The patient came to the clinic 03-January-2012 complaining of visual disturbances for 18 months with bitemporal hemianopia with decrease visual acuity, more the left  with bifrontal headache. The headache decreased after dramatic deterioration of visual functions.

MRI of the brain done 25-December-2011 showing huge pituitary adenoma with supra and infrasellar extension more to the left. There is also left maxillary polyp with sinusitis.

On examination, the patient visual acuity is 0.63 in the right and 0.03 in the left with bitemporal anopia more dense in the left. Hormonal studies performed showing decreased levels of LH, FSH, testosterone and GH. Prolactine was 21.8 ng/ml.

The patient was given antibiotics to resolve the infectious process in the sinuses, to avoid possible postoperative inflammatory complications.

Using C-arm, transsphenoidal approach achieved from the left nostril. The tumor was seen destroying the pituitary floor in the left side. Generous bony opening of the floor to expose most of the infrasellar extension. All the sellar and infrasellar parts were removed. Several fragments sent for histologic studies and the tumor mass was soft, but suckable with difficulty. he pituitary gland, which is actually the tumor wall was preserved. Using the endoscopic facilities with straight and 30 degree endoscopes, the suprasellar was removed with caution, so as not to violate the neural structures and not to allow CSF leak. Using Valsalva maneuver and putting the head of the patient head down below the heart level , the suprasellar part was pushed down and removed. Check for CSF leak was negative. The cavity of the resected tumor was filled with contrast and checked with the image-intensifier.

Routine closure of the wounds. Smooth postoperative recovery with improvement of the vision of the left eye.

The patient have a huge tumor with rounded shape and with infrasellar growth. There are no signs of cavernous sinus invasion. In this case the transsphenoidal approach is justified.

It is possible through this approach to see the most posterior parts of the suprasellar component of the tumor. The anterior parts are not seen and only the feeling by the curette and guising of the neurosurgeon remain to weight between radical resection and avoidance of CSF leak.