Methodological Reflections on the Comparison of Endoscopic and Microscopic Transsphenoidal Surgery for Pituitary Adenomas

I read with interest the study by Ferat et al. comparing endoscopic and microscopic transsphenoidal surgery for pituitary adenomas. The authors report favorable results for the endoscopic approach in terms of gross total resection, visual improvement, and hospital stay, highlighting an important and clinically relevant topic. However, several methodological issues warrant consideration. The lack of detailed baseline stratification for tumor complexity limits interpretation of whether the reported differences reflect surgical technique or preoperative imbalance. The 2009–2013 study period also raises the possibility of learning-curve effects and transition-related selection bias. In addition, hormonal remission outcomes may be difficult to compare without clear specification of the criteria used, as remission definitions vary by adenoma subtype and have evolved over time. The relatively small sample size may further reduce the ability to detect uncommon but serious complications, and the reported follow-up may be insufficient for long-term recurrence assessment. Overall, the study adds useful data, but future comparative analyses with more detailed baseline characterization, standardized remission criteria, and longer follow-up are needed.