Objective To evaluate the surgical strategy for giant pituitary adenomas apoplexy complicated with obstructive hydrocephalus.Methods Twenty-three patients with giant apoplectic pituitary adenomas associated with obstructive hydrocephalus,admitted to our hospital from January 2010 to March 2015,were chosen;their clinical and surgery data were retrospectively summarized.Results Transsphenoidal microsurgery was conducted in 22 patients and craniotomy in one.All tumors showed cystic degeneration and soft texture.Seven patients had faint yellow or hyaline cyst fluid and 16 had soybean sauce or dark red cyst fluid.Near-total tumor resection was achieved in 2 patients (8.7％),subtotal resection in 16 (69.6％),and partial resection in 5 (21.7％).Twenty-three patients were followed up for 4-38 months,one patient accepted repeated operation for residual rumors,5 had postoperative adjuvant radiation therapy,and no other patients showed re-growth or recurrence.Postoperatively,there was no long-term cerebrospinal fluid leakage and diabetes insipidus,with hydrocephalus disappeared in 100％,visual improved in 60.9％,and headache relieved in 81.8％.Conclusions Pituitary adenoma presented with apoplexy and concurrent obstructive hydrocephalus is often soft.Transsphenoidal microsurgery is the preferred safe and effective method which can relieve hydrocephalus and achieve improved clinical symptoms.