**5. Surgical approaches**

According to the literature, several surgical approaches are used to remove sphenoid meningiomas: subfrontal, fronto-lateral, fronto-temporal intradural, pterional, fronto-temporo-orbito-zygomatic [14, 31, 32]. Eyebrow incision supraorbital keyhole approach (essential modification of the standard frontallateral/supraorbital) could be used as well [33]. Recently, several authors have

reported their experience using this approach in the management of tumorous lesions around the sellar region [34, 35].

We are using two surgical approaches in our practice: fronto-lateral supraorbital and pterional. The advantages and disadvantages of both approaches are presented in **Table 2**.

In general, the patient's body should be strictly fixated despite the chosen approach to allow the operative field position and angles change. A rigid fixation of the head in the Mayfield or Sugita skull clamp should be used. We have abandoned the use of lumbar drainage to relax the brain during surgery. All surgeries are performed under general anesthesia with artificial lung ventilation.
