Evidence map›Paper›PMID 41604016›Full record

ArticlePituitary2026

Critical views for safe surgical phase progression in endoscopic endonasal transsphenoidal pituitary adenoma resection: modified Delphi consensus.

Tjasa Zaletel, Danyal Z Khan, Anjana Wijekoon, Zhehua Mao, Joao Paulo Almeida, Anouk Borg, Jonathan Chainey, Michael D Cusimano, Daniel A Donoho, Neil Dorward and 14 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Pituitary, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors.

Tjasa Zaletel *Department of Clinical and Movement Neurosciences, University College London, London, UK.
Danyal Z Khan *Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK. d.khan@ucl.ac.uk.
Anjana WijekoonThe UCL Hawkes Institute, University College London, London, UK.
Zhehua MaoThe UCL Hawkes Institute, University College London, London, UK.
Joao Paulo AlmeidaDepartment of Neurosurgery, IU Health, Indiana University, Indianapolis, IN, USA.
Anouk BorgDepartment of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
Jonathan ChaineyDivision de neurochirurgie, Département de chirurgie, Université de Montréal, Montréal, Canada.
Michael D CusimanoDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Daniel A DonohoDivision of Neurosurgery, Children's National Hospital, Washington, DC, USA.
Neil DorwardDepartment of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
Juan Carlos Fernandez-MirandaStanford University School of Medicine, 213 Quarry Road, Palo Alto, USA.
Giorgio FioreUnit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Theofanis GiannisDepartment of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
Alfonso Lagares Gomez-AbascalInstituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.
Lauren HarrisDepartment of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
Abhiney JainDepartment of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
Ruth LauDepartment of Neurosurgery, Hospital Universitari Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain.
Sacit B OmayDepartment of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA.
Igor ParedesInstituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.
Daniel PrevedelloDepartment of Neurosurgery, The Ohio State University and Wexner Medical Centre, Columbus, OH, USA.
Gabriel ZadaDepartment of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Danail StoyanovThe UCL Hawkes Institute, University College London, London, UK.
Sophia BanoThe UCL Hawkes Institute, University College London, London, UK.
Hani J MarcusDepartment of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeEndonasal transsphenoidal surgery is the gold-standard for pituitary adenoma resection, yet no intraoperative framework exists to confirm safe phase progression. Inspired by the Critical View of Safety in laparoscopic cholecystectomy and engineering “phase-gate” process, we propose the Critical Views for Phase Progression (CVPPs) – a set of visual cues confirming phase objectives and safe phase progression. Designed to be clinically relevant and machine-readable, CVPPs aim to support training and future AI-driven guidance systems.

methodsA three-round modified Delphi process was conducted involving 15 pituitary surgery experts from 13 centres across Europe and North America. CVPPs for the naso-sphenoid, sellar, and closure phases were classified as “Essential”, “Desirable” or “Not Necessary”. Consensus required ≥ 70% agreement. A local validation study was subsequently performed involving six experts who reviewed 15 intraoperative video clips and rated their confidence to proceed, which was compared against the predefined reference derived from the finalised CVPPs.

resultsConsensus identified essential and desirable CVPPs across all three phases for both micro- and macroadenoma variants, reflecting differences in exposure goals and surgical risk. Validation demonstrated high concordance between participant ratings and predefined references. Discrepancies arose only in a minority of intentionally incomplete (“unsafe”) views and were attributable to contextual misinterpretation of short video segments, rather than disagreement with the CVPP framework.

conclusionThis international, multicentre consensus is the first to define CVPPs. By standardising intraoperative visual benchmarks, CVPPs can enhance training, mitigate risks, and provide a foundation for future AI-driven guidance systems capable of real-time anatomical annotation and decision support.

Indexed as

AdenomaEndoscopyPituitary NeoplasmsConsensusDelphi TechniqueHumansConsensusCVPPDelphiEndoscopic endonasalEndoscopic transsphenoidal surgeryPituitary adenoma

Identifiers

PMID41604016
PMCPMC12852166

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.