There are two main management pathways with regards to thetreatment of the tumour. The first involves attempted gross totalresection of the tumour , the second approach is for more limitedsurgery, aimed at debulking the tumour to reduce the mass effect onthe optic pathways and/or to re-establish the cerebrospinal fluidpathways, followed by external beam radiotherapy or stereotacticradiosurgery (gamma knife); which show very promising results.The resent progress in high resolution imaging equipment (especiallythe MRI) showed the extent of the hypothalamic involvement whichpreoperatively guided the surgeon which patient is candidate forgross total removal and who is not.The extended endonasal approach is a very promising minimallyinvasive approach with many advantages but needs an experiencedhand as well as some complications need to be solved as CSF leak.