The transnasal transsphenoidal technique is the preferred approach for pituitary tumors confined primarily to the sella and parasellar regions. In the hands of experienced pituitary surgeons, the rates of morbidity and mortality are extremely low. Extended transsphenoidal approaches have been applied to gain access to the cavernous sinus and suprasellar regions. In some cases, resection via a transcranial approach may be warranted. Endoscopic techniques are being increasingly used and offer a minimally invasive approach and further reduce morbidity associated with the approach to pituitary tumors.