Non-written guidelines in pituitary tumor surgery. The hidden curriculum.

PURPOSE: Although clinical guidelines provide evidence-based recommendations for pituitary tumor management, real-world surgical practice also relies on non-written rules derived from tacit knowledge, experiential judgment, and shared professional norms. These principles help clinicians manage complexity and uncertainty, not fully addressed by formal protocols. This review aims to identify non-written guidelines across the perioperative continuum of pituitary surgery and to examine how they complement established patient safety frameworks.

METHODS

We examined recurring clinical heuristics transmitted through institutional mentorship, multidisciplinary case discussions, and accumulated perioperative experience. Identified non-written guidelines were organized into preoperative, intraoperative, postoperative, and institutional domains, and contextualized through reference to contemporary literature.

RESULTS

Non-written guidelines were found to play a role in complication prevention and in supporting coordinated multidisciplinary team performance. When articulated, these heuristics enhance situational awareness, support adaptive decision-making, and promote consistency of care, particularly within Pituitary Tumor Centers of Excellence.

CONCLUSIONS

Systematic articulation of non-written guidelines may help translate formal protocols into daily clinical practice, supporting safer care, more effective training, and more consistent performance in pituitary tumor surgery.