Another reason is some of these tumors can simply just get massive. They are so massive that they grow and when they grow, they primarily grow up rather than down into the sphenoid sinus. We’d love them if they all grew into this sphenoid sinus cavity, but because that bottom part’s covered with bone, the easiest place for these pituitary tumors to grow is up and then sideway, and then lastly down. But when they grow up, they can get very, very large and then all of a sudden distort the optic chiasm. They can then even sometimes grow around the optic chasm and truly massive ones can even go beyond that. When they do get that large, while we often will still do a transsphenoidal approach, it becomes pretty apparent to surgeons experience with this that, um, there are some of these tumors that you’re not going to get enough tumor out from below and then coming from above becomes the correct course of action. And so, that’s definitely one set of reasons that we would come from above and do a transcranial approach.
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