When you see the word “surgery”, I believe you must be shocked: “Is it going to be a craniotomy?” In fact, most pituitary adenomas can be minimally invasively removed through the nostrils and pterygoid sinus instead of a craniotomy. Just, the pituitary gland is deep in the brain, so far away from the nostrils, and the bone opening is very small, the doctor actually use what tools and methods to remove the tumor? Typically, pituitary adenomas are soft enough for the clinician to scrape them out with a long-handled spatula, and for larger tumors, the tumor is cut into smaller pieces and removed in small chunks. For example, if the tumor is overgrown upward, i.e., most of the tumor is located above the pyriform saddle, then the upper tumor may “fall out” after the lower tumor is removed and can be further removed. Therefore, surgeons sometimes divide the removal of a pituitary macroadenoma into two stages: first, they try to remove the pituitary adenoma “below” the pons; and then, by increasing intracranial pressure, they dislodge the tumor “above” the pons, which “falls into” the pons. The tumor “above” the septum is then dislodged by raising the intracranial pressure, “falling” into the saddle region, and then surgical removal is resumed. In some cases, even two separate operations are required. Of course, there are always exceptions. For example, the cavernous sinus is located on both sides of the pterygoid saddle and is the meeting place for the veins of the head and face. Not only that, but this area also has important nerves that control eye movements and the internal carotid artery that supplies blood to the brain, making it a “minefield”! If the tumor grows horizontally and protrudes into the cavernous sinus, the surgery will be extremely difficult. Therefore, in this case, it is difficult to remove the tumor completely through surgery, and the doctor needs to make a judgment on the specific situation.