A small fossa with a large suprasellar lesion above is always a difficult technical challenge for the transsphenoidal approach. It is often found in conjunction with an underpneumatized sphenoid which we believe may be the cause of the extent of the suprasellar component.
This is a rare indication for transcranial surgery but can present problems even in adults. In children, we have usually operated successfully via the transsphenoidal route with the aid of a high-speed drill to access the sella (18).
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