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Updated: Jan 16, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Systematic review of fluorescence-guided surgery in pituitary neuroendocrine tumours
Christopher Dillon Ovenden1, Nicholas Candy2, James McNeil3,4
1The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, Australia.
Objective:
Fluorescence-guided surgery represents a potential novel technique to improve the extent of tumour resection, minimise resection of normal tissue, and optimise outcomes in pituitary neuroendocrine tumour surgery. We systematically reviewed the available evidence on this topic to define the current role for fluorescence-guided surgery in this setting.
Design And Methods:
A systematic review was conducted in accordance with the PRISMA 2020 guidelines. MEDLINE, EMBASE, and the Cochrane Library were searched on 1st March 2025 for studies investigating the use of exogenous fluorophores or autofluorescence in pituitary surgery. Two authors independently screened studies and extracted data from included studies. Risk of bias assessment was performed using the Newcastle-Ottawa Scale.
Results:
From 1,604 studies identified, 22 studies involving 297 patients were included. Risk of bias was high in the vast majority of studies. Studies on six exogenous fluorophores were identified (indocyanine green, OTL38, bevacizumab-800CW, chlorin E6 photosensitiser, 5-aminolevulinic acid, and sodium fluorescein), with three studies assessing autofluorescence. Findings of included studies were variable, with small sample sizes and limited outcome reporting. 5-Aminolevulinic acid seems to have little use as a fluorophore in pituitary surgery. The clinical utility of the remaining fluorophores is not yet clearly defined. There are limited data on the utility of autofluorescence in pituitary surgery.
Conclusion:
At present, there is insufficient evidence to support the routine use of fluorescence-guided surgery in this setting, prompting the need for further research in this area.
Insights
Fluorescence-guided surgery shows promise for pituitary tumors but lacks sufficient evidence for routine use. Further research is needed to define the clinical utility of various fluorophores and autofluorescence techniques.
Area of Science:
- Neurosurgery
- Surgical Oncology
- Medical Imaging
Background:
- Pituitary neuroendocrine tumors (PitNETs) present surgical challenges.
- Fluorescence-guided surgery (FGS) offers potential benefits like improved resection and reduced normal tissue removal.
- The role of FGS in PitNET surgery requires systematic evaluation.
Purpose of the Study:
- To systematically review the evidence on FGS in pituitary neuroendocrine tumor surgery.
- To define the current role and clinical utility of FGS in this surgical setting.
Main Methods:
- Systematic review following PRISMA 2020 guidelines.
- Searched MEDLINE, EMBASE, and Cochrane Library for studies on FGS in pituitary surgery.
- Included 22 studies (297 patients) after screening 1,604 initial records.
Main Results:
- High risk of bias was noted in most included studies.
- Six exogenous fluorophores and autofluorescence were investigated.
- Findings were variable, with small sample sizes and limited outcome reporting; 5-aminolevulinic acid showed little utility.
Conclusions:
- Insufficient evidence currently supports routine FGS in pituitary neuroendocrine tumor surgery.
- The clinical utility of most investigated fluorophores remains undefined.
- Further high-quality research is necessary to establish the role of FGS.
