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Importance: Pituitary adenomas (PAs) present a notable economic burden on healthcare systems due to their management's reliance on multimodal, often costly interventions. Objective: To determine total and relative healthcare costs for PAs at Ontario-based institutions. Design: A retrospective, propensity-score-matched cohort analysis. Setting: Ontario, Canada, encompassing public healthcare facilities and covering costs over a 6-year study period. Participants: Adults diagnosed with PA (n = 1675) between April 1, 2013, and March 31, 2019, compared to a general population cohort and a hospitalized control cohort matched on demographics and health factors. Intervention/Exposures: Analysis of healthcare cost components (inpatient, outpatient, and diagnostic services) and cost trajectories postsurgery for PAs. Main Outcome Measures: Primary outcome was total annualized healthcare costs for patients with PA relative to the general and hospitalized cohorts. Relative costs were estimated using a negative binomial regression model. Results: Of 1675 patients with PA, total annualized costs were $49,992. Highest total costs were associated with inpatient hospitalization ($24,796) and physician services/diagnostic evaluations ($20,075). After propensity score matching, patients with PA had 12.7 times higher costs [95% confidence interval (CI) (10.9, 14.8), P <.0001] during the preadmission/admission period, which remained elevated postoperatively (P <.05). Total costs did not differ between patients with PA and the hospitalized cohort [RR 0.97, 95% CI (0.92, 1.03); P =.3271] in the preadmission/admission period; however, follow-up costs were 37% lower for patients with PA in the 1st follow-up year [RR 0.63, 95% CI (0.51, 0.77); P <.0001], and up to 50% lower by the 5th year [RR 0.50, 95% CI (0.36, 0.68); P <.0001]. Conclusions: This study provided a comprehensive assessment of the economic burden of PAs on the publicly-funded healthcare system. Patients with PA had higher annualized total costs across all observed time periods compared to the general population and lower annualized total costs compared to patients admitted to a surgical ward. Relevance: This study highlights the financial impact of PA management on healthcare resources and provides a basis for future research aimed at cost-efficiency improvements in long-term PA care. [ABSTRACT FROM AUTHOR]

Craniopharyngiomas are tumors that arise from the remnants of Rathkes pouch along the nasopharynx to the diencephalon. Current standard of care includes maximal surgical resection versus adjuvant radiation if a maximal resection is unfeasible. Pharmacological therapy with MAPK targeted agents is an emerging therapeutic option for tumors with BRAF V600E mutations. We report a 45-year-old male with a strictly third ventricle papillary craniopharyngioma with a BRAF V600E mutation. After initial surgery with subtotal resection, the patient demonstrated durable response to targeted BRAF and MEK inhibitor therapy with vemurafenib and cobimetinib. Our report suggests that targeted therapy may reduce the need for radiation and impact surgical interventions in select cases.

Abstract Endoscopic endonasal surgery (EES) is widely employed for interventions in skull base. Despite advancements in surgical techniques, cerebrospinal fluid (CSF) leakage remains a significant concern. The introduction of nasoseptal flap (NSF) dramatically reduced the CSF leakage rates, yet reconstruction techniques continue to vary among institutions and lack standardization. Recently, injectable hydroxyapatite (HA), traditionally used in open skull base reconstruction, has been adapted for use in EES. This study compares the effectiveness of HA and NSF reconstruction with the standard multilayer NSF reconstruction alone. We searched for eligible studies in PubMed, Embase, and Cochrane Library. CSF leakage rates and reconstruction-associated complication rates were thoroughly evaluated. We initially reviewed 3650 records, narrowing down to 13 articles for full-text examination. Of these, 3 retrospective cohort studies met our inclusion criteria, comparing outcomes of HA combined with NSF to NSF alone. The HA plus NSF group tended to exhibit lower rates of CSF leakage compared to the NSF alone group. Similarly, the rate of reconstruction-associated complication was also lower in the HA plus NSF group than in the control group. Skull base reconstruction using HA and NSF can be an effective way to minimize CSF leakage without major complications.

Introduction Endoscopic transsphenoidal surgery (ETS) is the standard practice in pituitary surgeries. The sellar exposure becomes the main factor which determines the residual disease in ETS. Not many studies can be found in the literature on the influence of anatomical variations of the sphenoid on intraoperative sella exposure. Objective The aim of the current study is to ascertain whether sphenoid sinus variations play a role in sellar exposure and residual tumor volume. Methods This is a prospective study conducted in a south Indian tertiary care center between June 2020 to June 2022, with 21 study participants who were scheduled to have ETS. The relation of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) parameters with the intraoperative area of sellar exposure and residual tumor volume was evaluated. Results Sphenoid sinus dimensions, like presellar width (mean = 1.89 ± 0.51 cm), maximum width (mean = 2.94 ± 1.09 cm), presellar depth (mean = 1.14 ± 0.55 cm), suprasellar depth (mean = 1.08 ± 0.24 cm), infrasellar depth (mean = 2.36 ± 0.92 cm), presellar height (mean = 2.22 ± 0.47 cm), or the 9 internal carotid artery (ICA)-related measures, did not have any correlation with the mean intraoperative area of sellar exposure (0.57 ± 0.28 cm 2). Also, the adequacy of sellar exposure did not relate to the residual tumor. Preoperative tumor volume was found to be higher (20.2 [55.3–13.2] cm 3) in patients with residual tumor compared with those with no residual tumor (5.9 [6.8–5.2] cm 3). Tumor extension had a significant association with the residual tumor volume. Conclusion According to the present study, anatomical variations of the sphenoid sinus do not influence the adequacy of sellar exposure. Further studies need to be undertaken concerning residual tumor volume as well as preoperative tumor volume and extension. [ABSTRACT FROM AUTHOR]

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Rathke cleft cysts are common cystic pituitary lesions seen on MR imaging. A subset of Rathke cleft cysts can rupture within the sella and are uncommon. The imaging appearance of a ruptured Rathke cleft cyst has been previously described with nonspecific imaging findings. We present 7 cases of ruptured Rathke cleft cysts and basisphenoid bone marrow enhancement below the sella that could be used to potentially distinguish a ruptured Rathke cleft cyst from other cystic lesions.