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Background: Transsphenoidal approach became the gold standard in the surgical treatment of pituitary adenomas in the past years, but the comparative efficacy of microscopic and endoscopic transnasal surgery has not been fully studied., Aims: To compare the microscopic and endoscopic transnasal approaches for the treatment of pituitary adenomas., Settings and Design: A retrospective analysis was performed, comparing adult patients with pituitary adenomas who had undergone transnasal microscopic surgery between January 2006 and December 2014 with the patients operated on with endoscopic surgery between March 2011 and December 2014 at Hospital Italiano de Buenos Aires., Material and Methods: Imaging, hormonal, and ophthalmological studies as well as complications were analyzed., Statistical Analysis: Due to the existence of dichotomous variables, Fisher's exact test was used for statistical analysis., Results: In all, 259 patients who had undergone microsurgery and 140 patients operated on with endoscopy were included. The pathologies compared were microsurgically resected nonfunctioning adenomas: 38.2% (n = 99) versus endoscopically resected: 42.1% (n = 59), and microsurgically resected functioning adenomas: 61.8% (n = 160) versus endoscopically resected: 57.9% (n = 81). A higher number of patients with invasive macroadenomas were reported in the group operated on with endoscopy (35.5% vs. 56.4%). When the patients with invasive pathology of the cavernous sinus were compared, percentages of total resection and hormonal control were higher for endoscopic surgeries (35% vs. 46.8%; 33.3% vs. 64%); however, this difference was not statistically significant. No statistically significant differences were found when postoperative complications were individually analyzed., Conclusion: The microsurgical and endoscopic approaches are safe and effective techniques to treat pituitary adenomas. For invasive adenomas, the endoscopic approach may report better results., Competing Interests: None