RETRACTION: Recurrence Rate and Exploration of Clinical Factors after Pituitary Adenoma Surgery: A Systematic Review and Meta-Analysis based on Computer Artificial Intelligence System

Background The first-line treatment for patients with any type of pituitary adenoma is trans-sphenoidal surgery. Considering the prevalence of the condition globally, the treatment is quite common. The recurrence of pituitary adenoma is a recognized occurrence in the medical field; however, there is limited comprehensive research and analysis of the predictive factors of recurrence rates and the clinical factors impacting relapse rates. Identifying the recurrence rates of pituitary adenomas and the clinical factors associated with them could help increase the remission rate by increasing focus on the specific aspects for early diagnosis and improved treatment. Objective The objective of the current systematic review and meta-analysis is to assess the recurrent rates based on previous studies and to explore the clinical factors after pituitary surgery. Methods A search was performed on PubMed, APA PsycINFO, Scopus, CENTRAL, and Google Scholar databases for English articles published from 1st January 2010 to 1st August 2022. Systematic reviews, meta-analysis, evidence syntheses, editorials, commentaries, preclinical studies, abstracts, theses, and preprints were excluded. Meta XL statistical software was used to conduct a prevalence meta-analysis. Results PubMed, PsycINFO, and Medline databases were searched. All of the articles were written between 2012 and 2022. In the beginning, 612 items were recognized. After removing duplicates and analyzing the remaining articles in terms of inclusion and exclusion criteria, 31 articles remained. Conclusion There is a relationship between recurrence rates and the follow-up period. There were conflicting results about the clinical factors after pituitary adenoma surgery, specifically age and tumor size. Some included studies that there was an association between macroadenomas and high recurrence rates. No study reported that gender was a clinical factor affecting pituitary adenoma surgery outcomes or the recurrence rate. Studies also reported that there was a correlation between the remnant tumor factor and the recurrence rates; adenoma remnants after surgery increased the risk of recurrence rates for patients.

Pituitary adenomas comprise approximately 10% of all intracranial tumors. Initially, subtle changes occur in the field of vision, which are difficult to assess clinically. It has been seen that following surgery of pituitary macroadenoma, total recovery of normal vision occurs in 35% of the patients, improvement of vision occurs in 60%, and in the rest there is no change in vision. Retinal nerve fiber layer thickness (RNFLT) undergoes retrograde degeneration following compression of optic apparatus by pituitary tumor. We planned a study to evaluate RNFLT before and after pituitary adenoma surgery and its correlation with visual acuity. Twenty patients (40 eyes) with diagnosed pituitary adenoma were included in the study. Preoperative visual acuity, fundus and RNFL thickness were calculated using spectral-domain OCT Optovue, Heidelberg Engineering, Heidelberg, Germany (RT 100 version 5.1), and postoperative measurement was done after 1 and 3 months. Four-quadrant mean of RNFLT was calculated. Results were tabulated and analyzed. Results of the study were analyzed using IBM SPSS Statistics version 19.0. There was no significant change in RNFLT after pituitary adenoma surgery, and it was found that patients with RNFLT within normal range preoperatively showed improvement in visual acuity after pituitary surgery. On the other hand, patients who had thinned-out RNFLT preoperatively showed no improvement in visual acuity. It was also found that once optic disc pallor sets due to chronic compression, then chances of its reversion to normal depend on its grading: only mild pallor disc has some chance to revert to normal, whereas moderate and severe pallor do not revert to normal. RNFLT and optic disc can be used as prognostic factors for evaluation of visual outcome in pituitary adenoma surgery.

Hypernatremia is a common postoperative complication after pituitary adenoma surgery. Despite its prevalence, there is a significant gap in research regarding the construction of predictive models for assessing risk. Therefore, it is essential to create a robust model to accurately predict the risk of postoperative hypernatremia. To explore the risk factors for developing hypernatremia after pituitary adenoma surgery and establish a prediction model. From April 2022 to June 2024, 269 patients were admitted to the Department of Neurosurgery at Qilu Hospital as part of this cohort study. Initially, the sample was split into a training set and a validation set using a ratio of 3:1 randomly. Then, a univariable analysis was conducted for each variable in the training set. Subsequently, the Least Absolute Shrinkage and Selection Operator (LASSO) regression and stepwise regression were employed to identify the candidate variables for further examination. A multivariable logistic regression analysis was then performed to develop a risk prediction model. A nomogram was created to enhance the model’s utility, and the Hosmer-Lemeshow (HL) test was implemented to evaluate the model’s goodness of fit. The predictive efficiency of the model was assessed by calculating the area under the receiver operating characteristic curve (AUC), while model discrimination was determined using the calibration plot and decision curve analysis (DCA). This study indicated that the overall incidence of hypernatremia after pituitary surgery is 8.55%. We collected data on 46 potential risk factors. After LASSO regression, we constructed three models: LR model (LASSO regression), FR model (forward stepwise regression), and BR model (backward stepwise regression). The multivariable analysis identified that LR model, including pituitary stalk involvement, surgery time, and output 1st day, is the most effective at predicting postoperative hypernatremia. The HL test of LR model indicated a p-value of 0.448, and the AUC value was 0.813. In the test set, the AUC was 0.894. The calibration plots and DCA plots demonstrate substantial clinical relevance. Additionally, we developed a nomogram for predicting hypernatremia after pituitary surgery based on this regression model. The prediction model serves as a clinically valuable tool for identifying patients at heightened risk of postoperative hypernatremia following pituitary surgery, facilitating timely implementation of prophylactic management protocols to optimize clinical outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-22512-2.

Objective Pituitary adenoma surgery has evolved rapidly in recent decades. This study aims to determine current practice across a wide range of European neurosurgical centers. Methods A list of eligible departments performing pituitary adenoma surgery was created. The survey consisted of 58 questions. For analysis, the departments were divided into four subgroups: academic/nonacademic, high-volume/low-volume, “mainly endoscopic/mainly microscopic practice,” and geographical regions. Results Data from 254 departments from 34 countries were obtained. In 108 centers (42.5%), <30 pituitary adenomas were operated per year. Twenty (7.9%) centers performed >100 adenoma surgeries per year. Number of neurosurgeons performing endonasal surgeries are as follows: 1 in 24.9% of centers and 2 in 49.8% of centers. All residents assisted endonasal surgeries in 126 centers (49.8%). In 28 centers (21.1%), all residents performed endonasal surgery under supervision during residency. In 141 centers (56.8%), the endoscopic approach was used in >90% of the surgeries. Regular pituitary board (either weekly or once a month) meetings were held in 147 centers (56.3%). Nonfunctioning adenomas represent >70% of pituitary caseload in 149 centers (58.7%). Conclusions In our survey, most centers perform less than 100 surgeries for pituitary adenomas. In most centers, pituitary surgeries are performed by one or two neurosurgeons. Residents have a limited exposure to this type of surgery, and the formal pituitary board is not a standard. Nonfunctioning adenomas make up most of surgically treated adenomas. This study can serve as a benchmark for further analyses of pituitary adenoma centers in Europe.

IntroductionDespite surgical treatment, pituitary adenomas often cause long‐term illness symptoms, that profoundly impact patients' quality of life physically, psychologically and socially. Healthcare professionals often fail to recognize and discuss the ensuing problems. Personal documentation, such as symptom monitoring, reflective writing or even posts on social media, may help this patient group to manage their daily life and support communication of their care needs. Documentation strategies and the role of documentation for people with long‐term symptoms after pituitary adenoma surgery are currently unknown.AimTo examine the effects and strategies of documenting symptoms, activities and physical and emotional well‐being among people living with long‐term pituitary adenoma.MethodsIn this Constructivist Grounded Theory study, 12 individuals living with long‐term illness symptoms after pituitary adenoma surgery described their documentation strategies in in‐depth interviews using teleconferencing and photo‐elicitation between August and October 2020.ResultsStrategies for documentation included analogue and digital media. One core category (Exercising autonomy) and three categories describing processes (Gaining insight, Striving for control and Sharing) emerged from the analysis. These three interrelated processes become an expression of autonomy to manage life and make sense of chronic illness. Personal documentation is a flexible tool that is used more extensively in times of ill health and less in times of relative well‐being. Sharing documentation with healthcare professionals facilitated care planning and sharing with friends and family fostered emotional well‐being.ConclusionPersonal documentation is a valuable resource for managing life after pituitary adenoma surgery. The current findings may be relevant to other chronic illnesses. Further research exploring potential tools for personal documentation is needed.Patient or Public ContributionWe deliberately chose a Constructivist Grounded Theory approach for this interview study. Using Constructivist Grounded Theory, we gave people living with long‐term symptoms a voice, allowing them to freely speak about managing their illness in connection with personal documentation. The theoretical sampling approach enabled us to invite participants that could provide a broad overview of the landscape of personal documentation.

Objective To discuss the application value of the APP client terminal in the improvement of the post-discharged continuing nursing of the patients with pituitary adenoma surgery. Methods One hundred and fifty-six patients with pituitary adenoma surgery who was hospitalized in the department of neurosurgery in Huashan Hospital Affiliated to Fudan University from July 2015 to June 2016 were included into the observation group. The continuing nursing in the observation group was made by APP client terminal. One hundred and sixty-seven patients with pituitary adenoma surgery who was hospitalized in the department of neurosurgery in Huashan Hospital Affiliated to Fudan University from July 2014 to June 2015 were included into the control group. The continuing nursing in the control group was conventional health education, telephone follow-up. Three months after the patients' discharge, the effects of the continuing nursing were evaluated for the patients in the two groups with the evaluation form of the continuing nursing for the patients with pituitary adenoma surgery. Results The score of the continuing nursing evaluation form for the patients with pituitary adenoma surgery in the observation group was (45.47±10.98) , which was significantly higher than that in the control group (70.24±15.48) (t=16.67, P<0.05) . Conclusions The APP client terminal can effectively improve the health education effects of the continuing nursing in the postoperative patients with pituitary adenoma, which is worth popularizing and referring. Key words: Pituitary neoplasms; Health education; Postoperative period; Continuing nursing; APP client terminal

Pituitary adenoma surgery is a complex procedure due to critical adjacent neurovascular structures, variations in size and extensions of the lesions, and potential hormonal imbalances. The integration of artificial intelligence (AI) and machine learning (ML) has demonstrated considerable potential in assisting neurosurgeons in decision-making, optimizing surgical outcomes, and providing real-time feedback. This scoping review comprehensively summarizes the current status of AI/ML technologies in pituitary adenoma surgery, highlighting their strengths and limitations. PubMed, Embase, Web of Science, and Scopus were searched following the PRISMA-ScR guidelines. Studies discussing the use of AI/ML in pituitary adenoma surgery were included. Eligible studies were grouped to analyze the different outcomes of interest of current AI/ML technologies. Among the 2438 identified articles, 44 studies met the inclusion criteria, with a total of seventeen different algorithms utilized across all studies. Studies were divided into two groups based on their input type: clinicopathological and imaging input. The four main outcome variables evaluated in the studies included: outcome (remission, recurrence or progression, gross-total resection, vision improvement, and hormonal recovery), complications (CSF leak, readmission, hyponatremia, and hypopituitarism), cost, and adenoma-related factors (aggressiveness, consistency, and Ki-67 labeling) prediction. Three studies focusing on workflow analysis and real-time navigation were discussed separately. AI/ML modeling holds promise for improving pituitary adenoma surgery by enhancing preoperative planning and optimizing surgical strategies. However, addressing challenges such as algorithm selection, performance evaluation, data heterogeneity, and ethics is essential to establish robust and reliable ML models that can revolutionize neurosurgical practice and benefit patients.

Trigeminocardiac reflex (TCR) represents now a nearly ubiquitary phenomenon in skull base surgery. Functional relevance of the intrainterventional TCR occurrence is hitherto only proven for vestibular schwannoma.In a retrospective observational study, 19 out of 338 (8%) enrolled adult patients demonstrated a TCR during transsphenoidal/transcranial surgery for pituitary adenomas. The 2 subgroups (TCR vs non-TCR) had similar patient's characteristics, risk factors, and histology. Preoperatively, there was a similar distribution of normal pituitary function in the TCR and non-TCR subgroups. In this TCR subgroup, there was a significant decrease of that normal pituitary function after operation (37%) compared to the non-TCR group (60%) (P < 0.03). The TCR subgroup therefore demonstrated a 3.15 times (95%CI 1.15–8.68) higher risk for non-normalizing of postoperative pituitary function compared with the non-TCR subgroup (P < 0.03).It is presented, for the first time, an impact of TCR on the functional hormonal outcome after pituitary surgery and strongly underline again the importance of the TCR in clinical daily practice. As a consequence, TCR should be considered as a negative prognostic factor of hormonal normalization after surgery for pituitary adenomas that should be included into routine practice.

Pituitary adenomas are common, and transsphenoidal surgery remains the standard treatment for symptomatic cases. While most postoperative complications are well described, symptomatic arterial vasospasm after pituitary surgery is exceptionally rare but potentially life-threatening, and no consensus exists regarding its management. A systematic review was conducted following PRISMA 2020 guidelines across PubMed, Embase, Cochrane Library, Springer Nature, Academic Search Premier, JAMA Network, MEDLINE Complete, and ScienceDirect, without date restrictions. Eligible studies included case reports and reviews describing postoperative arterial vasospasm after pituitary adenoma surgery. Extracted data included demographics, tumor characteristics, surgical approach, presentation, diagnosis, treatment, and outcomes. Of 180 records screened, 28 met inclusion criteria, representing 40 patients, supplemented by one case from our series. In total, 41 patients were analyzed. Most tumors were macroadenomas (mean size 39mm), with 80% treated via a transsphenoidal approach. Intraoperative cerebrospinal fluid leakage occurred in 84%, and postoperative sellar hematoma or subarachnoid hemorrhage in 94%. Vasospasm typically developed around day 7 (mean 7.3 days), most often presenting with motor deficits or decreased consciousness, and consistently involved the anterior circulation, frequently affecting multiple vessels. Management strategies included triple-H therapy (68%), nimodipine (46%), and angioplasty (44%). Outcomes were poor, with 22.5% mortality, 32.5% residual deficits, and only 45% discharged without sequelae. Symptomatic arterial vasospasm following pituitary surgery is rare but life-threatening. Intraoperative CSF leakage, sellar hematoma, or postoperative subarachnoid hemorrhage appear to increase risk. Vigilant monitoring and early, aggressive management following principles of aneurysmal subarachnoid hemorrhage are essential to optimize outcomes. Symptomatic arterial vasospasm after pituitary surgery, though rare, carries a high risk of mortality and long-term disability, making early recognition and aggressive management in high-risk patients essential to improving outcomes.

Radiologic Predictors for Extent of Resection in Pituitary Adenoma Surgery. A Single-Center Study.

Objective To investigate the factors associated with hyponatremia after pituitary adenoma surgery and its prognosis.Methods Clinical data of 120 pituitary adenoma patients treated in our hospital form Jan.2008 to Dec.2010 were retrospectively collected.The incidence of hyponatremia after surgery,clinicopathology and related treatment were analyzed.Results In the 120 patients,28 (23.3％) occurred hyponatremia.The blood natrium concentration recovered to normal in 7 patients within 3 days,and in 21 patients within 4 -7 days.Hyponatremia was associated with age,size of adenoma,type and diabetes insipidus early after surgery(x2 =12.6,12.4,5.38 and 6.51,Ps ＜0.05).Conclusion Hyponatremia after pituitary adenoma surgery is frequent in patients with giant pituitary adenoma,history of diabetes insipidus and older than 50 yrs.Monitoring blood electrolyte and treatment with sodium in 1 - 2 weeks after surgery would be helpful to prevent potential severe compilations. Key words: Hyponatremia; Pituitary adenoma; Surgery

BackgroundResidual tumor tissue after pituitary adenoma surgery, is linked with additional morbidity and mortality. Intraoperative magnetic resonance imaging (ioMRI) could improve resection. We aim to assess the improvement in gross total resection (GTR), extent of resection (EOR), and residual tumor volume (RV) achieved using ioMRI.MethodsA systematic review was carried out on PubMed/MEDLINE to identify any studies reporting intra- and postoperative (1) GTR, (2) EOR, or (3) RV in patients who underwent resection of pituitary adenomas with ioMRI. Random effects meta-analysis of the rate of improvement after ioMRI for these three surgical outcomes was intended.ResultsAmong 34 included studies (2130 patients), the proportion of patients with conversion to GTR (∆GTR) after ioMRI was 0.19 (95% CI 0.15–0.23). Mean ∆EOR was + 9.07% after ioMRI. Mean ∆RV was 0.784 cm3. For endoscopically treated patients, ∆GTR was 0.17 (95% CI 0.09–0.25), while microscopic ∆GTR was 0.19 (95% CI 0.15–0.23). Low-field ioMRI studies demonstrated a ∆GTR of 0.19 (95% CI 0.11–0.28), while high-field and ultra-high-field ioMRI demonstrated a ∆GTR of 0.19 (95% CI 0.15–0.24) and 0.20 (95% CI 0.13–0.28), respectively.ConclusionsOur meta-analysis demonstrates that around one fifth of patients undergoing pituitary adenoma resection convert from non-GTR to GTR after the use of ioMRI. EOR and RV can also be improved to a certain extent using ioMRI. Endoscopic versus microscopic technique or field strength does not appear to alter the impact of ioMRI. Statistical heterogeneity was high, indicating that the improvement in surgical results due to ioMRI varies considerably by center.

We set out to prospectively study the peri-operative changes of the hypothalamic-pituitary-adrenal axis (HPA), and to test the hypothesis that the peri-operative corticoid replacement regimen used at the authors' institution in patients with impaired HPA undergoing transsphenoidal pituitary adenoma surgery is adequate. Thirty seven patients (21 females, 16 males, mean age 50.6 years) underwent transsphenoidal pituitary adenoma surgery (mean tumour diameter 20.6 mm, 13 tumours hormone-secreting). The HPA functions of these patients were classified as impaired (group A, n = 15) or preserved (group B, n = 22) according to the results of a pre-operative corticotrophin releasing-hormone test (CRHT). Eleven patients (9 female, 2 male, mean age 53.6 years) without pituitary adenomas and with a preserved HPA (as assessed by medical history and morning serum cortisol (MSC) measurements), undergoing decompressive surgery for degenerative lumbar disc disease, were also studied (group C). On the day of surgery, the patients of group A received 100 mg hydrocortisone (HC) replacement therapy, which was thereafter gradually tapered off in a standardised fashion. The patients of groups B and C were not treated with corticoids. Pre-operative, intra-operative and post-operative variables of these three patient groups were compared. The urinary free cortisol excretion (UFC) in group A declined from 6732 +/- 7683 microg/d on the day of surgery to 305 +/- 358 microg/d on the 10(th) post-operative day. In group B, the respective UFC values were 12,851 +/- 16,278 microg/d and 223 +/- 235 microg/d. In both of these groups, the mean UFC did not fall into the normal range during the first ten post-operative days. On none of the post-operative days, was there a significant difference between the UFC of groups A and B. The UFC values of group C dropped from 177 +/- 157 microg/d on the day of surgery to 87 +/- 61 microg/d on post-operative day six, reaching the normal range from the 2(nd) post-operative day onwards. All UFC values of group C were significantly lower than those of group A and B. None of the evaluated clinical, laboratory and MRI parameters, as disclosed by uni- and multivariate analysis, showed any significant influence on the peri-operative UFC values. The peri-operative UFC of pituitary adenoma patients with preserved HPA was very high, as compared to patients with degenerative lumbar disc disease. The present study showed for the first time, that the proposed regimen of peri-operative corticoid replacement therapy used in patients with pituitary adenomas and impaired HPA raised cortisol levels to match the physiological increase of UFC in patients with pituitary adenoma surgery and preserved HPA. However, although statistically not significant, the UFC of patients with pituitary adenomas and preserved HPA seemed considerably higher on the day of surgery than in patients with pituitary adenomas and HPA impairment. Although there is no evidence to make it mandatory, administration of 150 mg instead of 100 mg HC substitution on the day of pituitary adenoma surgery in patients with HPA impairment may be prudent.

Stent-Assisted Coil Embolization for a Ruptured Posterior Communicating Artery Pseudoaneurysm After Endoscopic Transsphenoidal Surgery for Pituitary Adenoma

The management of pituitary adenomas in the elderly has become a relevant clinical issue, in relationship with improved life expectancy and spreading use of imaging techniques. In this single-center and retrospective study, we investigated the impact of age on peri- and postsurgical outcomes in patients undergoing transnasal sphenoidal (TNS) surgery for pituitary adenomas. One-hundred-sixty-nine patients (62% males) undergoing endoscopic transphenoidal (TNS) surgery for nonfunctioning pituitary adenomas (NFPAs) were enrolled. Patients were subdivided into three groups according to age tertiles: ≤56 (group 1), 57-69 (group 2), and ≥70 (group 3) years. Postsurgical and endocrinological outcomes were evaluated and compared among the three age groups. 37/169 patients (21.9%) developed at least one perisurgical complication, without significant association with the patients' age (P = 0.838), Charlson co-morbidity score (P = 0.326), and American Society of Anesthesiologist score (P = 0.616). In the multivariate regression analysis, the adenoma size resulted the only determinant of perisurgical complication (odds ratio [OR] 1.07, 95% confidence interval [C.I.] 1.00-1.13; P = 0.044). The development and the recovery of at least one pituitary hormone deficiency were observed in 12.2% and 14.2% of patients, respectively. The risk of developing new pituitary hormone deficiencies was correlated with cavernous sinus invasion as evaluated by magnetic resonance imaging (hazard ratio [HR] 4.19, 95% C.I. 1.39-12.66; P = 0.010), whereas the probability to normalize at least one pituitary hormone deficiency was significantly correlated with younger age of patients (HR 0.27, 95% CI 0.12-0.61; P = 0.002). The results of this study reinforce the concept that endoscopic TNS surgery is a safe therapeutic option in the elderly patients with NFPA, even in presence of comorbidities and high anesthetic risk.