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Updated: Apr 1, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Nationwide shift from microscopic to endoscopic transsphenoidal pituitary surgery
John D Rolston1, Seunggu J Han2, Manish K Aghi2
1California Center for Pituitary Disorders and Center for Minimally Invasive Skull Base Surgery, Department of Neurological Surgery, University of California, 505 Parnassus Ave., M779, San Francisco, CA, 94143, USA. john.rolston@ucsf.edu.
Endoscopic transsphenoidal surgery use has significantly increased while microscopic surgery use has decreased nationwide between 2003 and 2013. This trend in pituitary surgery techniques warrants further investigation into its causes.
Area of Science:
- Neurosurgery
- Surgical Technology Trends
Background:
- Transsphenoidal pituitary surgery is performed using either an operating microscope or an endoscope.
- The comparative adoption rates of these two surgical techniques have not been previously documented.
Purpose of the Study:
- To investigate the national and state-level trends in the utilization of microscopic versus endoscopic transsphenoidal pituitary surgery.
- To determine the relative frequency of each surgical approach over a defined period.
Main Methods:
- Data on all microscopic and endoscopic transsphenoidal pituitary surgeries were obtained from Centers for Medicare and Medicaid Services Part B data files.
- Analysis covered the years 2003 to 2013, comparing national and state-level trends over time.
Main Results:
- A significant increase in endoscopic transsphenoidal surgery utilization was observed from 2003 to 2013.
- Conversely, a significant decrease in microscopic transsphenoidal surgery utilization occurred during the same period.
- The majority of states (38 out of 48) showed an increase in endoscopic procedures and a decrease in microscopic procedures.
Conclusions:
- Nationwide data reveal a definitive shift towards endoscopic transsphenoidal surgery, displacing the use of the microscopic approach.
- The reasons driving this observed trend in surgical technique preference require further in-depth investigation.
