en Neurosurgery Neurosurgery Original Research Original Research <strong>Background: </strong>Pituitary adenoma (PA) is a frequent intracranial lesion, that needs surgical evacuation. In this study, we&nbsp; evaluated the surgical outcome of PA treated via endoscopic and microscopic&nbsp; trans-sphenoidal approach<br> &nbsp;&nbsp; <strong>Methods:</strong> In this retrospective cross-sectional study, we evaluate ten years of PA surgery experience&nbsp; in the northwest of Iran. 721 patients underwent trans sphenoidal surgery of PA. Complication of the surgery, extension of tumors resection, demographic and clinical findings (gender, age , tumor type ,..) were reviewed in this study. SPSS version 25 and statistical tests including chi square and T-test were used. P-value ˂0.5 was considered as statistically significant.<br> &nbsp;&nbsp; <strong>Results:</strong> 483 males (58.9%) and 336 females (41.02%) were included in this study. Mean age of patients was 47.3&plusmn;1.96 years.The most common initial complaints were deterioration of vision (n=528, 64.4%) and headache (n=343, 41.88%), followed by accelerated development (n=254, 31.01%), amenorrhea and galactorrhea (n=253, 30.8%). 57 (6.95%) patients had symptoms of Cushing&rsquo;s disease. 105 (12.8%) patients had acromegaly. TR was achieved in 87.5% of cases and sub-TR in 103 (12.5%) cases and no patient had a partial or insufficient resection. After surgery, the endocrine function was normalized in 76 (31.7%) patients who had preoperative hyper hormonal levels. 36 (4.3%) patients developed postoperative CSF leakage; of which, 4 (0.48 %) patients did not improve by lumbar drainage and other conservative treatments&nbsp; and needed reoperation for reconstruction of the skull base.<br> &nbsp;&nbsp; <strong>Conclusion:</strong> The combination of microscopic and endoscopic trans-sphenoidal approach in PA surgery can be lead to total resection of tumors. Pituitary Adenoma, Pituitary Hormone, Trans-Sphenoidal Approach 688 691 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-5758-1&slc_lang=en&sid=1 Firouz Salehpoor firouzsalehpour@tbzmed.ac.ir 200319475328460063092 200319475328460063092 No Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Amir Kamalifar kamalifar.m@umsu.ac.ir 200319475328460063093 200319475328460063093 Yes Farhad Mirzaii farhadmirzaii@tbzmed.ac.ir 200319475328460063094 200319475328460063094 No Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Javad Aghazadeh aghazadeh attari@tbzmed.ac.ir 200319475328460063095 0001-3421-3478-9870 No Department of Neurosurgery, Faculty of Medicine, Urumia University of Medical Sciences, Urumia, Iran Mehrnoush Mousavi Aghdas mousavi@tbzmed.ac.ir 200319475328460063096 0002-5476-5467-7790 No Department of ENT, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Samar Kamalifar samarkamalifar@gmail.com 200319475328460063097 200319475328460063097 No Student Research Committee, Faculty of Medicine, Arak University of Medical Sciences, Markazi, Arak, Iran Asgar Bagheri asgarbagheri@tbzmed.ac.ir 200319475328460063098 200319475328460063098 No Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Hosein Hamadani hoseinhamadani@tbzmed.ac.ir 200319475328460063099 200319475328460063099 No Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran