4.6 Review

Current and Future Advances in Surgical Therapy for Pituitary Adenoma

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Radiomics analysis allows for precise prediction of silent corticotroph adenoma among non-functioning pituitary adenomas

Wenting Rui et al.

Summary: The study aimed to predict silent corticotroph adenomas (SCAs) among non-functioning pituitary adenomas using noninvasive radiomics. Radiomics features were found to be the most important, followed by gender and age in predicting SCAs.

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IDEAL-D Framework for Device Innovation A Consensus Statement on the Preclinical Stage

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Summary: The IDEAL-D framework aims to evaluate medical devices at the preclinical stage to ensure safety and expedite the translation of new devices into clinical practice while maintaining a balance between risk mitigation and rapid innovation.

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Machine Learning for Outcome Prediction in First-Line Surgery of Prolactinomas

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Summary: This study demonstrates the performance benefits of combining a diverse set of classification algorithms to predict the outcomes of first-line surgery in prolactinoma patients. Additionally, considering two performance metrics jointly to evaluate the discrimination capacity of a diverse set of classifiers offers added benefits.

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Robotic Handle Prototypes for Endoscopic Endonasal Skull Base Surgery: Pre-clinical Randomised Controlled Trial of Performance and Ergonomics

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Summary: This study aimed to develop an ergonomic handle for improving the performance of endoscopic endonasal skull base surgery. Two different prototypes were designed and evaluated, and the rotating joystick-body handle showed the most substantial improvement in both performance and ergonomics.

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Article Endocrinology & Metabolism

Integrative Clinical, Radiological, and Molecular Analysis for Predicting Remission and Recurrence of Cushing Disease

Paloma Moreno-Moreno et al.

Summary: In this study, clinical, biochemical, and molecular markers were evaluated to predict the long-term clinical outcome and remission in ACTHomas patients. The results showed that certain clinical variables and molecular markers were associated with tumor remission and relapsed disease. An integrative model combining selected clinical variables and molecular markers accurately predicted the clinical evolution and remission of patients with ACTHomas. These findings highlight the importance of using a combination of clinical and molecular biomarkers in the evaluation and follow-up of ACTHomas patients.

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Article Surgery

A Novel Intraoperative Ultrasound Probe for Transsphenoidal Surgery: First-in-human study

Ivan Cabrilo et al.

Summary: The researchers developed a novel ultrasound probe that is slimmer and successfully demonstrated its safe and feasible use in 5 cases. The surgical time was slightly longer, but no adverse events were encountered.

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Machine learning as a clinical decision support tool for patients with acromegaly

Cem Sulu et al.

Summary: This study developed machine learning models to predict postoperative remission, remission at last visit, and resistance to somatostatin receptor ligands (SRL) in patients with acromegaly. The models identified clinical features associated with prognosis.

PITUITARY (2022)

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Data mining analyses for precision medicine in acromegaly: a proof of concept

Joan Gil et al.

Summary: This study aimed to predict the response of acromegaly patients to somatostatin receptor ligands (SRL) using mathematical modeling and clinical information. Accuracy of patient stratification was significantly improved when the cohort was fragmented based on relevant clinical characteristics. The proposed stratification method based on tumor characteristics, sex, age, and multiple biomarkers achieved accuracies ranging from 71% to 95%. The use of data mining offers a promising approach for personalized medicine in acromegaly.

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Low-rank fusion convolutional neural network for prediction of remission after stereotactic radiosurgery in patients with acromegaly: a proof-of-concept study

Nidan Qiao et al.

Summary: This study utilized artificial intelligence approaches to analyze pathological images and predict endocrine outcomes in patients with active acromegaly after stereotactic radiosurgery. The model showed strong predictive power and outperformed established prognostic markers.

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A patient-reported outcome measure for patients with pituitary adenoma undergoing transsphenoidal surgery

Elika Karvandi et al.

Summary: This study developed and validated a patient reported outcome measure for patients with pituitary adenomas undergoing transsphenoidal surgery. The final questionnaire included 25 questions with four subscales. This PROM is the first validated measure for this patient group.

PITUITARY (2022)

Review Oncology

Specialised Surgical Instruments for Endoscopic and Endoscope-Assisted Neurosurgery: A Systematic Review of Safety, Efficacy and Usability

Holly Aylmore et al.

Summary: This systematic review identified specialised instruments for endoscopic and endoscope-assisted neurosurgery that were generally safe, effective, and ergonomic, although the learning curve was noted as a disadvantage in some cases. Future development should focus on improving articulation based on established guidelines for neurosurgical innovation.

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Multimodal data integration using machine learning improves risk stratification of high-grade serous ovarian cancer

Kevin M. Boehm et al.

Summary: In this study, a multimodal data integration framework using machine learning was developed to interpret various types of data and improve the diagnosis accuracy of high-grade ovarian serous carcinoma. The research uncovered quantitative features that contributed to prognosis, and demonstrated the potential of integrating data from different sources for risk stratification of cancer patients.

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Article Clinical Neurology

Analysis of 7-tesla diffusion-weighted imaging in the prediction of pituitary macroadenoma consistency

John W. Rutland et al.

Summary: This study found that high-resolution ADC is a sensitive measure of tumor consistency in pituitary adenomas, suggesting that 7T DWI may hold clinical value in the preoperative workup and surgical management of patients with pituitary macroadenomas.

JOURNAL OF NEUROSURGERY (2021)

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Surgical Education in the Time of COVID: Understanding the Early Response of Surgical Training Programs to the Novel Coronavirus Pandemic

Erin M. White et al.

Summary: The early impact of the COVID-19 pandemic on general surgery residency training nationwide was characterized by widespread changes in the surgical training environment, with a shift towards virtual clinical care and resident didactics. While all programs implemented strategies to protect resident health, disparities in wellness initiatives were noted between university programs and independent programs.

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Machine learning in predicting early remission in patients after surgical treatment of acromegaly: a multicenter study

Nidan Qiao et al.

Summary: This study developed and validated interpretable and applicable machine learning models to predict early endocrine remission after surgical resection of a GH-secreting pituitary adenoma. The prediction accuracy of the trained models was better than those using single variables.

PITUITARY (2021)

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Machine Learning for Surgical Phase Recognition A Systematic Review

Carly R. Garrow et al.

Summary: This study provides an overview of the use of ML models and data streams in automated surgical phase recognition. Through screening 2254 articles, the commonly used ML models and data sources were identified. The results demonstrate that ML can achieve high accuracy in surgical phase recognition.

ANNALS OF SURGERY (2021)

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Thin-Slice Pituitary MRI with Deep Learning-based Reconstruction: Diagnostic Performance in a Postoperative Setting

Minjae Kim et al.

Summary: The study evaluated the diagnostic performance of 1-mm slice thickness MRI with deep learning-based reconstruction compared to 3-mm slice thickness MRI in postoperative pituitary adenoma evaluation. The results showed that 1-mm MRI+DLR had good diagnostic performance, especially in identifying cavernous sinus invasion compared to 3-mm MRI.

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CSF Rhinorrhea After Endonasal Intervention to the Skull Base (CRANIAL) ? Part 2: Impact of COVID-19

Soham Bandyopadhyay et al.

Summary: During the COVID-19 pandemic, preoperative screening protocols and operative modifications have facilitated endonasal neurosurgery, following the guidelines of the Pituitary Society. The study found no evidence of COVID-19 infection in the cohort and no mortality at 30 days postoperatively, supporting the use of risk mitigation strategies for future pandemic waves.

WORLD NEUROSURGERY (2021)

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CSF Rhinorrhoea After Endonasal Intervention to the Skull Base (CRANIAL)-Part 1: Multicenter Pilot Study

Danyal Z. Khan et al.

Summary: The CRANIAL study aims to determine the scope of skull base repair methods and rates of postoperative cerebrospinal fluid (CSF) rhinorrhea. A total of 187 cases were included, with tissue glues, grafts, and vascularized flaps as the most common repair techniques. CSF rhinorrhea occurred in a small percentage of patients, with qualitative feedback on the project largely positive.

WORLD NEUROSURGERY (2021)

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4K 3-dimensional video microscope system (orbeye) for transsphenoidal pituitary surgery

Roman Rotermund et al.

Summary: The study evaluated the use of the Orbeye 4K 3D video microscope in transsphenoidal pituitary surgery and found it to be beneficial in terms of instrument size, positioning, surgeon's ergonomics, learning curve, image resolution, and high magnification. There were no significant differences in surgical duration, complications, or extent of resection compared to traditional microsurgery.

ACTA NEUROCHIRURGICA (2021)

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Radiomics With Ensemble Machine Learning Predicts Dopamine Agonist Response in Patients With Prolactinoma

Yae Won Park et al.

Summary: This study aimed to predict the response of prolactinoma patients to dopamine agonists using an ensemble machine learning classifier with MRI images, with the ensemble classifier showing the best performance in the test set.

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Deep learning-based thin-section MRI reconstruction improves tumour detection and delineation in pre- and post-treatment pituitary adenoma

Da Hyun Lee et al.

Summary: When detecting small pituitary adenomas, 1 mm DLR MRI has higher sensitivity than 3 mm routine MRI for better delineation of normal pituitary gland. Readers prefer 1 mm DLR MRI over 3 mm routine MRI for its overall superiority in imaging quality and diagnostic performance.

SCIENTIFIC REPORTS (2021)

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Lateral one-third gland resection in Cushing patients with failed adenoma identification leads to low remission rates: long-term observations from a small, single-center cohort

Lukas Andereggen et al.

Summary: This study found that resection of one-third of the lateral pituitary gland based on IPSS predictions in CD patients without intraoperative adenoma identification resulted in low morbidity and long-term remission in 31% of patients, with some patients experiencing new pituitary hormone deficits. Long-term control of hypercortisolism was achieved in 77% of patients, but additional therapies were needed for 69% of them. Considering the small sample size, the decision to perform lateral one-third-gland resection should be carefully discussed with patients before surgery.

ACTA NEUROCHIRURGICA (2021)

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Neuroendoscopic training in neurosurgery: a simple and feasible model for neurosurgical education

Mario Gomar-Alba et al.

Summary: The bell pepper-based model provides a cost-effective and simple way for neurosurgery residents to enhance their neuroendoscopic skills, allowing for exposure to camera skills, instrument handling, and hand-eye coordination inherent to most neuroendoscopic procedures.

CHILDS NERVOUS SYSTEM (2021)

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Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly

Tyler Cardinal et al.

Summary: The study aimed to identify predictive factors for long-term remission of acromegaly after surgical resection of pituitary adenomas. Postoperative GH levels on day 1 and changes in IGF-1 levels postoperatively were found to be useful in predicting hormonal remission. The findings suggest that these factors can help guide clinical follow-up and the need for adjuvant therapy in acromegaly patients.

FRONTIERS IN ENDOCRINOLOGY (2021)

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Prediction of the Recurrence of Non-Functioning Pituitary Adenomas Using Preoperative Supra-Intra Sellar Volume and Tumor-Carotid Distance

Wenli Chen et al.

Summary: This study found that the ratio of supra-intrasellar volume and tumor-carotid distance were significantly correlated with the recurrence of NFPAs, and the V-D value had a predictive importance for preoperative recurrence of NFPAs. Patients with higher V-D values tended to relapse earlier and should be closely monitored.

FRONTIERS IN ENDOCRINOLOGY (2021)

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Artificial Intelligence in Brain Tumour Surgery-An Emerging Paradigm

Simon Williams et al.

Summary: Artificial intelligence (AI) has become an important tool for improving the management of brain tumor surgery by providing support, optimizing surgical plans, and predicting prognosis for patients. While AI has the potential benefits in brain tumor surgery, barriers to successful clinical implementation and ethical concerns must be addressed.

CANCERS (2021)

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Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

Danyal Z. Khan et al.

Summary: This review analyzed the current literature on skull base repair techniques after pituitary and skull base tumor resection, finding a variety of different repair methods and summarizing the most commonly used techniques in low and high CSFR risk cases.

PITUITARY (2021)

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Fluid Restriction After Transsphenoidal Surgery for the Prevention of Delayed Hyponatremia: A Systematic Review and Meta-Analysis

Carlos Perez-Vega et al.

Summary: Postoperative fluid restriction after transsphenoidal surgery is found to be effective in preventing hyponatremia and hospital readmission, with the potential to decrease healthcare costs, as shown in a meta-analysis and systematic review of the literature.

ENDOCRINE PRACTICE (2021)

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Development and Evaluation of Deep Learning-based Automated Segmentation of Pituitary Adenoma in Clinical Task

He Wang et al.

Summary: An automated segmentation method for the sellar region was developed, along with tools to extract invasiveness-related features. The proposed methods showed high accuracy in predicting tumor consistency, indicating their clinical usefulness for preoperative planning in patients with pituitary adenoma.

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM (2021)

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Pituitary society expert Delphi consensus: operative workflow in endoscopic transsphenoidal pituitary adenoma resection

Hani J. Marcus et al.

Summary: The purpose of surgical workflow analysis is to systematically break down operations into hierarchical components, facilitating education, training, and understanding of surgical variations. Through an international expert panel consensus, a detailed surgical workflow including 40 steps and 4 phases has been generated.

PITUITARY (2021)

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An intuitive surgical handle design for robotic neurosurgery

Emmanouil Dimitrakakis et al.

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INTERNATIONAL JOURNAL OF COMPUTER ASSISTED RADIOLOGY AND SURGERY (2021)

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Clinical features and complications of acromegaly at diagnosis are not all the same: data from two large referral centers

Elena V. Varlamov et al.

Summary: This study compared clinical disease manifestations at diagnosis between two large University referral centers, highlighting significant differences in symptoms and signs frequency, often > 20 percentage points between centers. Center was found to be a predictor of many signs and symptoms, independent of acromegaly biochemical severity or disease duration.

ENDOCRINE CONNECTIONS (2021)

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Development of Machine Learning Models for Predicting Postoperative Delayed Remission in Patients With Cushing's Disease

Yanghua Fan et al.

Summary: Machine learning models were developed to predict delayed remission in Cushing's disease patients who did not achieve immediate remission postoperatively. Factors such as younger age, lower body mass index, higher Knosp grade, and absence of tumor on pathological examination correlated with lower rates of delayed remission. The Adaboost model, incorporating 18 features including preoperative 24-hour urine free cortisol, postoperative morning serum cortisol, and age, showed superior predictive ability compared to traditional methods.

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Postoperative Day 1 Morning Cortisol Value as a Biomarker to Predict Long-term Remission of Cushing Disease

Fang Wang et al.

Summary: Our study identified that postoperative day 1 morning serum cortisol level, female sex, and proliferative index are significantly associated with Cushing disease recurrence. These could be used as biomarkers to predict long-term remission after neurosurgery.

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM (2021)

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Effects of a transsphenoidal surgery quality improvement program on patient outcomes and hospital financial performance

Christina E. Sarris et al.

Summary: After implementing a comprehensive quality improvement program for pituitary surgery patients, there were significant improvements in patient outcomes, decreased outcome variability, and enhanced hospital financial performance. Future studies may provide further insight into disease remission, patient satisfaction, and how the surgeon learning curve impacts quality efforts.

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Automated operative workflow analysis of endoscopic pituitary surgery using machine learning: development and preclinical evaluation (IDEAL stage 0)

Danyal Z. Khan et al.

Summary: This study utilized machine learning techniques to automatically analyze operative videos of endoscopic transsphenoidal approach surgery for pituitary adenoma resection, developing a model that accurately recognizes surgical phases and steps.

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Aida Kafai Golahmadi et al.

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He Wang et al.

Summary: An automated segmentation method for the sellar region and tools to extract invasiveness-related features were developed for predicting tumor consistency in patients with pituitary adenoma. The proposed methods showed high accuracy and clinical usefulness in supporting neurosurgeons in preoperative decision-making.

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Maria Fleseriu et al.

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James MacFarlane et al.

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Evgenii Belykh et al.

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