A BSTRACT Objectives: This systematic review and meta-analysis evaluated the effectiveness of transsphenoidal surgery (TSS) in achieving remission and reducing recurrence in pituitary adenomas. Materials and Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. A comprehensive search of nine databases was performed for studies published between 2010 and 2025. Eligible studies included cohort, case–control, and randomized controlled trials reporting remission and/or recurrence outcomes after TSS. Study selection, data extraction, and quality assessment using the Newcastle–Ottawa Scale were independently conducted by two reviewers. Random-effects meta-analyses were applied where appropriate. Results: A total of 42 studies involving 6416 patients were included. Endoscopic TSS (ETSS) was reported in 62.32% of studies. Meta-analysis demonstrated that ETSS was associated with a significantly higher endocrine remission rate compared with microscopic TSS (MTSS) (RR = 1.25, 95% CI 1.12–1.40). No significant difference was observed in gross total resection rates (RR = 0.99, 95% CI 0.93–1.05). Descriptive pooled analysis showed recurrence rates of 7.1% for ETSS and 11.8% for MTSS, although no direct comparative studies were available for recurrence outcomes. Visual remission following ETSS was reported in 81.8% of patients with optic chiasm compression. Conclusion: These findings support the effectiveness of TSS, particularly through the endoscopic approach, in improving remission outcomes, with favorable recurrence profiles reported across included studies.
Wardhana et al. (2026) studied this question.