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This article, published in the Journal of Neurological Surgery, examines the impact of frailty on surgical outcomes in patients with Cushing's disease (CD). The study analyzed data from the Registry of Adenomas of the Pituitary and Related Disorders (RAPID) and found that mild frailty independently predicted outcomes after transsphenoidal surgery for CD. Mildly frail patients had longer hospital stays and were more likely to be discharged to skilled nursing facilities. The study suggests that assessing frailty could be useful for preoperative risk stratification and prognostication in CD patients. [Extracted from the article]

This article explores the use of radiomic feature analysis to predict overall survival and progression-free survival after surgery in patients with skull base chordomas. The study extracted radiomic features from preoperative MRI scans and used unsupervised analysis to identify distinct groups based on these features. The results showed that the radiomic features were able to model overall survival and progression-free survival, and were also associated with genetic markers commonly used in clinical decision-making. The authors suggest that radiomics-based imaging biomarkers could be a noninvasive and cost-effective way to personalize care for patients with skull base chordomas. [Extracted from the article]

Importance: Benchmarks aid in improve outcomes for surgical procedures. However, best achievable results that have been validated internationally for transsphenoidal surgery (TS) are not available. Objective: We aimed to establish standardized outcome benchmarks for TS of pituitary adenomas. Design: A total of 2685 transsphenoidal tumor resections from 9 expert centers in 3 continents were analyzed. Setting: Patients were risk stratified, and the median values of each center's outcomes were established. The benchmark was defined as the 75th percentile of all median values for a particular outcome. The postoperative benchmark outcomes included surgical factors, endocrinologyspecific values, and neurology-specific values. Results: Of 2685 patients, 1149 (42.8%) defined the low-risk benchmark cohort. Within these benchmark cases, 831 (72.3%) patients underwent microscopic TS, and 308 (26.8%) patients underwent endoscopic endonasal resection. Of all tumors, 799 (29.8%) cases invaded the cavernous sinus. The postoperative complication rate was 19.6% with mortality between 0.0% and 0.8%. Benchmark cutoffs were ≤2.9% for reoperation rate, ≤1.9% for cerebrospinal fluid leak requiring intervention, and ≤15.5% for transient diabetes insipidus. At 6 months, benchmark cutoffs were calculated as follows: readmission rate: ≤6.9%, new hypopituitarism ≤6.0%, and tumor remnant ≤19.2%. Conclusions: This analysis defines benchmark values for TS targeting morbidity and mortality and represents the best outcomes in the best patients in expert centers. These cutoffs can be used to assess different centers, patient populations, and novel surgical techniques. It should be noted that the benchmark values may influence each other and must be evaluated in their own context. [ABSTRACT FROM AUTHOR]