Despite advancements in endoscopic treatment for pituitary neuroendocrine tumors(PitNETs), refractory PitNETs remain challenging due to their invasiveness, incomplete resection, and recurrence, with suboptimal outcomes from current therapeutic modalities. Immunotherapy, which enhances anti-tumor immune responses, presents a promising approach for managing refractory PitNETs. Single-cell sequencing has recently revealed tumor heterogeneity and immune microenvironment characteristics of PitNETs, providing a foundation for immunotherapy applications. Studies have revealed that immune infiltration varies across PitNET subgroups, offering insights for targeted immunotherapy. However, challenges persist, including a lack of validated immunotherapeutic targets, limited clinical trials, monotonous approaches, and uncertain efficacy. Future research should prioritize multi-omics analyses to identify new targets, expand basic and clinical research, explore diverse immunotherapeutic strategies, and develop personalized and combination therapies.

Prolactinomas are the most common subtype of pituitary neuroendocrine tumors(PitNETs),which can be treated with drugs surgery,radiotherapy and so on.For invasive and non-invasive prolactinomas,there is still controversy on the treatment choice of drugs or surgery as the first-line option.In the past decade,with the progress of endoscopic transsphenoidal minimally invasive technology in-depth understanding of PitNETs pseudocapsule,and constructions of Pituitary Tumor Centers of Excellence(PTCOE),the biochemical remission rate by surgical treatment has been significantly improved.For some specific subtypes of prolactinomas,such as microadenomas and enclosed macroadenomas(Knosp grade 0-2),the biochemical remission rate can achieve 90％with the treatment of endoscopic transsphenoidal surgery,which was similar with the drug efficacy.Therefore,the International Pituitary Society made the latest consensus statement on the clinical treatment of prolactinomas suggested that surgery can be performed as first-line option for some selected prolactinomas.This shift of therapeutic strategy was determined in the form of consensus statement,which has a strong clinical guiding significance.

Prolactinomas are the most common subtype of pituitary neuroendocrine tumors(PitNETs),which can be treated with drugs surgery,radiotherapy and so on.For invasive and non-invasive prolactinomas,there is still controversy on the treatment choice of drugs or surgery as the first-line option.In the past decade,with the progress of endoscopic transsphenoidal minimally invasive technology in-depth understanding of PitNETs pseudocapsule,and constructions of Pituitary Tumor Centers of Excellence(PTCOE),the biochemical remission rate by surgical treatment has been significantly improved.For some specific subtypes of prolactinomas,such as microadenomas and enclosed macroadenomas(Knosp grade 0-2),the biochemical remission rate can achieve 90％with the treatment of endoscopic transsphenoidal surgery,which was similar with the drug efficacy.Therefore,the International Pituitary Society made the latest consensus statement on the clinical treatment of prolactinomas suggested that surgery can be performed as first-line option for some selected prolactinomas.This shift of therapeutic strategy was determined in the form of consensus statement,which has a strong clinical guiding significance.

Objective To investigate the perinatal outcomes after elective neurosurgery in pregnant women complicated by space-occupying lesions in saddle area.Methods Clinical data were retrospectively collected and analyzed from five gravidas with space-occupying lesions in saddle area,who underwent neurosurgery at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2017 to February 2018,including gestational age,perioperative management,surgical procedures,postoperative complications,pregnancy outcomes and pathological results.Results (1) Progressively deteriorated impaired vision was the chief complaint of all five patients.Space-occupying lesions in saddle area were detected by cranial MRI (plain scan).The surgical indication was clear as there was compression on optic nerve and a risk of blindness due to optic nerve atrophy,Two patients were operated in the third trimester and three in the second trimester.Postoperative pathology showed there were two cases with meningioma,two with pituitary macro adenoma and one with abscess of pituitary.Only one patient had mild postoperative cerebrospinal fluid rhinorrhea,which was improved three months later,and no complications were reported in the other four cases.All five patients had obvious improvement of vision after surgical intervention and no relapse was reported during a follow-up of 4-12 months.(2) Four gravidas continued their pregnancies to full or nearly full term,among which three underwent cesarean section due to obstetrical indications (one breech pregnancy,one twin pregnancy with scarred uterus and one complicated by hypertensive diseases of pregnancy with poor blood pressure control) and one delivered vaginally.Postpartum involution of the uterus was well in all of the four cases 42 d after delivery.The women with pituitary abscess terminated the pregnancy due to intraamniotic injection of ethacridine lactate at 20 weeks of gestation.Five neonates were all born with Apgar scores of 10 at 1,5 and 10 min without any visible defects at birth and all grew and developed normally at 4-12 months after birth.Conclusions For gravidas with space-occupying lesions in saddle area,it is necessary to weigh the pros and cons and choose an individualized treatment plan.Resection of saddle area lesions in the second or third trimester backed by a multidisciplinary team is a safe and feasible procedure if postponing the operation until delivery may cause irreversible or even life-threatening consequences.

Objective To investigate the effects of electrocorticography(ECoG) monitoring in microsurgical treatment of intracranial cavernous hemangiomas(ICH).Methods Fifteen cases of ICH with secondary epilepsy were investigated from 2000 to 2005.They all had been performed ECoG monitoring during operation for determining the precise position and scope of focal epileptogenicity.Results Follow-up visit found 10 cases cured without drugs,4 cases total controlled with 1/4~1/3 quantity of premedicant,1 case had epileptic seizure by chance with drugs.Conclusion ECoG monitoring can provide the direction during the surgical procedure,and controls the postoperative epileptic seizure.