Transsphenoidal approaches usually are the preferred method for treatment of pituitary tumors because of a lower risk of complications. Microscope has been used alone in treatment of such tumor for long time. Recently, with minimal invasive surgery, endoscope has been introduced as an alternative and effective tool in transsphenoidal surgery. The aim of the present study was to present a review of literature dealing with pituitary tumors and to evaluate the role of endoscope in dealing with giant pituitary tumors with suprasellar and parasellar extensions. During the endoscopic approach, the wide view of the nasal anatomy allows the surgeon to determine the appropriate level of entry into the sphenoid sinus more easily (either by visualizing the sphenoid ostia or the level of the superior turbinate). This wide angle of view and superior visualization of the sphenoid anatomy provide excellent information regarding superior and inferior limits of the sella. Pre-operative multisliced axial and coronal CT scans are very helpful as they allow a detailed display of major bony structures which act as anatomical landmarks of the endoscopic route (nasal turbinates, sphenoid ostium, etc) and assessment of the rhino-sinus structures (particularly about symmetry and aeration of the sphenoid sinus and the relationships of the sphenoid septum to the sellar floor and carotid canal). Diabetes insipidus (DI) was diagnosed if the patient had documented urine output 300 ml/hour for more than 3 hours, with a specific gravity of less than 1.005. Together with serum osmolality was greater than 300-mOsm/kg and urine osmolality was less than 200-mOsm/kg and/or serum sodium was greater than 150-mEqg/l. If the patient diagnosed to have DI, the patient should have ADH replacement therapy for deficiency. Complete hormonal profile should be done on the third post-operative week to assess the pituitary functions, to start the adequate replacement therapy if required, and to compare between the pre-operative and the post-operative hormonal profile. Any patients with post-operative visual deterioration or disturbed conscious level, follow up CT and MRI brain must be done as fast as possible to exclude postoperative intracranial abnormalities. The growing experience and the current development of optical devices and instrumentations in the field of transsphenoidal surgery, allow the development of new strategies for less traumatic and safer approaches to the sella and cranial base. In this way, it should be possible, by educative measures, to stimulate young neurosurgeons to learn this endoscopic technique, providing them with all the opportunities and encouragements in acquiring competence in this field.