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Introduction: Carpal tunnel syndrome is the most common nerve entrapment peripheral neuropathy, caused by the compression of the median nerve in the wrist. Conservative treatment has a success rate of 75%. There are three surgical approaches: open, endoscopic and minimally invasive, all of which are highly effective. Trying to determine which is the most beneficial method is a controversial subject. Objective: To determine the advantages, drawbacks, and complications of the approaches using validated scales. Results: 48 patients with EMG-confirmed carpal tunnel syndrome were treated surgically with: a) Open release, b) Endoscopic release (Agee technique). Intraoperative findings with the endoscopic approach were a decreased carpal space and abundant fibroadipose tissue. Patients were followed-up and the results were assessed considering: CSTC, DASH, pain, Tinel sign, Phalen sign, sensitivity, muscle strength, wrist mobility. Conclusions: Both procedures are safe, no complications were reported. The patients treated with endoscopic release did significantly better during the immediate postoperative period, p = 0.001, up to 3 months postop p = 0.0001. They continued to improve up to 6 months, but the differences were not significant anymore. At one year postop, no significant difference was seen between the results of the patients from both groups. No differences were found in the CSTC. The DASH showed a very significant difference; p = 0.004 in favor of the endoscopic release. [ABSTRACT FROM AUTHOR]