Objective To evaluate the overall effectiveness of microsurgery for elderly pituitary adenomas,and to select the optimal surgical approaches for this type of tumor. Methods Microsurgical operation was performed on 190 patients with elderly pituitary ademomas,and these patients were retrospectively analysed. The 190 cases were divided into transsphenoidal group and transcranial group with a comparison analysis of respective removal percentage,postoperative complication and follow-up. Results In the transsphenoidal group with 158 cases,total removal were performed in 112 cases (71.0%),subtotal removal in 30 cases,partial removal in 16 cases. In the transcranial group with 32 cases,total removal were performed in 8 cases (25.0%),subtotal removal in 16 cases,partial removal in 8 cases. Conclusions Transsphenoidal approach was characterized by shorter hospitalization period,less therapeutic charges and better postoperative quality of life and it should be of choice for the treatment of the elderly pituitary adenomas.