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Transsphenoidal surgery has evolved much over nearly 100 years. Initially operations were performed often without any input from endocrinology colleagues, and without preoperative imaging, operative magnification and illumination. Advances in the understanding of the biology of pituitary tumours, close co-operation between endocrinologists, surgeons and oncologists, and huge advances in imaging and surgical techniques have led to the evolution of the current transsphenoidal operation to the pituitary fossa to the point where a ‘cure’ is often possible with low complication rates. The indications, contraindications of transsphenoidal surgery will be discussed, together with nature of the surgical approach and how it can be applied to particular pituitary tumours and suprasellar lesions.