Introduction: Intracranial surgery was the first procedure used historically to treat pituitary tumors. This study aims to report the indications of trans-cranial surgery of pituitary adenomas and specify its limits in our experience at the Neurosurgery Department of Fann Hospital. Material and Methods: This is a retrospective, descriptive and analytical study spread over a period of 4 years from January 1, 2016, to December 31, 2020 conducted at the Neurosurgery Department of the Fann University Hospital in Senegal, including all patients in whom the diagnosis of pituitary adenoma was evoked on clinical criteria, confirmed by data from computed tomography (CT), magnetic resonance imaging (MRI), and operated by trans-cranial approach. Results: According to our results, the trans-cranial approach using a pterional approach alone was the most common in our experience in 66.67% (n = 6 in this study). A combined endoscopic trans-sphenoidal approach first and then the secondary pterional approach was performed in 33.33% (n = 3) of our patients. Partial resection was performed in 06 patients (66.67%), and wide resection in 3 patients (33.33%). The evolution of the patients treated surgically by the high approach was marked by an improvement of the visual disorders in 22.22% of the cases, and an absence of recurrence in the whole series. A tumour residue was found in 33.33% of cases. Conclusion: Trans cranial approaches still have their place in the management of pituitary adenomas even if they are burdened with a very high mortality and morbidity rate in our series.
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