Patients with pituitary tumors often ask clinical questions about the choice of pituitary tumor surgery, and we hope this article will help pituitary tumor patients understand the surgical approach. There are 2 types of pituitary tumor surgery: transnasal butterfly approach and transcranial approach. Pituitary tumors are located at the base of the skull. The transnasal butterfly approach is to open the skull base and operate from below the tumor. The advantage of this approach is that it has less impact on brain tissue and endocrine function. Transcranial approach is to open the brain tissue to reach the skull base and remove the tumor from above the tumor, which has the advantage of low incidence of cerebrospinal fluid leakage and the disadvantage of affecting the brain tissue and endocrine function. Nowadays, the transcranial approach can be preferred in about 90% of pituitary tumor cases, but transcranial surgery should be considered when the tumor develops anteriorly, posteriorly or bilaterally.