The management of vascular and tumorous lesions of the parasellar region still remains one of the most demanding tasks in neurosurgery. It is only a short time ago that the major concepts of the anatomy of the so-called cavernous sinus were described in detail. Surgical interventions in this region are very complex, they are time-consuming and require an extensive back ground of experience in surgery of the cranial base. Pioneer anatomical studies of the parasellar region done by Taptas, and the daring direct operative approach introduced by Parkinson pro moted the development of modern neuroradiological intervention proce dures, which were initiated by Serbinenko and further refined by Debrun, Vifiuela and others. The technique of the detachable balloon catheter stimulated surgeons to proceed with the direct operative approach to lesions of the parasellar region. Today, it is hard to imagine a successful man agement of vascular pathologies of this region without a complementary use of the two techniques.