Surgical Approaches for Suprasellar Tumors

The frontobasal interhemispheric approach and pterional approach were utilized in this study on the basis of the tumor growth pattern and neurosurgeon’s preference. The side chosen for craniotomy was decided according to the direction of tumor extension and invasiveness. The frontobasal interhemispheric approach was carried out by the coronal skin incision behind the hairline and a paramedian unifrontal craniotomy. The dural flap was subsequently rotated medially from the base, with the major bridge vein to the midline or superior sagittal sinus being protected. For the pterional approach, a standard frontotemporal craniotomy was conducted with the sphenoid wing being drilled. The dura was opened curvilinearly towards the base, and cerebrospinal fluid (CSF) was released by sharp dissection of the sylvian fissure to expose the tumor adequately in the suprasellar area. The frontal lobe was lifted gravitationally with less retraction force with sufficient CSF drainage. Following craniotomy, we carried out tumor resection within the tumor capsule to avoid harming the perforating arterial branches that supply the optic apparatus and hypothalamus through various corridors of each approach, including the interoptic, interhemispheric, optico-carotid, as well as carotico-oculomotor spaces.