Pituitary adenoma is a common tumor in the saddle area. With the development of neuroimaging and microneurosurgical techniques, approximately 95% or more of pituitary adenomas can be removed by transnasal approach surgery. The important difference and advantage of endoscopic transsphenoidal approach for pituitary adenoma removal from traditional transsphenoidal microsurgery is that it is less invasive and can protect the normal structures of the nasal cavity and butterfly sinus to the maximum extent. The surgery mainly utilizes the natural space of the nasal cavity to form the surgical access, thus avoiding fractures and mucosal bleeding of the nasal septum and turbinates caused by the forced expansion of the retractor. The surgery is entered directly through the ventral wall of the pterygoid sinus, and after incising the mucosa, it mainly relies on grinding drills to remove the ventral wall of the pterygoid sinus, the septum and the saddle base, which can significantly reduce intraoperative bleeding. Due to the optical illumination characteristics of the endoscope and the angle of the endoscope for close observation, it increases the observation range during surgery and can clearly identify important anatomical landmarks, which can clearly display the pituitary gland and residual tumor during surgery, and can maximize the removal of tumor, protect normal pituitary tissue, reduce side injuries and improve the quality of surgery. Because of the small trauma, complete hemostasis and no need to stuff the nasal cavity after surgery, patients do not feel the discomfort of stuffing the nasal cavity after surgery, and they have light postoperative reaction and quick recovery. Although the endoscopic transnasal pterygoid approach to remove pituitary adenoma has the advantages of good field of vision, microinvasiveness and few nasal complications, the endoscopes currently used in clinical practice are mostly two-dimensional planar mirrors with no sense of depth, and the surgery is performed in the relatively narrow nasal cavity, which requires long-term training for the operator to be able to apply comfortably. With the improvement of endoscopic equipment and instruments and the continuous improvement of medical personnel’s skills, endoscopic transnasal pterygoid sinus approach for pituitary adenoma removal will be further developed.