First randomized clinical trial to assess superiority of IOMRI over conventional fluoroscopy in pituitary surgery. Extent of resection was similar in both treatment arms. Endoscopic resection lead to higher remission rates than microscopic resection. Overall 17% patients (8/48) were misdiagnosed as complete resection after post-op MRI was done. IOMRI helped optimize resection rate in 25% (5/20) of patients operated in study arm A.