Pituitary Pituitary function after endonasal surgery for nonadenomatous parasellar tumors: Rathke's cleft cysts, craniopharyngiomas, and meningiomas Joshua R. Dusick, MD a , Nasrin Fatemi, MD b , Carlos Mattozo, MD a , David McArthur, PhD, MPH a , Pejman Cohan, MD c , Christina Wang, MD d , Ronald S. Swerdloff, MD d , Daniel F. Kelly, MD b, ⁎ a Division of Neurosurgery, University of California at Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA b Neuro-Endocrine Tumor Center, at John Wayne Cancer Institute and Saint John's Health Center, Santa Monica, CA 90404, USA c Division of Endocrinology, University of California at Los Angeles David Geffen School of Medicine, and UCLA Pituitary Tumor and Neuroendocrine Program, UCLA Gonda Diabetes Center, Los Angeles, CA 90095, USA d Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA 90502, USA Received 10 January 2008; accepted 5 March 2008 Abstract Background: Transsphenoidal surgery for parasellar nonadenomatous lesions has the possibility to either improve or worsen pituitary hormonal function. Herein we present the rates and risk factors of new hormonal failure and recovery in patients undergoing surgery for either an RCC, craniopharyngioma, or tuberculum sella meningioma. Methods: All consecutive patients treated over an 8-year period by endonasal surgery for an RCC, craniopharyngioma, or tuberculum sella meningioma were analyzed. Patients treated with prior sellar radiotherapy were excluded. Preoperative and postoperative pituitary hormonal status was determined. Patient characteristics, tumor size, intraoperative and postoperative events, and extent of tumor resection were correlated with new or resolved hypopituitarism. Results: In total, 50 patients with an RCC, 18 with a craniopharyngioma and 13 with tuberculum sellae meningioma, were analyzed. New anterior pituitary failure and permanent DI occurred as follows: in RCCs, 6% and 2%; in craniopharyngiomas, 31% and 39%; and in meningiomas, 9% and 0%. Overall, improved hormonal function occurred in 57% of patients with an RCC including recovery of one or more anterior axes in 9 (41%) of 22 patients and resolution of hyperprolactinemia in 12 (67%) of 18 patients; no patients with a craniopharyngioma or meningioma had resolution of hypopituitarism. Younger age was predictive of hormonal recovery in patients with an RCC (P = .026). Conclusions: New hypopituitarism after transsphenoidal surgery occurs in approximately one third of patients with a craniopharyngioma and in less than 10% of patients with an RCC or suprasellar meningioma. Hormonal function improves in the majority of patients undergoing drainage of an RCC but is unlikely to occur after removal of a craniopharyngioma or suprasellar meningioma. © 2008 Elsevier Inc. All rights reserved. Keywords: Transsphenoidal surgery; Pituitary failure; Meningioma; Craniopharyngioma; Rathke's cleft cyst Available online at www.sciencedirect.com Surgical Neurology 70 (2008) 482 – 491 www.surgicalneurology-online.com Abbreviations: DI, diabetes insipidus; FSH, follicle stimulating hormone; GH, growth hormone; IGF-1, insulin-like growth factor 1; LH, leuteinizing hormone; MRI, magnetic resonance imaging; RCC, Rathke's cleft cyst; TSH, thyroid stimulating hormone; UCLA, University of California at Los Angeles. ⁎ Corresponding author. Neuro-Endocrine Tumor Center, Santa Monica, CA 90404, USA. Tel.: +1 310 582 7450; fax: +1 310 582 7495. E-mail address: kellyd@jwci.org (D.F. Kelly). 0090-3019/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.surneu.2008.03.027