• Sauson Soldozy, Faraz Farzad, Steven Young, Kaan Yağmurlu, Pedro Norat, Jennifer Sokolowski, Min S Park, John A Jane, and Hasan R Syed.
• Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
• World Neurosurg. 2021 Feb 1; 146: 315-321.e1.

BackgroundMachine learning has emerged as a viable asset in the setting of pituitary surgery. In the past decade, the number of machine learning models developed to aid in the diagnosis of pituitary lesions and predict intraoperative and postoperative complications following transsphenoidal surgery has increased exponentially. As computational processing power continues to increase, big data sets continue to expand, and learning algorithms continue to surpass gold standard predictive tools, machine learning will serve to become an important component in improving patient care and outcomes.MethodsRelevant studies were identified based on a literature search in PubMed and MEDLINE databases, as well as from other sources including reference lists of published articles.ResultsRadiomics and artificial neural networks comprise the majority of machine learning-based applications in pituitary surgery. Radiomics serves to quantify specific imaging features, which can then be used to noninvasively identify tumor characteristics and make definitive diagnoses, circumventing presurgical biopsy altogether. Neural networks can be adapted to predict intraoperative changes in visual evoked potentials or cerebral spinal fluid leak. In addition, these algorithms may be combined with others to predict tumor aggressiveness, gross total resection, recurrence and remission, and even total cost burden.ConclusionsThe field of machine learning is broad, with radiomics and artificial neural networks comprising 2 commonly used supervised learning methods in pituitary surgery. Given the large heterogeneity of pituitary and sellar lesions, the promise of machine learning lies in its ability to identify relationships and patterns that are otherwise hidden from standard statistical methods. While machine learning has great potential as a clinical adjunct during the surgical preplanning process and in predicting complications and outcomes, challenges moving forward include standardization and validation of these paradigms.Copyright © 2020 Elsevier Inc. All rights reserved.

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