Quantified Volumetric Analysis and Clinical Outcomes of Endoscopic Endonasal Transsphenoidal Pituitary Macroadenoma Resection
Bibliographic record
Abstract
Introduction: Endoscopic endonasal transsphenoidal surgery (eTSS) has become the standard for pituitary adenoma resection. Volumetric analysis offers better estimation of preoperative tumor size and extent of resection (EOR). This retrospective analysis aims to investigate and quantify the effect of initial tumor volume and EOR on outcomes and complication rates in eTSS for pituitary macroadenomas. Methods: Over 150 patients underwent eTSS for pituitary adenoma resection at the Montreal Neurological Institute from 2006 to 2013 by the senior author (D.S.). A subset of 17 patients with macroadenomas, confirmed with histopathology, was analyzed. Quantified volumetric analysis was performed on gadolinium-infused magnetic resonance images, preoperatively and 2 to 12 months postoperatively. The variables reported include patient demographics, visual field improvements (vFI), gross total resection rates (GTRR), OR time, length of hospital stay, complications, recurrences, and reoperation rates. These data were extracted from patient files along with neurosurgery, ENT, endocrinology, and neuro-ophthalmology clinic notes. Results: A total of 17 patients were included in the analysis (11 males and 6 females). Five had undergone a previous resection. The patients' age at time of surgery ranged from 40 to 79 years (mean = 60 years and SD = 12). Patients typically presented preoperatively with headache (59%) and visual field deficits (59%). The pathology confirmed nonsecreting macroadenoma tissue in all the 17 patients. The average preoperative tumor volume was 9.9 cm 3 and the average extent of tumor resection was 83% (SD = 19). The average follow-up was 3.4 years (SD = 1.5). Postoperatively, visual fields improved in 80% of patients presenting with a visual field deficit. Overall, four patients had tumor recurrence over the course of follow-up. Two patients were reoperated, one for tumor recurrence and one for symptomatic residual tumor. Conclusion: Quantified volumetric analysis is an accurate tool to define the tumor volume and EOR in the study of eTSS for macroadenomas. Our preliminary data confirm that eTSS is an effective treatment method with high EOR (> 83%) and improved visual fields. This research aims to better define the correlation between EOR and clinical outcomes and morbidity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".