Summary: In a small randomised study with long follow-up, pure endoscopic transsphenoidal pituitary surgery achieved the intended surgical goal and preserved anterior pituitary function better than endoscope-assisted microscopic surgery, with a lower recurrence probability, while most other long-term outcomes were similar.
PICO Summary
| Element | Detail |
|---|---|
| Population | 33 patients undergoing elective transsphenoidal pituitary adenoma surgery; mean follow-up 6.3 years; Germany. |
| Intervention | Pure endoscopic transsphenoidal approach. |
| Comparison | Endoscope-assisted microscopic approach. |
| Outcome | In the microsurgical arm, endoscopic inspection found residual tumour in 7/15 (46.7%) not seen by microscope. Endoscopy was associated with lower recurrence (OR 0.24), greater long-term achievement of the surgical goal (OR 3.80), and better anterior pituitary function (OR 1.60). Hospital stay, complications (16.7% vs 20.0%), pituitary/olfactory function, DI, SIADH, vision, and SNOT scores did not differ. |
Endoscopic vs microscopic pituitary surgery
RCT · pituitary adenoma · 6.3-year follow-up
Endoscopy improved long-term surgical-goal achievement and anterior pituitary function, but this single-centre 33-patient trial leaves most outcomes similar and effects imprecise.
Expert Commentary
This is a useful randomised contribution to a field dominated by retrospective series, and the most striking observation is almost an in-built validation: in nearly half the microscope-operated cases, the endoscope then revealed residual tumour the microscope had missed, which makes the panoramic, around-corners view a plausible explanation for the better goal achievement and lower recurrence. Better preservation of anterior pituitary function is also genuinely meaningful, since hypopituitarism means lifelong replacement. My caveats are real, though. This is a single-centre study of just 33 patients, the odds ratios come with the wide uncertainty that small numbers bring, and most outcomes, complications, vision, nasal function, diabetes insipidus, did not differ between techniques. There is also an unavoidable surgeon-experience and learning-curve element that a small trial cannot fully separate from the technique itself. Can I use this with my patients? Indirectly, as a referral and counselling point rather than a surgical decision I make. For a patient facing pituitary surgery, particularly a functioning adenoma where completeness drives remission, it supports favouring centres with established endoscopic expertise, while being honest that long-term outcomes look broadly similar and operator volume matters greatly.
References
Eördögh M, Bárány L, Rosenstengel C, et al. Comparison of endoscopic and endoscope-assisted microscopic transsphenoidal surgery for pituitary adenoma resection: a prospective randomized study. Front Endocrinol (Lausanne). 2025;16:1552526. doi:10.3389/fendo.2025.1552526