To compare patients with pituitary adenoma who underwent transphenoidal (TS) and transcranial (TC) surgery, the visual outcome and postoperative complications. Retrospective analysis of case notes of 45 patients {(90 eyes) 14 TC, 31 TS} with pituitary adenoma who underwent pituitary tumour resection between 1998 and May 2002. The patients’ age ranged from 16 to 66 years with a mean ± SD of 41.7 ± 31.1 years. 56% are male. Fourteen patients were operated by TC. Preoperatively, visual acuity deficit occurred in 64% vs 96% (TS vs TC, p =0.011).