Abstract
A Background/Objectives: Sellar and parasellar tumors constitute a heterogeneous group of lesions whose management requires complex synthesis of radiological anatomy, endocrine dynamics, symptom evolution, and patient physiology. Although authoritative guidelines exist-such as those of the Congress of Neurolog ical Surgeons (CNS) for pituitary adenomas [1], the European Association of Neuro-Oncology (EANO) for meningiomas [2], the European Society of Endocrinology (ESE) [3], and the Pituitary Society [4]-these recommendations remain domain-specific and do not provide a unified structure for real-world decision-mak ing. We propose a clinically oriented six-node algorithm designed to integrate these domains into a coherent, sequential logic.
Methods: A narrative review of neurosurgical, endocrine, and radiological literature from 2010-2025 was performed. Guidelines from CNS, EANO, ESE, and the Pituitary Society were analyzed in depth. A structured algorithm was derived, comprised of six nodes: (A) urgency of presentation, (B) patient physiological profile, (C) radiological determinants, (D) endocrine characterization, (E) therapeutic pathway selection, and (F) risk-adapted follow-up. Three representative clinical cases-a planum sphenoidale meningioma requiring transcranial resection, an elderly patient with incidental NFPA followed for years before progression, and a young patient with stable asymptomatic NFPA-were integrated directly into the narrative to illustrate algo rithmic reasoning.
Results: The algorithm captured the full clinical trajectories of all three cases, demonstrating concordance with CNS, EANO, and endocrine guidelines while offering enhanced granularity. Case 1 highlighted the pri macy of radiological anatomy in determining surgical approach. Case 2 illustrated the validity of extended surveillance in elderly asymptomatic NFPA, followed by necessary transition to surgery upon radiological progression. Case 3 exemplified long-term observation in young asymptomatic NFPA lacking invasive features. In each case, the algorithm resolved ambiguities inherent in guideline documents and provided a structured rationale for management. Open Access.
Conclusions: The proposed six-node model offers a comprehensive framework for sellar tumor management. Integrating urgency, physiology, radiology, endocrine evaluation, treatment feasibility, and follow-up strategy into a unified sequential algorithm enhances clarity, supports multidisciplinary coherence, and aligns with but refines existing guidelines. Embedded clinical cases demonstrate its applicability in diverse scenarios.
DOI: doi.org/10.63721/26JCTC0133
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