Pituitary tumors in the computational era, exploring novel approaches to diagnosis and outcome prediction with machine learning.

Machine learning has emerged as a viable asset in the setting of pituitary surgery. In the last 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. The field of machine learning is broad, with radiomics and artificial neural networks comprising two commonly utilized supervised learning methods 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. 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.