Pituitary adenoma surgery has evolved rapidly in recent decades, changing clinical practice markedly and raising new challenges. There is no current consensus or guidelines for perioperative care that includes possible complication management. This study aims to determine current practice across European neurosurgical centres. We created a list of eligible departments performing pituitary adenoma surgery based on cooperation with EANS, national neurosurgical societies, and personal communication with local neurosurgeons. We contacted the chairpersons from each department and asked them (or another responsible neurosurgeon) to fill out the survey. The survey consisted of 58 questions. For further analysis, departments were divided into subgroups: "academic"/ "non-academic centre", "high-volume"/"low-volume", "mainly endoscopic"/ "mainly microscopic"/ "mixed practise", and by geographical regions. Data from 254 departments from 34 countries were obtained. The average time to complete the survey was 18 min. Notably, the endoscopic approach is the predominant surgical approach in Europe, used in 56.8% of the centres. In routine cases without intraoperative cerebrospinal fluid leak, high-volume centres are less pedantic with sellar closure when compared with low-volume centres (p < 0.001). On the other hand, when a postoperative cerebrospinal fluid leak occurs, high-volume centres are more active and indicate early reoperation (p = 0.013). Less than 15% of the participating centres perform early postoperative MRI scans. Marked variation was noted among different groups of respondents and some contentious issues are discussed. Such information can encourage useful debate about the reasons for the variations seen and perhaps help develop standardised protocols to improve patient outcomes. A future research focus is to compare European results with other regions.

Department of Methodology Faculty of Physical Education and Sport Charles University Prague Czech Republic

Department of Neurosurgery and Neurooncology 1st Faculty of Medicine Charles University and Military University Hospital Prague Czech Republic

Department of Neurosurgery Johannes Gutenberg Universität Mainz Mainz Germany

Department of Neurosurgery King's College London UK

Department of Neurosurgery Lariboisière University Hospital Paris France

Institute of Biophysics and Informatics 1st Faculty of Medicine Charles University Prague Czech Republic

Neurosurgery Department Radboud University Medical Center Nijmegen Netherlands

Neurosurgery Department University Hospital Donostia San Sebastian Spain

Neurosurgery Unit Department of Neuroscience Rita Levi Montalcini University of Turin Turin Italy

St Department of Neurosurgery Aristotle University of Thessaloniki Thessaloniki Greece

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Endocrinological aspects of pituitary adenoma surgery in Europe