Surgical approach

• Sub frontal
• Through anterior cranial fossa by elevating the frontal lobe of the brain
• Trans sphenoidal
• Through sphenoidal air sinus.
• This is entered either via the ethmodial air cells after raising the periosteum from the medial wall of orbit or by elevating nasal mucosa from nasal septum

Pitituary enlargement

• Presents with features of raised intra cranial presseure
• Widens the pitituary fossa and erodes clinoid process and petrous crest.
• Compresses the optic chiasma causing bitemporal hemianopia

Pitituary tumors

• If they involve chromophils, can cause endocrine dysfunction together with compression effects
• Chromophobe adenomas only cause pressure effects and intracranial pressure.