Correlation of Magnetic Resonance Imaging (MRI) findings with operative findings in 81 patients with craniopahryngiomas revealed MRI features characteristic for relationships of craniopharyngiomas of different topographic groups with the optic chiasm and the floor of the third ventricle (3rdVF). Supradiaphragmatic tumours encroaching upon the third ventricle or even reaching its roof, which do not cause hydrocephalus and displace the chiasm upwards, grow below the 3rdVF. These extraventricular tumours should be removed by extra-axial routes. Translamina terminalis approach may jeopardize the hypothalamic structures within the 3ldVF. Craniopharyngiomas growing entirely retrochiasmatically and enlarging the lateral ventricles, grow at least partially intraventricularly. Intra-extraventricular tumours may be approached extra-axially and also through the lamina terminalis or (he foramina of Monro. In case of their giant size one stage combined tran-scallosal and subfrontal (translamina terminalis and extra-axial routes) approach via one unilateral craniotomy is suitable.
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