Objective: To explore the effects of transsphenoidal approach microscopic and endoscopic surgery on the total tumor resection rate and hormone changes in patients with Pituitary adenomas (PA). Methods: 141 patients with PA who underwent transsphenoidal approach resection in our hospital from June 2022 to September 2024 were retrospectively collected as the research subjects. According to different treatment methods, the research subjects were divided into the endoscopic group (treated with transsphenoidal resection under neuroendoscopy, n=70) and the microscopic group (treated with transsphenoidal resection under microscope, n=71). The total tumor resection rate, hormone levels [Adrenocorticotropic hormone (ACTH), Growth hormone (GH), and Prolactin (PRL)], and the occurrence of complications were statistically compared between the two groups. Result: The total tumor resection rate in the endoscopic group was significantly higher than that in the microscopic group (P<0.05). One week after the operation, the levels of ACTH, GH and PRL in both groups were significantly lower than those before the operation, and the levels of ACTH, GH and PRL in the endoscopic group were significantly lower than those in the microscopic group (P<0.05). The incidence of postoperative complications in the endoscopic group was significantly lower than that in the microscopic group (P<0.05). Conclusion: Compared with microscopic resection surgery, transsphenoidal neuroendoscopic resection surgery for PA has a better therapeutic effect. It can improve hormone levels, increase the total tumor resection rate, and has higher safety.