Transcranial approaches to pituitary tumors were proposed by the pioneers of neurosurgery and are still adopted with different modifications in selected cases. The main goal of this surgery is to decompress the optic pathways. The kind of approach is mainly dictated by the dimension, location, and consistency of the tumor mass and by other coexistent vascular pathologies. The transcranial approaches most frequently adopted are grouped as fronto-pterional, transfrontal, and combined approaches. This article reviews the indications for each transcranial approach. Moreover, the transcranial approaches to pituitary tumors are described in detail, stressing technical aspects and the prevention of complications. Particular attention is given to the fronto-orbitozygomatic (FTOZ) approach with intradural and extradural decompression of the optic nerve. This approach is the one most frequently used in our recent experience. Results are encouraging in particular in terms of postoperative visual function. Complications related to these procedures and their perioperative management are also reported.
ASJC Scopus subject areas
- Clinical Neurology