioning sellar masses treated with trans sphenoidal surgery (TSS) over the last 15 years to understand their types, success of surgery, and course over time.

Patients and Methods

We retrospectively reviewed all cases of non-functioning sellar masses managed at our hospital over the last 15 years (January 2007-December 2021). Out of 181 sellar masses that were resected by TSS during this period, 91 were functional PA and 90 were non-functional sellar masses. These sellar masses included non-functioning pituitary adenomas and other non-pituitary seller masses operated at our center during the above period and are the subject of this study.

Results

The patients included 29 (32%) females and 61 (68%) males with a median age of 41 years (range 13-75 years). The sellar masses were non-functional PA in 50 (55.6%)cases, atypical PA in 30 (33.3%) cases and non-PA in 10 (11%) cases. The 10 non-PA tumors included craniopharyngioma 3 cases, meningioma 3 cases, chordoma 1 case, giant cell tumor of the bone 1 case, spindle cell oncocytoma 1 case and Rathke cyst 1 case. The median largest tumor diameter was 3.15 cm (Interquartile range 2.2-4. 0). Only 5 cases (5.6%) were intrasellar, the other 85 cases (94.4%) had suprasellar (75 cases, 83%) and/or parasellar (32 cases, 35.6%) extension. Necrosis/cystic changes on MRI were present in 24 cases (26.7%). TSS was performed in 86 cases (95.6%) and transcranial surgery in 4 (4.4%) cases. The surgeries were complicated by transient central DI in 21 cases (23.3%), permanent CDI in 6 cases (6.7%), CSF leak in 8 cases (9%), bleeding in 2 (2.2%), stroke in 3 (3.3%) and partial or panhypopituitarism in 58 cases (64.4%). Twenty-two (24.4%) patients underwent a second TSS, 6 (6.7%) transcranial surgery, 32 (35.6%) external radiotherapy. At a median follow-up of 8.5 years (IQ range 4.63-12.18), only 19 (21%) patients had no evidence of residual tumor on follow-up MRI. The other 71 (79%) cases continued to have evidence of residual tumor, either completely intrasellar in 30 (33.3%) cases or with the suprasellar or parasellar residual component in 41 (45.6%) cases.

Conclusions

Non-functioning PA and other non-pituitary sellar tumors constitute 50% of sellar masses. Most are non-functioning PA, but atypical PA and other non-PA tumors can masquerade as PA. Most of these Non-functioning sellar masses are large with supra and parasellar extension. Surgery effectively reduces tumor size but is rarely curative and frequently complicated by hypopituitarism of variable severity and local complications.

Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.