A unique and shared regional pathway to accompany patients with pituitary adenoma and other lesions of the sellar and parasellar region , from diagnosis to treatment up to checks over time: this is the new Diagnostic Therapeutic Assistance Pathway (PDTA) "Pituitary Unit" of the Sardinia Region, approved by the Regional Council at the end of a long and detailed process.

This is an important recognition for ARNAS G. Brotzu : within the new program, the Neurosurgery Complex Unit, directed by Dr. Carlo Conti, has been identified as the sole regional referral center for the surgical treatment of these conditions. Dr. Nicola Desogus , head of the Endoscopic Pituitary and Skull Base Surgery Unit at Brotzu Neurosurgery, was among the main promoters and developers of the program, which is the second such center in Italy after Emilia-Romagna.

THE DISEASE – Pituitary adenomas are generally benign tumors that affect the pituitary gland, a small gland located at the base of the brain that controls numerous body functions through the production of certain hormones. They represent approximately 10-15% of intracranial tumors. In Sardinia, an estimated 30-45 new cases are diagnosed each year, which may require surgical treatment.

The new PDTA was created with the aim of guaranteeing Sardinian patients an organised, multidisciplinary and homogeneous path , avoiding fragmentation in care and encouraging care to be taken by centres with specific expertise.

The model envisages close collaboration between Neurosurgery and Endocrinology, along with other specialties involved in diagnosis and treatment, such as Ophthalmology, Neuroradiology, and Anesthesia . Three endocrinology centers have been identified within the regional network: the Cagliari University Hospital, directed by Francesco Boi (with Francesca Pigliaru as the contact person), the Sassari University Hospital, directed by Francesco Tolu (with Francesca Badessi as the contact person), and the Cagliari Local Health Authority (ASL) directed by Guidi Almerighi (with Paolo Epminonda as the contact person). ARNAS G. Brotzu is the only regional referral surgical center.

"This is a significant achievement for Sardinian healthcare and for our hospital," said Carlo Conti, director of the Neurosurgery Unit at Brotzu. "The centralization of surgery in a single regional center allows us to concentrate expertise and experience, improving the surgical quality offered to patients through a shared and highly specialized approach."

THE PROCESS – The process can begin in the emergency room , a hospital ward , or an outpatient clinic . Once the pathology has been identified, the patient undergoes the necessary tests to define the type of lesion and determine the most appropriate treatment. Before surgery , endocrinological, ophthalmological, and anesthesiological evaluations are performed, and any necessary radiological tests are scheduled. In cases where surgery is indicated, the reference technique is transsphenoidal endoscopic surgery , which allows the pituitary gland to be reached through the nasal cavities, avoiding opening the skull. The goal is to remove the lesion, when possible, and, above all, to decompress any affected nerve structures, particularly the optic chiasm. The evolution of technologies used in the operating room, including the most modern high-definition endoscopic equipment, has further improved the precision and safety of the procedure. After surgery, the patient is followed through clinical, radiological, and endocrinological monitoring, with check-ups scheduled in the phases following discharge.

Treatment for pituitary adenomas doesn't end with surgery: some tumors can produce excess hormones, while in other cases, surgery may require hormone replacement therapy. Therefore, the new approach involves a shared follow-up between Neurosurgery and Endocrinology, with visits, blood tests, MRI scans, and further tests scheduled based on the characteristics of the disease and clinical progress. Even in the presence of residual tumor or a recurrence, the case is evaluated jointly by specialists to identify the most appropriate strategy, which may include further surgery, medical therapy, or, when indicated, radiosurgery.

QUALITY OF CARE – Specific quality indicators are also included to monitor the efficiency of the process and the timeliness of care . Objectives include, for example, achieving a 90% rate of follow-up visits within 30 days.

(Unioneonline/vl)

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