Whenever we talk about pituitary adenoma surgery, many patients turn pale when they hear the name of this surgery, and many people instinctively think “it must open the brain, it is too scary”. In fact, most pituitary adenomas nowadays do not require craniotomy and can be removed minimally invasively through the nasal aperture and the pterygoid sinus. The pterygoid sinus is an air cavity surrounded by bone not far from the posterior nostril, and its bony structures encircle the area where the pituitary gland is located, known as the pituitary fossa. The pituitary gland sits precariously on top of this depression on the back of the pterygoid bone like a horse, hence the name of this part of the pterygoid bone, the pterygoid saddle. During surgery, the pituitary fossa is accessed through the nostrils by opening the pterygoid sinus, allowing the surgeon to perform the surgery with the help of a microscope or endoscope and in a smaller surgical space, thus reducing the trauma associated with the surgery. The pituitary gland is located in the middle of the skull and is very deep, how can the pterygoid saddle be reached without opening the skull? Currently, there are three basic routes in clinical surgery: 1. Enter the pterygoid sinus through the posterior nasal aperture and perform the surgical operation of pituitary tumor removal. This approach is by far the most common one. 2. Another way is to open a “tunnel” along the nasal septum to reach the pterygoid sinus. 3, There is also a traditional method, namely the sublabial approach, in which an incision is made at the root of the upper lip, i.e., the root of the upper teeth, and the nasal cavity is entered through the upper gums, and then the pterygoid sinus is reached. Of course, everything is inevitable, and for some larger tumors, doctors need to perform craniotomy, so please follow the doctor’s advice for clinical details.