Abstract: Objective To compare the clinical effect of pterygoid approach versus subfrontal approach in the resection of tuberculum sellae meningioma. Methods Totally 76 patients with tuberculum sella meningioma treated by microsurgery in our hospital from May 2010 to May 2018 were selected.According to the approach method,they were divided into pterygoid approach group (group A,n=34) and subfrontal approach group (group B,n=42).The operating time,intraoperative bleeding volume,hospitalization time,degree of resection,visual acuity improvement and postoperative complications were compared between the two groups. Results There was no significant difference in the proportions of gradeⅠresection and gradeⅡresection,operating time,intraoperative blood loss and hospital stay between the two groups (P>0.05).The improvement of visual acuity in group A was 76.47%,which was higher than that in group B (71.43%),without significant difference (P>0.05).The incidence of postoperative complications was 17.65% (6/34) in group A,which was a little lower than that in group B (19.04%,8/42),and the difference was not statistically significant (P>0.05). Conclusion Surgical approach selection for tuberculum sellae meningioma should be based on the characteristics of the tumor and its relationship with the surrounding tissues.No difference is found in tumor resection degree,hospital stay,visual acuity improvement and postoperative complications between the two approaches.