目的　探讨经蝶窦显微手术切除侵袭海绵窦的垂体腺瘤的手术适应证和手术技巧。　方法　 42例侵袭海绵窦的垂体腺瘤病例均采用经口 鼻 蝶窦入路 ,共进行 45次手术。术中在C 臂X线机或神经导航监测下尽可能开大侧方鞍底 ,显微放大下切开鞍底硬膜。依肿瘤侵袭的方向、通道按不同次序分块切除肿瘤。少量残留的病例加用溴隐亭治疗 ,溴隐亭治疗无效及部分残留病例加用放射治疗。　结果　无手术死亡 ,近全切除 2 1例 ,次全切除 18例 ,部分切除 3例。术后 2～ 3月复查MRI ,影像学肿瘤消失 19例 ,少量残留 2 0例 ,部分残留 3例。　结论　该类肿瘤伴蝶鞍扩大、术前MRI检查提示质地软 ,可经蝶窦手术 ,采用显微手术有助于肿瘤全切除及对鞍隔、颈内动脉等重要结构的保护 Objective To investigate surgical indications and surgical techniques of transsphenoidal microsurgical removal of pituitary adenoma invading the cavernous sinus. Methods A total of 42 cases of pituitary adenomas invading the cavernous sinus were treated by oral orpinal sinus approach. Intraoperative C-arm X-ray machine or neuronavigation monitoring as much as possible to open the side of the large side of the saddle, cut slightly open the sella subdural. According to the direction of tumor invasion, the channels are divided according to the different order of the tumor. A small amount of residual cases plus bromocriptine treatment, bromocriptine treatment ineffective and some residual cases plus radiation therapy. Results There was no surgical death, 21 cases were treated with total resection, 18 cases were treated with subtotal resection and 3 cases were partially resected. MRI was reviewed from February to March after surgery, 19 cases of tumor disappeared, 20 cases of small residual tumor and 3 cases of residual tumor. Conclusions This type of tumor with enlargement of the sellae, preoperative MRI examination showed soft texture, via the sphenoid sinus surgery, the use of microsurgery is helpful for complete resection of the tumor and protection of important structures such as the septum and internal carotid artery