A Century of Transsphenoidal Pituitary Surgery: Bibliometric Insights Into Global Research Trends and the Evolution of Evidence

BACKGROUND AND OBJECTIVES: Transsphenoidal pituitary surgery has evolved substantially since its first description over 100 years ago, necessitating systematic characterization of its development. We conducted bibliometric analyses of the transsphenoidal surgery literature to map the field's growth, identify thematic shifts, and highlight gaps in the modern evidence base. METHODS: Publications related to the transsphenoidal surgical approach were identified from the Web of Science database. The data set was screened for irrelevant publications using an automated regular-expression natural language processing approach. Bibliometric analyses and visualizations were performed using open-source Python libraries. RESULTS: The final data set consisted of 4167 primarily English-language works published since 1910. Most articles were original research and were concentrated within a small subset of journals. Although research output was concentrated among the United States, China, and Japan, collaboration networks were dense and globally distributed. Pathology mapping showed episodic surges across diagnoses, with major pituitary adenoma subtypes dominating total output. Microscopic terminology surged beginning in the 1960s but declined after the introduction of endoscopy, which rose sharply after the early 1990s and became the dominant approach by 2003. Simultaneously, higher-level evidence designs (prospective studies, randomized trials, and systematic reviews) have steadily increased since the 1980s and were over-represented among highly cited works. Despite a sharp rise in publication volume since the early 1990s, the share of publications related to pediatric populations has steadily decreased. Critically, despite near-universal clinical practice of preoperative Staphylococcus aureus decolonization and surgical site preparation, their documentation and study in the existing literature remain minimal. CONCLUSION: This analysis details a century of transsphenoidal surgery research, demonstrating rapid expansion of the literature, a definitive shift from microscopic to endoscopic techniques, and a maturation of evidence quality. By identifying specific evidence gaps concerning infection prophylaxis and pediatric populations, these findings provide a structured baseline for prioritizing future research efforts.