Currently there are three major surgical approaches into the sphenoid sinus during transsphenoidal microsurgery. The first approach is the sublabial incision with submucous resection along the nasal septum. It is particularly advantageous in patients with small nasal apertures, in pediatric patients, and for large tumors extending into the cavernous sinuses or into the clivus. The second approach, the transnasal submucous tunnel, is presently the most frequent technique used, although it provides the narrowest operation field. The third technique is the direct transnasal approach. This method is less destructive to structures in the nasal cavity and less time-consuming. In the period of 20 months the authors performed 81 transsphenoidal microsurgical operations in 44 women and 37 men. Visual field defect was the most frequent indication for surgery in 42 cases, followed by hormonal abnormality in 24 patients. The sublabial approach was used in 69 cases, the technique of transnasal submucous tunnel in 10 patients, and the direct transnasal approach in 2 cases. The authors encountered no short-term or long-term complications related to various surgical approaches to the sphenoid sinus.