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This article discusses the establishment of a national pituitary surgical research platform called RAPID, which aims to improve patient care and surgical outcomes for pituitary disorders. The initial focus of the collaboration is on Cushing's disease. The study provides an overview of the patient cohort, surgical outcomes, and lays the foundation for future research. The data collected from nine academic pituitary centers shows that 528 patients with Cushing's disease were treated by 26 neurosurgeons from 2003 to 2023. The report highlights insights into surgical outcomes and disease recurrence rates across different surgeons and environments. The collaboration is expected to advance the standard of care for patients with pituitary disorders. [Extracted from the article]

Context Pituitary apoplexy (PA) has been traditionally considered a neurosurgical emergency, yet retrospective single-institution studies suggest similar outcomes among patients managed medically. Objective We established a multicenter, international prospective registry to compare presentation and outcomes in PA patients treated with surgery or medical management alone. Methods A centralized database captured demographics, comorbidities, clinical presentation, visual findings, hormonal status, and imaging features at admission. Treatment was determined independently by each site. Key outcomes included visual, oculomotor, and hormonal recovery, complications, and hospital length of stay. Outcomes were also compared based on time from symptom onset to surgery, and from admission or transfer to the treating center. Statistical testing compared treatment groups based on 2-sided hypotheses and P less than.05. Results A total of 100 consecutive PA patients from 12 hospitals were enrolled, and 97 (67 surgical and 30 medical) were evaluable. Demographics, clinical features, presenting symptoms, hormonal deficits, and imaging findings were similar between groups. Severe temporal visual field deficit was more common in surgical patients. At 3 and 6 months, hormonal, visual, and oculomotor outcomes were similar. Stratifying based on severity of visual fields demonstrated no difference in any outcome at 3 months. Timing of surgery did not affect outcomes. Conclusion We found that medical and surgical management of PA yield similar 3-month outcomes. Although patients undergoing surgery had more severe visual field deficits, we could not clearly demonstrate that surgery led to better outcomes. Even without surgery, apoplectic tumor volumes regress substantially within 2 to 3 months, indicating that surgery is not always needed to reduce mass effect. [ABSTRACT FROM AUTHOR]

(1) Background: Cushing's disease (CD) is a serious endocrine disorder caused by an adrenocorticotropic hormone (ACTH)-secreting pituitary neuroendocrine tumor (PitNET) that stimulates the adrenal glands to overproduce cortisol. Chronic exposure to excess cortisol has detrimental effects on health, including increased stroke rates, diabetes, obesity, cognitive impairment, anxiety, depression, and death. The first-line treatment for CD is pituitary surgery. Current surgical remission rates reported in only 56% of patients depending on several criteria. The lack of specificity, poor tolerability, and low efficacy of the subsequent second-line medical therapies make CD a medical therapeutic challenge. One major limitation that hinders the development of specific medical therapies is the lack of relevant human model systems that recapitulate the cellular composition of PitNET microenvironment. (2) Methods: human pituitary tumor tissue was harvested during transsphenoidal surgery from CD patients to generate organoids (hPITOs). (3) Results: hPITOs generated from corticotroph, lactotroph, gonadotroph, and somatotroph tumors exhibited morphological diversity among the organoid lines between individual patients and amongst subtypes. The similarity in cell lineages between the organoid line and the patient's tumor was validated by comparing the neuropathology report to the expression pattern of PitNET specific markers, using spectral flow cytometry and exome sequencing. A high-throughput drug screen demonstrated patient-specific drug responses of hPITOs amongst each tumor subtype. Generation of induced pluripotent stem cells (iPSCs) from a CD patient carrying germline mutation CDH23 exhibited dysregulated cell lineage commitment. (4) Conclusions: The human pituitary neuroendocrine tumor organoids represent a novel approach in how we model complex pathologies in CD patients, which will enable effective personalized medicine for these patients. [ABSTRACT FROM AUTHOR]

Objectives  Endoscopic endonasal approaches (EEAs) for petrosectomies are evolving to reduce perioperative brain injuries and complications. Surgical terminology, techniques, landmarks, advantages, and limitations of these approaches remain ill defined. We quantitatively analyzed the anatomical relationships and differences between EEA exposures for medial, inferior, and inferomedial petrosectomies. Design  This study presents anatomical dissection and quantitative analysis. Setting  Cadaveric heads were used for dissection. EEAs were performed using the medial petrosectomy (MP), the inferior petrosectomy (IP), and the inferomedial petrosectomy (IMP) techniques. Participants  Six cadaver heads (12 sides, total) were dissected; each technique was performed on four sides. Main Outcomes and Measures  Outcomes included the area of exposure, visible distances, angles of attack, and bone resection volume. Results  The IMP technique provided a greater area of exposure (p  < 0.01) and bone resection volume (p  < 0.01) when compared with the MP and IP techniques. The IMP technique had a longer working length of the abducens nerve (cranial nerve [CN] VI) than the MP technique (p  < 0.01). The IMP technique demonstrated higher angles of attack to specific neurovascular structures when compared with the MP (midpons [ p  = 0.04], anterior inferior cerebellar artery [ p  < 0.01], proximal part of the cisternal CN VI segment [ p  = 0.02]) and IP (flocculus [ p  = 0.02] and the proximal [ p  = 0.02] and distal parts [ p  = 0.02] of the CN VII/VIII complex) techniques. Conclusion  Each of these approaches offers varying degrees of access to the petroclival region, and the surgical approach should be appropriately tailored to the pathology. Overall, the IMP technique provides greater EEA surgical exposure to vital neurovascular structures than the MP and the IP techniques. [ABSTRACT FROM AUTHOR]

Objective  This study investigated the impact of residual tumor volume (RTV) on tumor progression after subtotal resection and observation of WHO grade I skull base meningiomas. Study Design  This study is a retrospective volumetric analysis. Setting  This study was conducted at a single institution. Participants  Patients who underwent subtotal resection of a WHO grade I skull base meningioma and postsurgical observation (July 1, 2007–July 1, 2017). Main Outcome Measure  The main outcome was radiographic tumor progression. Results  Sixty patients with residual skull base meningiomas were analyzed. The median (interquartile range) RTV was 1.3 (5.3) cm 3. Tumor progression occurred in 23 patients (38.3%) at a mean duration of 28.6 months postsurgery. The 1-, 3-, and 5-year actuarial progression-free survival (PFS) rates were 98.3, 58.6, and 48.7%, respectively. The Cox multivariate analysis identified increasing RTV (p  = 0.01) and history of more than 1 previous surgery (p  = 0.03) as independent predictors of tumor progression. In a Kaplan–Meier analysis for PFS, the RTV threshold of 3 cm 3 maximized log-rank testing significance between groups of patients dichotomized at 0.5 cm 3 thresholds (p  < 0.01). The 3-year actuarial PFS rates for meningiomas with RTV ≤3 cm 3 and >3 cm 3 were 76.2 and 32.1%, respectively. When RTV >3 cm 3 was entered as a covariate in the Cox model, it was the only factor independently associated with tumor progression (p  < 0.01). Conclusion  RTV was associated with tumor progression after subtotal resection of WHO grade I skull base meningioma in this cohort. An RTV threshold of 3 cm 3 was identified that minimized progression of the residual tumor when gross total resection was not safe or feasible. [ABSTRACT FROM AUTHOR]

Objectives  To better understand the risk-benefit profile of skull base meningioma resection in older patients, we compared perioperative complications among older and younger patients. Design  Present study is based on retrospective outcomes comparison. Setting  The study was conducted at a single neurosurgery institute at a quaternary center. Participants  All older (age ≥ 65 years) and younger (<65 years) adult patients treated with World Health Organization grade 1 skull base meningiomas (2008–2017). Main Outcome Measures  Perioperative complications and patient functional status are the primary outcomes of this study. Results  The analysis included 287 patients, 102 older and 185 younger, with a mean (standard deviation [SD]) age of 72 (5) years and 51 (9) years (p  < 0.01). Older patients were more likely to have hypertension (p  < 0.01) and type 2 diabetes mellitus (p  = 0.01) but other patient and tumor factors did not differ (p ≥ 0.14). Postoperative medical complications were not significantly different in older versus younger patients (10.8 [11/102] vs. 4.3% [8/185]; p  = 0.06) nor were postoperative surgical complications (13.7 [14/102] vs. 10.8% [20/185]; p  = 0.46). Following anterior skull base meningioma resection, diabetes insipidus (DI) was more common in older versus younger patients (14 [5/37] vs. 2% [1/64]; p  = 0.01). Among older patients, a decreasing preoperative Karnofsky performance status score independently predicted perioperative complications by logistic regression analysis (p  = 0.02). Permanent neurologic deficits were not significantly different in older versus younger patients (12.7 [13/102] vs. 10.3% [19/185]; p  = 0.52). Conclusion  The overall perioperative complication profile of older and younger patients was similar after skull base meningioma resection. Older patients were more likely to experience DI after anterior skull base meningioma resection. Decreasing functional status in older patients predicted perioperative complications. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Sinonasal Outcomes Test‐22 (SNOT‐22) is used widely as a patient‐reported sinonasal quality‐of‐life (QOL) instrument for endoscopic endonasal pituitary surgery. However, it has never been validated in this population. This study explores the psychometric validity of SNOT‐22 to determine if it is a valid scale in patients undergoing endoscopic pituitary surgery. Study Design: Multicenter prospective trial. Methods: Adult patients (n = 113) with pituitary tumors undergoing endoscopic surgery were enrolled in a multicenter study. Patient‐reported QOL was assessed using SNOT‐22 and the Anterior Skull Base Nasal Inventory‐12. Face validity, internal consistency, responsiveness to clinical change, test–retest reliability, and concurrent validity were determined using standard statistical methods. Results: Internal consistency using Cronbach's alpha at baseline and 2 weeks postoperatively were 0.911 and 0.922, indicating SNOT‐22 performed well as a single construct. Mean QOL scores were significantly worse at 2 weeks than baseline (16.4 ± 15.1 vs. 23.1 ± 16.4, P <.001), indicating the scale is responsive to clinical change. However, only 11/22 items demonstrated significant changes in mean scores at 2 weeks. Correlation between scores at 2 and 3 weeks was high, suggesting good test–retest reliability, r(107) = 0.75, P <.001. Factor analysis suggests the five‐factor solution proposed for the SNOT‐22 in rhinosinusitis patients is not valid in pituitary surgery patients. Conclusions: The SNOT‐22 is a valid QOL instrument in patients undergoing endoscopic pituitary surgery. However, because it includes 22 items, can be applied only as a single construct, 50% of the items do not demonstrate changes after surgery, and is not as sensitive to change as other scales, shorter instruments developed specifically for this patient population may be preferable. Level of Evidence: 2 Laryngoscope, 131:E2757–E2763, 2021 [ABSTRACT FROM AUTHOR]

Objective  The carotico-clinoid foramen and interclinoid bridge are two anatomical variants of the sellar region. If these anatomical variants go unrecognized and are not managed safely by the surgeon during expanded endoscopic endonasal surgery for a posterior clinoidectomy, a carotid artery injury may occur. We summarize a method to safely navigate in the presence of the carotico-clinoid foramen and interclinoid bridge in an endoscopic endonasal approach. Study Design  The study involves cadaveric dissection and management of the anatomical variants. Setting  The study took place in a cadaveric dissection laboratory. Participants  The object of study is one cadaveric head. Main Outcome Measures  After discovering the two variants in both cavernous sinuses of a cadaveric head, we established a stepwise coping strategy to avoid carotid artery injury while performing an endoscopic endonasal bilateral interdural pituitary transposition, and we report the final view after endoscopic management. Results  Debulking of the middle clinoid process can decrease the obstacle effect, and the pituitary transposition can be performed medial to the ossified carotico-clinoid ligament. Disconnection of the interclinoid bridge is the prerequisite to an effective posterior clinoidectomy, and distinguishing the transition between the sellar diaphragm and the interclinoid bridge is essential. Conclusion  In the presence of both the carotico-clinoid foramen and the interclinoid bridge, a bilateral interdural pituitary transposition can still be performed, although preoperative strategic preparation, full inspection, and stepwise disconnections are of paramount importance in such a scenario to avoid cavernous carotid artery injury. [ABSTRACT FROM AUTHOR]