OBJECTIVEThyroid-stimulating hormone (TSH)–secreting pituitary adenoma (TSHoma) is a rare type of pituitary adenoma; thus, little is known about TSHomas. The purpose of this study was to analyze clinical characteristics and therapeutic outcomes of TSHomas based on a single-center experience. The authors also searched for reliable preoperative and early postoperative factors that could predict long-term endocrinological remission.METHODSThe clinical, radiological, and pathological characteristics and surgical and endocrinological outcomes of 31 consecutive cases of TSHomas that were surgically treated between 2005 and 2017 were reviewed retrospectively. Preoperative factors were evaluated for their ability to predict long-term remission by comparing remission and nonremission groups. TSH and free thyroxine levels were measured at 2, 6, 12, 18, and 24 hours after surgery to determine whether they could predict long-term remission.RESULTSGross-total removal of tumor was achieved in 28 patients (90.3%), and 26 patients (83.9%) achieved endocrinological remission by surgery alone based on long-term endocrinological follow-up (median 50 months, range 32–81 months). The majority of the tumors were solid (21/31, 67.7%), and en bloc resection was possible in 16 patients (51.6%). Larger tumor size and tumor invasion into cavernous sinus and sphenoid sinus were strong predictors of lower rates of endocrinological remission. Immediate postoperative TSH level at 12 hours after surgery was the strongest predictor, with a 0.62 μIU/mL cutoff. Postoperative complications included CSF rhinorrhea in one patient and epistaxis in another patient, who underwent additional surgical treatment for the complications.CONCLUSIONSTumor size and extent are major prognostic factors for both extent of resection and endocrinological remission. The consistency of TSHomas was more likely to be solid, which makes extracapsular dissection more feasible. Long-term remission of TSHomas could be predicted even during the early postoperative period.

Study Design: This was a retrospective cohort study. Objective: The objective of this study was to investigate whether machine learning (ML) can perform better than a conventional logistic regression in predicting postoperative C5 palsy of cervical ossification of the posterior longitudinal ligament (OPLL) patients. Summary of Background Data: C5 palsy is one of the most common postoperative complications after surgical treatment of OPLL, with an incidence rate of 1.4%–18.4%. ML has recently been used to predict the outcomes of neurosurgery. To our knowledge there has not been a study to predict postoperative C5 palsy of cervical OPLL patient with ML. Methods: Four sampling methods were used for data balancing. Six ML algorithms and conventional logistic regression were used for model development. A total of 35 ML prediction model and 5 conventional logistic prediction models were generated. The performances of each model were compared with the area under the curve (AUC). Patients who underwent surgery for cervical OPLL at our institute from January 1998 to January 2012 were reviewed. Twenty-five variables of each patient were used to make a prediction model. Results: In total, 901 patients were included [651 male and 250 female, median age: 55 (49–63), mean±SD: 55.9±9.802]. Twenty-six (2.8%) patients developed postoperative C5 palsy. Age ( P =0.043), surgical method ( P =0.0112), involvement of OPLL at C1–3 ( P =0.0359), and postoperative shoulder pain ( P ≤0.001) were significantly associated with C5 palsy. Among all ML models, a model using an adaptive reinforcement learning algorithm and downsampling showed the largest AUC (0.88; 95% confidence interval: 0.79–0.96), better than that of logistic regression (0.69; 95% confidence interval: 0.43–0.94). Conclusions: The ML algorithm seems to be superior to logistic regression for predicting postoperative C5 palsy of OPLL patient after surgery with respect to AUC. Age, surgical method, and involvement of OPLL at C1–C3 were significantly associated with C5 palsy. This study demonstrates that shoulder pain immediately after surgery is closely associated with postoperative C5 palsy of OPLL patient.

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