Pituitary tumors, a condition that may be frequently encountered in neurosurgical practice, are a group of tumors that arise from the anterior and posterior pituitary lobes and the epithelial remnant cells of the craniopharyngeal canal. So are pituitary tumors serious and when do they require surgery? Let’s answer the questions: Are pituitary tumors serious? It should be said that pituitary tumor is a relatively serious intracranial disorder. Of course, there are mild and severe clinical staging, but patients with mild disease may also gradually worsen. Some patients may be clinically insignificant or asymptomatic; others may have abnormal hormone secretion syndrome, or tumor compression of surrounding tissues, or other hypofunction, all of which are very serious and can affect the patient’s growth and development, reproductive function, learning and working ability; there is also a more serious case of pituitary stroke, and an explosive pituitary stroke may even have a fatal risk. A fulminant pituitary stroke can even be fatal. How are pituitary tumors treated? There are three main types of treatment for pituitary tumors: medication, radiation therapy and surgery. Treatment of pituitary tumors is a multidisciplinary and comprehensive process that should be individualized according to the size of the pituitary tumor, hormone secretion, complications and co-morbidities, the patient’s age, whether he/she has fertility requirements and the patient’s financial situation. When do I need surgery? At present, the treatment of pituitary tumors is still mainly surgical. A neurosurgeon needs to make a scientific assessment based on the patient’s specific condition to decide whether surgery is needed, and most cases are treated surgically. There are various surgical methods for pituitary tumors, such as traditional transcranial surgery and transnasal butterfly microsurgery, but these still have certain drawbacks, such as large trauma, many complications and easy recurrence. At present, neuroendoscopic transnasal butterfly approach is used for tumor resection, which can completely remove the tumor under the direct view of endoscopic open field and achieve good results. And the surgery is minimally invasive, reaching the operation area through natural channel with little damage and no external incision.