Non-adenomatous sellar lesions represent a diagnostic and occasionally a therapeutic challenge. The purpose of the study was to provide an overview of the clinical and radiographic characteristics of non-adenomatous sellar lesions operated at our department, with emphasis on treatment options. In our transsphenoidal surgical series of 300 cases, 29 non-adenomatous sellar lesions (9.7%) were identified by histology. Medical files and imaging findings were retrospectively analysed. Clinical presentation was usually a result of local mass effect. Imaging features were not always diagnostic. Of 29 non-adenomatous sellar lesions, total tumour excision with transsphenoidal surgery was achieved in 17, and no supplemental treatment was needed. Lesions partially resected were further treated with reoperation, radiation therapy, or medical therapy, tailored to individuals. In our experience, non-adenomatous sellar lesions represent a more prevalent clinical entity than expected. Pituitary surgeons should be aware of their existence to reconstruct treatment strategy, proceeding to adjuvant therapy when necessary.