title: The role of outcomes data for assessing the expertise of a pituitary surgeon.
abstract: OBJECTIVE
  Over the past four decades, advances in surgical technique, instrumentation, and anatomical knowledge have fueled the evolution and sophistication of transsphenoidal pituitary surgery. Paralleling these advances have been major improvements in endocrinological and overall clinical outcomes in patients with pituitary adenomas and other parasellar lesions such as Rathke's cleft cysts and craniopharyngiomas. In this review, we assess the impact of neurosurgeon expertise as a determinant of outcome in pituitary surgery.
  
  
  RESULTS
  Published data since the 1980s indicate that remission rates, overall clinical outcomes and surgical complication rates in pituitary and parasellar surgery are related to neurosurgeon practice volume and cumulative clinical experience. More recently, pituitary surgery has been increasingly performed using an endonasal endoscopic approach. Reports over the last decade suggest when an experienced pituitary neurosurgeon performs a fully endoscopic or endoscope-assisted tumor removal; outcomes are similar if not better than when performed by a traditional microscopic transsphenoidal approach.
  
  
  CONCLUSIONS
  A focused clinical practice and large transsphenoidal surgical volume appear to be important outcome determinants for patients with pituitary and parasellar tumors. Strategies that may further improve patient outcomes include establishing guidelines for pituitary tumor centers of excellence and more focused residency and fellowship training in endonasal endoscopic transsphenoidal surgery. Encouraging regionalization of care to higher volume pituitary tumor centers of excellence and promoting patient education on the importance of surgical expertise may further enhance pituitary patient outcomes.
authors.affiliation: Neuroscience Institute and Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA.
authors.forename: Kiarash
authors.initials: K
authors.lastname: Shahlaie
authors.forename: Nancy
authors.initials: N
authors.lastname: McLaughlin
authors.forename: Amin B
authors.initials: AB
authors.lastname: Kassam
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Kelly
mesh_terms: D004650:Employee Performance Appraisal / Q000379:methods*; D013507:Endocrine Surgical Procedures / Q000266:history / Q000379:methods / Q000706:statistics & numerical data; D055317:Evidence-Based Practice / Q000706:statistics & numerical data; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D010902:Pituitary Gland / Q000601:surgery*; D011361:Professional Competence / Q000706:statistics & numerical data; D013223:Statistics as Topic; D016896:Treatment Outcome