What is the better minimally invasive surgery in pituitary surgery: endoscopic endonasal transsphenoidal approach or keyhole supraorbital approach?

Endoscopic endonasal transsphenoidal approach (EETA) is an acceptable procedure as truly minimally invasive neurosurgery in handling pituitary tumor. EETA can serve many patients in many aspects especially the hospital stay and the scarification. However EETA still has some limitations that can cause serious complications. These complications such as cerebrospinal fluid leakage and bleeding control are less likely to occur ifneurosurgeons use conventional approach named as Pterional approach which was described by Yarsargil. To gain the benefit of both pterional approach and minimally invasive surgery Keyhole Supraorbital Approach (KSA) was proposed by Perneczky in 1999. This approach has not the mentioned limitation. However, there are many controversies between these two approaches in that what is the better minimally invasive surgery in pituitary surgery? The present article, by clearing the pro and con of each approach, can help neurosurgeons select the most appropriate way in handling pituitary surgery.