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1990). Intrasellar tumor or those with only a small suprasellar component clearly are best operated using the trans sphenoidal approach (Laws 1980). Approach through the temporal fossa has been advocated for those tumors which have a sizable retrosellar component (Symon and Sprich 1985). Finally, a bifrontal approach can be useful, enabling the surgeon to work laterally to both of the optic nerves and tracts (Sarnii and Bini 1991). The author believes that each of these approaches is useful and may be employed when the occasion demands.

This higher percentage reflects that in a number of these patients the operator felt that the tumor was totally removed, only to be shown to be wrong on postoperative CT or magnetic resonance imaging (MRl) scanning. These "inadvertent" tumor remnants were removed with greater facility. Radical Removal of Craniopharyngiomas 1971-1991 35 Secondary Operations The following two cases illustrate that reoperation after initial operative intervention, radiation therapy (including high intensity radiation therapy), or both does not preclude total tumor removal.

The duration of preoperative symptoms is an important prognostic factor. In cases of severe preoperative visual deficit we recommend decompressing the optic pathways in a first stage before dissecting the tumor and removing it. It is clear that total removal of the lesion gives the best ophthalmological results. 28 M. Choux et al. 2) Neurological Results Postoperative neurological deficits are rare. 7% (Shapiro et al. 4% (Pierre-Kahn et al. 1988). In our cooperative series late epilepsy is described in 16% of the cases.