The transsphenoidal microsugrical approach is the mainstay of treatment for growth hormone-(GH) producing adenomas, adrenocorticotropic hormone-(ACTH) producing adenomas, and macroadenomas.

Surgical treatment for pituitary adenoma:^[1]

• Rapid deterioration of vision is considered as an immediate indication for surgery to relieve pressure produced by an expanding tumor mass.
• The transsphenoidal microsurgical approach to a pituitary lesion is the most widely employed surgical approach to pituitary lesions and represents a major development in the safe surgical treatment of both hormonally active and nonfunctioning tumors.
• This approach is often successful in debulking tumors, even those that have a significant suprasellar extension (without hourglass-shape appearance).

Contraindications to transsphenoidal microsurgical approach include:

• Tumors with a significant suprasellar extension with an hourglass-shaped narrowing between the intrasellar and suprasellar component, blind attempts to reach the suprasellar tumor may lead to cerebral damage.
• An infection in the sphenoid sinus

Craniotomies via a pterional or subfrontal approach may be performed if transsphenoidal microsurgical approach is contraindicated.