This study aimed to compare three different surgery approaches for pituitary adenoma excision.A total of 162 patients underwent pituitary adenoma excision through the sphenoid sinus approach.Among patients,5 underwent the sublabio-septo-sphenoidal approach (abbreviated as "sublabio approach"),7 underwent the sphenoid sinus approach and 150 underwent the nasal septum approach.The operative cases that underwent the sublabio approach showed severe surgical trauma because of the complicated operation procedure.The sphenoid sinus approach was relatively easy to operate,but the procedure may confuse an inexperienced operator,which occurred in 2 out of 7 cases in our study.The anatomical landmark was clearer under the nasal septum approach than the other approaches.Thus,operators were less likely to make mistakes during the nasal septum operation.In our study,a success rate of 100% was obtained for the 68 patients who underwent nasal septum operation.The nasal septum approach was suitable for most patients with pituitary adenoma.The hierarchy of the anatomy was distinctive and easily controlled.Thus,the entire nasal septum operation was relatively safe,effective and minimally invasive and can be completed by an operator with sufficient anatomical knowledge and operation skill.