Objectives Endoscopic endonasal transsphenoidal adenomectomy (TSA) is the most frequently performed skull base surgery and researchers have recently focused on preserving nasal function. The transseptal approach is a promising procedure owing to its less injury to nasal mucosa. Therefore, we conducted this study to investigate whether the transseptal approach could reduce nasal morbidities with comparable neurosurgical outcomes. Study design Retrospective chart review. Setting Single-institution tertiary care centre. Participants 25 patients of transseptal approach from January 2019 to December 2020 and 25 patients of transnasal approach from January 2017 to December 2018. Main outcome measures Lund-Kennedy endoscopic scores, 22-item sinonasal outcome test (SNOT-22) scores, TIB smell identification tests (TIBSIT®) scores, the rate of gross total resection, endocrine control, and postoperative complications were collected. Results The postoperative SNOT-22 (4.40 vs. 7.36, P =.005) and Lund-Kennedy endoscopic scores (2.72 vs, 5.08 at 2 weeks, 0.88 vs. 3.52 at 1 month, 0.48 vs. 2.12 at 3 months, 0.04 vs. 1.76 at 6 months, all adjusted P < .01) were significantly lower in the transseptal group, while the TIBSIT scores were not significantly different (41.6 vs. 42.4 preoperatively, P = .68; 41.6 vs. 40.2 postoperatively, P = .46). The rates of gross total resection, recovery of hormonal abnormalities, and complications were not significantly different. In multivariate analysis, the transseptal approach remained an independent factor for lower SNOT-22 scores and Lund-Kennedy endoscopic scores. Conclusion The transseptal approach provides better recovery of nasal mucosa and intact olfactory function without compromising neurosurgical outcomes.