This review compares endocrine outcomes after endoscopic and microscopic transsphenoidal surgery for pituitary adenomas and highlights cautious, evidence-limited support for endoscopic approaches.
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Review Article
* These authors contributed equally
This review compares endocrine outcomes after endoscopic and microscopic transsphenoidal surgery for pituitary adenomas and highlights cautious, evidence-limited support for endoscopic approaches.
Transsphenoidal surgery remains a principal treatment for most functioning and symptomatic non-functioning pituitary adenomas, but the relative endocrine and safety outcomes of endoscopic transsphenoidal surgery (ETS) and microscopic transsphenoidal surgery (MTS) remain debated. This systematic review and meta-analysis searched PubMed/MEDLINE, Embase, Web of Science Core Collection, Cochrane Library, Scopus, ClinicalTrials.gov, and reference lists for comparative studies published from January 2010 to March 2025. Eight studies comprising 769 patients were included in the endocrine-success analysis, with 392 patients treated by ETS and 377 by MTS. The pooled random-effects estimate favored ETS for the composite endocrine-success endpoint, defined as biochemical remission for functioning adenomas or preserved pituitary function in mixed and non-functioning cohorts (risk ratio [RR] 1.26, 95% confidence interval [CI] 1.13–1.41; I2 = 17.8%). The functioning-only subgroup had an imprecise, non-significant estimate (RR 1.06, 95% CI 0.63–1.80), whereas mixed cohorts favored ETS (RR 1.22, 95% CI 1.11–1.34). Diabetes insipidus and cerebrospinal fluid (CSF) leak were infrequently reported and had wide CIs. New hypopituitarism was not meaningfully pooled because events were sparse and between-study heterogeneity was substantial; raw study-level counts are therefore presented. The available literature suggests an association between ETS and improved endocrine success, but interpretation is limited by heterogeneous outcome definitions, confounding by indication, and the predominance of retrospective cohorts. Complication outcomes remain underpowered, and no definitive conclusion can be drawn regarding differences in postoperative morbidity between approaches.
Pituitary adenomas are common sellar tumors and account for a substantial proportion of primary intracranial neoplasms; population-based data also indicate that clinically recognized adenomas are less frequent than incidental radiological or autopsy findings1,2. Their clinical effects range from hormone hypersecretion, such as acromegaly or Cushing disease, to mass effect with visual compromise, headache, and hypopituitarism3. Medical therapy remains central for selected tumor subtypes, particularly prolactinomas, whereas surgical resection is frequently used for functioning adenomas re....
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This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 framework14. The review was not registered in PROSPERO; it was registered in INPLASY (registration number: INPLASY202650157), and the eligibility criteria, outcomes, and analysis plan were specified before extraction of outcome data. Study screening, data extraction, and statistical verification were performed by two independent reviewers and adjudicated by a senior reviewer. PubMed/MEDLINE, Embase, Web of Science Core Collection, Cochrane Library, and Scopus were searched from January 1, 2010, to March 1, 2025, with additional s....
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This systematic review and meta-analysis suggest that ETS is associated with higher endocrine success than MTS in contemporary comparative studies of pituitary adenoma surgery. The pooled primary estimate favored ETS, and leave-one-out sensitivity analysis did not identify a single study responsible for the result. However, the evidence should be interpreted cautiously because the endpoint combines biochemical remission in functioning adenomas with preservation of pituitary function in mixed and non-functioning cohorts. .......
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The authors have no conflicts of interest to declare.
No specific funding was received for this work. Language-editing assistance was used to improve grammar, formatting, and journal-style consistency; all scientific content, study selection, data extraction, statistical analysis, data interpretation, and final decisions remain the responsibility of the authors. No artificial intelligence tool was used for study screening, data extraction, statistical analysis, or scientific interpretation.
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