Endoscopic endonasal transsphenoidal approach (EETA) is an acceptable procedure as truly minimally invasive
neurosurgery in handling pituitary tumor. EETA can serve many patients in many aspects especially the hospital stay and the
scarification. However, EETA still has some limitations that can cause serious complications. These complications such as
cerebrospinal fluid leakage and bleeding control are less likely to occur if neurosurgeons use conventional approach named
as Pterional approach which was described by Yarsargil. To gain the benefit of both pterional approach and minimally
invasive surgery, Keyhole Supraorbital Approach (KSA) was proposed by Perneczky in 1999. This approach has not the
mentioned limitation. However, there are many controversies between these two approaches in that what is the better
minimally invasive surgery in pituitary surgery? The present article, by clearing the pro and con of each approach, can help
neurosurgeons select the most appropriate way in handling pituitary surgery.

Keywords: Minimally invasive neurosurgery, Endoscopic endonasal transsphenoidal, Keyhole supraorbital, Pituitary