Transfrontal surgery is necessary for very large extrasellar extensions, and this is most often seen in young acromegalics presenting with rapidly growing tumours. Cure of acromegaly using this operative approach is virtually unknown due to the difficulty in clearing the pituitary fossa of tumourous tissue, and postoperative radiotherapy is necessary. Field defects may be relieved, but the morbidity of this operative approach is higher as it involves craniotomy, frontal lobe retraction and section of an olfactory nerve.
