Journal of Innovative Clinical Trials and Case Reports

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 Neurological 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-making. 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 primacy 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.

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.