Objective. The objective of the study was to develop the tactics of surgical treatment of large and giant pituitary adenomas, spreading into the posterior cranial fossa. Material and methods. Patients with large hormonally inactive pituitary adenoma, extending to the right cavernous sinus and posterior cranial fossa. Results. The endoscopic endonasal removal a large endo-supra-latero(D)-retrosellar pituitary tumor was conducted. Control MRI shows that the tumor was removed radically. Oculomotor disturbances were observed in the early postoperative period, which significantly regressed within 6 months. The article provides detailed analysis of the world literature on the issue under discussion. Illustrative pre-, intra-, and post-operative photographs, as well as histological preparations are shown. Conclusion. Modern minimally invasive techniques make it possible to remove large pituitary adenomas (and other tumors) of the posterior cranial fossa using endoscopic endonasal approach. Such operations must be carried out at highly specialized institutions by the surgeons who have extensive experience in endoscopic transnasal surgery of skull base tumors.