The review of Ammirat et al1 on endoscopic versus microscopic resection of pituitary adenomas is a timely and controversial contribution as can be seen from the two editorial commentaries by Dr Laws2 and Dr Oldfield and Dr Jane.3 Most importantly, it paradigmatically highlights a major problem in the scientific analysis of neurosurgical techniques which will become far more pressing in the future. When healthcare resources are dwindling, the introduction of new and potentially costly techniques will have to be evaluated rigorously against the ‘old’ standard technique. Schumpeter's principle of creative destruction which describes how new products and processes will render older ones obsolete is in full swing here.4

As to pituitary adenoma resection, Ammirat et al1 tried to elucidate which approach is superior using the technique of systematic review and meta-analysis. Disappointingly, their substrate …