An Enhanced Recovery Protocol for Endoscopic Endonasal Pituitary Surgery

Enhanced Recovery After Surgery (ERAS) protocols have been progressively introduced to peri-operative care for decades. ERAS is an evidence-based approach to surgical care which employs multimodal strategies that include pre-operative counselling, standardized analgesia and anesthetic regimens, optimization of nutrition, early mobilization and use of minimally invasive techniques. The main goal of ERAS is to shorten hospital length of stay (LOS), reduce complications, and improve patient satisfaction and outcomes. That said, there are currently no consensus guidelines regarding ERAS after neurosurgery, and very limited reports of ERAS protocols after endoscopic endonasal pituitary surgery. Here, we present a comprehensive ERAs protocol for pituitary surgery. Following a literature review and multidisciplinary meetings with relevant stakeholders, an evidence-based institutional protocol for peri-operative care was successfully established and implemented at our neurosurgical centre. We describe the peri-operative approach to enhanced pituitary care and demonstrate feasibility of this collaborative process. Like other surgical specialties, we suspect that widespread implementation of ERAS protocols in neurosurgical practice will lead to improved patient outcomes. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany