Effectiveness of transsphenoidal surgery on remission and recurrence rates of pituitary adenomas: A systematic review and meta-analysis.

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.