Correlation of Clinical, Imaging, and Histopathologic features of Sellar, Supra-sellar and Para-sellar Region Masses with Surgical Approach: A Single Institutional Experience from Yemen."
TL;DR
Preoperative imaging and hormonal status provide a robust framework for preoperative risk stratification and surgical planning via histopathology in resource-limited settings in Yemen.
Abstract
Objective
Sellar and parasellar masses represent a heterogeneous group of pathologies with significant clinical and surgical implications. In conflict-affected regions like Yemen, these challenges are compounded by resource constraints and delayed clinical presentation. This study aims to establish the baseline incidence and determine the predictive value of preoperative markers for histopathological diagnosis and surgical planning.
Methods
A prospective, single-center observational study was conducted at Al-Thawra Modern General Hospital (TMGH), Yemen, between December 2022 and December 2025. Data from 49 consecutive patients were collected, including demographics, hormonal profiles, and MRI characteristics (location, T2-homogeneity, vascular encasement). Statistical analysis involved bivariate analysis and multivariate logistic regression to identify independent predictors.
Results
The study (median age 56.0 years, Interquartile Range (IQR): 40.25-61.00) demonstrated a significant female predominance (77.6%). Headache was a universal symptom (100%), with (median symptom duration of 10 months (IQR 4-12 ). Pituitary adenoma was the most frequent pathology (57.1%), followed by meningioma (32.6%) and craniopharyngioma (10.2%). Multivariate analysis identified pituitary location (OR 4.93), mass homogeneity (OR 4.58), hormonal levels (OR 3.22), and fundus findings (OR 2.02) as independent predictors of histopathology. Subgroup analysis showed mass size as the primary factor differentiating surgical approaches (p=0.005).
Conclusion
Preoperative imaging and hormonal status provide a robust framework for preoperative risk stratification and surgical planning via histopathology in resource-limited settings. The heavy reliance on open surgery (85.5%) underscores the urgent need for investment in endoscopic infrastructure and specialized training in Yemen.