The paper by Ammirati and Colleagues1 comes to the conclusion that, in the performance of transsphenoidal pituitary surgery, the traditional microsurgical approach is less likely to be accompanied by vascular complications than the transnasal endoscopic method. In the short term, that appears to be the only discernible difference between the two techniques.

This conclusion is reached on the basis of what is purported to be a meta-analysis of the pertinent published English literature. They present a detailed and time consuming, but, in the opinion of this reviewer, deeply flawed methodology.

In fact, the actual numbers of vascular complications leading to this conclusion were 14 of 3023 microscopic cases reported from 1997 through 2009 and 26 of 1887 endoscopic cases reported from 2002 through 2011. It should …