(AS2) Columbia Softball Skull Base Award (2023 Award Winner): Pituitary Apoplexy Surgical Timings and Outcomes Registry (PASTOR): Results from a Multi-center International Observational Study of Pituitary Apoplexy

Monday, April 24, 2023

2:50pm – 2:55pm PST

Location: Los Angeles Convention Center, 406AB

Presenting Author(s)

Adam Mamelak, MD, FAANS

Professor of Neurosurgery
Cedars-Sinai Medical Center
Los Angeles, California, United States

Disclosure(s):

Adam Mamelak, MD, FAANS: Blaze Bioscience: Consultant (Ongoing), Ownership Interest (Ongoing)

Introduction: Pituitary Apoplexy (PA) has traditionally been treated as a neurosurgical emergency. However, several retrospective single-institution studies have demonstrated that nonsurgical treatment is equally effective selected patients. We conducted a multicenter international observational study to survey contemporary practices and outcomes for PA.

Methods: Patient demographics, treatment type, tumor characteristics, frailty, quality of life, headache, and outcomes were tracked in a HIPPAA compliant cloud-based registry. Treatment was determined by the physician team at each center. Groups were then analyzed to compare surgical versus non-surgical treatment outcomes at 3 months. We further compared between “early” (1-4 days after symptom onset) versus “late” (>4 days) surgery groups.

Results: 100 consecutive PA patients from 8 hospitals in the US, 1 in Canada, 2 in Asia, and 1 in France were enrolled over 4 years. Adequate data for analysis was available on 97 patients (97%) (66 surgical and 31 medical). Pre-PA clinical features including age, sex, BMI, morbidities, medications, and fragility were no different between groups (p>.05). Similarly, presenting symptoms, hormonal deficits, opthalmoparesis, radiographic findings, and tumor size were not different between groups. Severe temporal visual field deficit was more common in the surgical group (33% v 10%, p=0.017). Altered level of consciousness was rare in both groups (10% surgical, 6.7% medical, N.S.). Outcomes at 3-6 months were similar between groups, including hormonal, visual, oculomotor and QOL scores (p =0.4-p=0.9 range). Timing of surgery did not correlate with presenting symptoms or outcome at 3 months.

Conclusion : In patients without severe visual field deficits, this first-ever multi-center international observational study of PA indicates that patients managed surgically and medically have similar outcomes. The timing of surgery did not correlate with outcomes. Despite more patients presenting with severe visual deficits undergoing surgery, it remains unclear if surgery significantly improved outcomes at 3 months.