The commonest cause of incomplete resection of pituitary adenomas appears to be invasion of the cavernous sinus, and there are increasing numbers of publications describing different surgical approaches to this problem. Parkinson (1) pioneered the transcranial operative approach, and Hakuba (2) has reported four modifications, including his experience with 13 different neoplasms. The main disadvantage, even in the hands of experienced neurosurgeons, is the high complication rate (2-6).
In this issue of the European Journal of Endocrinology, Matsumo et al. (6) report a slightly modified transcavernous approach that they have used in four patients with different types of pituitary adenomas, and they have compared the results obtained in four patients with adenomas that were operated by the transsphenoidal technique. This is the first investigation to compare the endocrine outcome in large invasive adenomas using these different techniques but, because of the small number of cases, and their heterogeneity, it must