Invasiveness in pituitary adenomas has been defined and investigated from multiple perspectives, with varying results when its predictive value is considered. A systematic literature review, following PRISMA guidelines, was performed, searching PubMed and Scopus databases with terms that included molecular markers, histological, radiological, anatomical and surgical data on invasiveness of pituitary adenomas. The results showed that differing views are still present for anatomical aspects of the sellar region that are relevant to the concept of invasiveness; radiological and histological diagnoses are still limited, but might improve in the future, especially if they are related to surgical findings, which have become more accurate thanks to the introduction of the endoscope. The aim is to achieve a correct distinction between truly invasive pituitary adenomas from those that, in contrast, present with extension in the parasellar area through natural pathways. At present, diagnosis of invasiveness should be based on a comprehensive analysis of radiological, intra-operative and histological findings.

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The technical development in skull base surgery, especially to the anterior cranial fossa, has allowed for improvement in the quality of life and the long-term prognosis of patients suffering from different types of tumors that can affect this anatomical area. Applying these advanced techniques requires a thorough understanding of the skull base anatomy and surrounding structures to perform surgery without potential intraoperative complications related to the pathology itself as well as potential complications related to the surgical approach that has been chosen to treat this pathology. The purpose of this paper is to offer a comprehensive review of the surgical anatomy of the anterior skull base and the technical nuances of the surgical approaches that are more frequently used in this region. Detailed knowledge of these aspects is essential both for the choice of the surgical approach and for its correct execution when an anterior cranial fossa lesion need to be resected.Abstract: The anterior cranial fossa (ACF) is a complex anatomical region that can be affected by a broad spectrum of pathology. For the surgical treatment of these lesions, many approaches have been described, each of them with different scope and potential surgical complications, often associated with significant morbidity. Traditionally, tumors involving the ACF have been operated by transcranial approaches; however, in the last two decades, endoscopic endonasal approaches (EEAs) have been gaining popularity. In this work, the authors review and describe the anatomical aspects of the ACF and the technical nuances of transcranial and endoscopic approaches for tumors located in this region. Four approaches were performed in embalmed cadaveric specimens and the key steps were documented. Four illustrative cases of ACF tumors were selected to demonstrate the clinical application of anatomical and technical knowledge, which are essential in the preoperative decision-making process.

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