Patterns of Pituitary Injury during Endoscopic Transsphenoidal Pituitary Surgery: Correlation of Intra-Operative Videos with Endocrinological Outcomes in 76 Patients
Bibliographic record
Abstract
Background: Pituitary gland manipulation and intra-operative injury is thought to be a major cause of hypopituitarism following transsphenoidal surgery. Despite numerous surgical series, the mechanisms of surgical injury to the gland has not been a major focus of study. The objective of the current study was to correlate the occurrence of post-operative hypopituitarism with patterns of intra-operative pituitary gland manipulation. Methods: In this series, 76 consecutive patients underwent endoscopic transsphenoidal pituitary or Rathke’s cleft cyst resection at the Jewish General Hospital, between November 2011 and July 2016. The position of the normal residual pituitary gland was identified pre-operatively and video recordings for all patients were reviewed. A grading scheme was devised to characterize the extent of forces applied intra-operatively during the resection of the tumor. A visual analogue scale was also used to grade the overall extent of injury to the gland. Results: Mean age was 54 years old. The overall incidence of new pituitary hormonal axis deficiency was 5.2%. The rate of injury between macro- and micro-adenomas was similar. Potential mechanisms of injury observed included inadvertent incision of the effaced gland during tumor exposure, direct curettage on the gland, partial gland resection and indirect traction on the gland during tumor dissection. In patients who developed pituitary hormonal axis insufficiencies post-operatively, the tumor consistency with either more firm or a tumor capsule adherent to the normal gland was observed, leading to traction forces to the gland when standard curettage techniques were implemented. Conclusion: In this preliminary abstract, tumor curettage in cases with a firm tumor consistency or tumor capsule adherence to the normal gland was associated with post-operative hypopituitarism. Intra-operative recognition of these patterns may help prevent pituitary injury via more traction free dissection techniques.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 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) | 0.002 | 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".