No reliable medical tumor therapy of NFPA could be established. Small tumors need yearly follow-up by MRI, endocrine, and ophthalmologic assessment. The effectiveness of transnasal selective microsurgery in > 90% has been proven. With improvements of surgical facilities like better visualization, transcranial surgeries are rarely necessary. Surgery and endocrine management have to be under control of experienced specialists, and will be described in detail within the direct perioperative period and the necessary long-term followup. Large immediate or later mostly slowly regrowing tumor rests may be treated again by surgery or special radiotherapy.