Background Intracranial vessel injury is a severe complication of transsphenoidal surgery (TSS) for lesions of sellar region. The purpose of this study was to improve recognition of the complication. Methods The clinical data of 400 cases of TSS for sellar region from 1964 to 2004 were reviewed retrospectively Ten patients with complications of intracranial vessel injury were included in this study, 7 underwent transsphenoidal microsurgery and 3 underwent endoscopic TSS. Subarachnoid hemorrhage (SAH) occurred in 8 cases, hemorrhage of cavernous sinus in one, and post-operative cerebral hemorrhagic infarction caused by thrombosis of injured right internal carotid artery in one. The clinical data of all the patients were analyzed. Results The SAH resulted from hemorrhage of residues of tumor in 2 patients and from damaged sellar and arachnoidea in 6 patients. The cause of hemorrhage of anterior intercavernous sinus was malformation of anterior intercavernous sinus. The reason of thrombus of internal carotid artery was manipulation of operation. Three patients died and six patients were cured. One patient lived with hemiplegia. Conclusions The cause of intracranial vessels injury of TSS is complicated. Detailed anatomic knowledge of seller and skilled operation is helpful to reduce the complication. Chin Med J 2009;122(10):1154-1156