Perioperative Outcomes Following Endoscopic Skull Base Surgery for Pituitary Apoplexy vs Elective Adenoma Resection

Sunday, October 18, 2026

8:54 AM - 9:00 AM PT

Location: Theatre 411

Presenting Author(s)

MT

Mishek Thapa, BS

Medical Student
David Geffen School of Medicine, University of California, Los Angeles
Los Angeles, California, United States

Co-Author(s)

NV

Nathan Vu, BS

Medical Student
David Geffen School of Medicine, UCLA, United States
Albert Y. Li, BA

Medical Student
Keck School of Medicine
Los Angeles, CA, United States
JS

Jeffrey D. Suh, MD

Professor
UCLA David Geffen School of Medicine
Los Angeles, California, United States
Jivianne T. Lee, MD

Professor
UCLA School of Medicine
Los Angeles, California, United States
RL

Rory J. Lubner, MD

Assistant Professor of Head and Neck Surgery
UCLA David Geffen School of Medicine, United States

Senior Author(s)

Marilene B. Wang, MD

Professor
UCLA Head and Neck Surgery
Los Angeles, CA, United States

Disclosure(s):

Mishek Thapa, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Pituitary apoplexy (PA) is a surgical emergency requiring urgent decompression due to the concern for permanent vision loss and adrenal insufficiency, and comparative data on perioperative outcomes in these patients versus those undergoing elective pituitary surgery remain limited.

Methods: A retrospective cohort study was performed using TriNetX to identify adults undergoing skull base surgery for pituitary pathology. The PA cohort included patients with PA undergoing surgery within 1 month of diagnosis. The comparison cohort included pituitary adenoma patients undergoing identical procedures, excluding PA or intracranial hemorrhage. Cohorts were matched 1:1 on demographics, comorbidities, and anticoagulant use. 10 postoperative outcomes were assessed over 6 months. Subgroup analyses were stratified by sex and age (18-64 vs ≥65 years).

Results: After matching, 4,740 patient pairs were analyzed (mean age 52; 48% male). PA patients had significantly higher visual deficits (9.94% vs 5.71%; HR 1.78, p< 0.0001), meningitis (1.08% vs 0.63%; HR 1.71, p=0.019), headache (11.29% vs 9.27%; HR 1.23, p=0.010), postoperative hemorrhage (3.30% vs 2.58%; HR 1.28, p=0.050), and orbital injury (3.21% vs 2.43%; HR 1.33, p=0.033). No differences in mortality, diabetes insipidus, CSF leak, or readmission were observed. Males had increased orbital injury (3.70% vs 2.32%; HR 1.61, p=0.011); females had increased meningitis (1.31% vs 0.64%; HR 2.04, p=0.014) and headache (14.15% vs 9.40%; HR 1.53, p< 0.0001). Younger patients had higher meningitis (1.27% vs 0.66%; HR 1.94, p=0.017) and CSF leak rates (2.28% vs 1.32%; HR 1.73, p=0.014); older patients had increased hemorrhage (3.82% vs 2.35%; HR 1.63, p=0.021). Visual deficits remained elevated across all subgroups (3.70%-10.33% vs 2.32%-6.47%; HR 1.61-2.07; p≤0.011).

Conclusions: PA patients undergoing endoscopic surgery demonstrate significantly elevated risks of visual deficits, meningitis, headache, hemorrhage, and orbital injury compared to elective adenoma resection, emphasizing the need for enhanced perioperative monitoring in apoplexy cases.