With continuing advancements in minimally invasive endoscopic nasal and sinus surgical techniques, image-guided endoscopic transsphenoidal approaches to the pituitary gland and anterior skull base have progressively become more popular. Clinical records were reviewed retrospectively from 2001 to 2006. Twenty-nine consecutive patients with pituitary tumours underwent transnasal endoscopic surgery. We outlined our endoscopic surgical technique with the use of image guidance. The duration of surgery, complications, and hospital stay were also reviewed. Image guidance can be applied during transnasal transsphenoidal endoscopic surgery and requires a minimal amount of time. It can reduce morbidity and allow for a more complete and safer operation with minimal postoperative discomfort. It can significantly reduce postoperative hospital stay, resulting in a reduced cost to the medical system.