Purpose: To discuss the management of sphenoid mycetoma in patients undergoing endoscopic transsphenoidal pituitary surgery. Methodology: Retrospective case series of two patients with sphenoid mycetoma undergoing endoscopic transsphenoidal pituitary surgery and discuss management of such cases. Results: Case 1 was a 42-year old lady with a 31cm pituitary lesion causing hypopituitarism, diabetes insipidus and bitemporal hemianopia. Case 2 was an 87-year-old man with a growing residual pituitary macroadenoma causing visual loss. In both cases, preoperative CT scan was suggestive of sphenoid chronic fungal sinusitis. Both patients underwent endoscopic sphenoidotomy with intraoperative confirmation of sphenoid mycetoma which was removed. Endoscopic transsphenoidal pituitary resection was performed at a later date as a staged procedure. Review of the literature on such cases reveals this to be rare, with mixed management. Limited case reports suggest concurrent surgical evacuation of a non-invasive mycetoma and pituitary resection may be safe. However, a potential complication is the seeding of fungal infection intracranially or trapping fungal debris within the sphenoid if a flap is required especially in large pituitary lesions. We discuss the management of such cases including the thought process behind the decision to choose a staged procedure versus simultaneous evacuation of the mycetoma and pituitary lesion. Conclusion: Encountering concurrent sphenoid mycetoma in pituitary surgery is rare. Multi-disciplinary decision making considering the possible complications and clinical urgency of pituitary resection is required in deciding whether to stage or perform mycetoma evacuation and pituitary surgery at the same time.