Role of transcranial approaches in the treatment of sellar and suprasellar lesions.

The principles in the surgical management of sellar and suprasellar tumors are to relieve mass effect, normalize pituitary hypersecretion, preserve or restore normal pituitary function, prevent tumor recurrence and to provide tissue for pathological and scientific study. Over the past century, the transsphenoidal approach has evolved as the approach of choice for pituitary surgeons. Despite the limitations of transcranial approaches in accessing the intrasellar component of pituitary adenomas and historically their increased morbidity and mortality, there are situations where transcranial procedures have considerable advantages over transsphenoidal approaches. As a consequence, transcranial approaches retain an essential role in the treatment of certain sellar and suprasellar tumors and it remains necessary for all pituitary surgeons to master this approach.