Current and Future Advances in Surgical Therapy for Pituitary Adenoma

Abstract

The vital physiological role of the pituitary gland, alongside its proximal critical neurovascular structures means pituitary adenomas cause significant morbidity or mortality. Whilst enormous advancements have been made in the surgical care of pituitary adenomas, treatment failure and recurrence remain challenges. To meet these clinical challenges, there has been an enormous expansion of novel medical technologies (e.g. endoscopy, advanced imaging, artificial intelligence). These innovations have the potential to benefit each step of the patient journey, and ultimately, drive improved outcomes. Earlier and more accurate diagnosis addresses this in part. Analysis of novel patient data sets, such as automated facial analysis or natural language processing of medical records holds potential in achieving an earlier diagnosis. After diagnosis, treatment decision-making and planning will benefit from radiomics and multimodal machine learning models. Surgical safety and effectiveness will be transformed by smart simulation methods for trainees. Next-generation imaging techniques and augmented reality will enhance surgical planning and intraoperative navigation. Similarly, the future armamentarium of pituitary surgeons, including advanced optical devices, smart instruments and surgical robotics, will augment the surgeon's abilities. Intraoperative support to team members will benefit from a surgical data science approach, utilising machine learning analysis of operative videos to improve patient safety and orientate team members to a common workflow. Postoperatively, early detection of individuals at risk of complications and prediction of treatment failure through neural networks of multimodal datasets will support earlier intervention, safer hospital discharge, guide follow-up and adjuvant treatment decisions. Whilst advancements in pituitary surgery hold promise to enhance the quality of care, clinicians must be the gatekeepers of technological translation, ensuring systematic assessment of risk and benefit. In doing so, the synergy between these innovations can be leveraged to drive improved outcomes for patients of the future.

Morphometric analysis of transsphenoidal surgery in Peruvian population

“…[ 28 ] As a result, meticulous surgical planning is paramount for the effective management of patients with pituitary adenomas, particularly in an environment where surgical, medical, and radiological treatments have significantly progressed. [ 8 , 14 ] Moreover, the selection of instruments for delicate and precise manipulation of neuroanatomy aims for optimal outcomes and minimizing complications; in other words, shorter hospital stays. [ 4 , 33 ] Furthermore, additional studies are needed to validate these findings and determine the impact on postoperative outcomes of patients with pituitary tumors in the Peruvian population.…”

A Handheld Robot for Endoscopic Endonasal Skull Base Surgery: Updated Preclinical Validation Study (IDEAL Stage 0)

“…18 However, continuum robots present their own issues related to sterilizability, controllability, and the need for a support base, which may limit distal-end dexterity and force delivery. 17,21 Handheld robots bypass many of these challenges.…”

Multidisciplinary Team Care in Pituitary Tumours

“…The mission and main clinical goals of the Pituitary MDT/PTCOE are summarised in Table 1 . Ultimately, the key goal is to eliminate, or at least reduce, the excess morbidity and mortality due to pituitary tumours, pituitary hypersecretion syndromes, and other disorders affecting the pituitary, as well as manage the anterior or posterior pituitary hormone deficiencies [ 8 , 10 , 11 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. For most patients, this requires the establishment of a complex program of care and the need for long-term follow-up [ 10 , 11 ].…”