case_images: PMC8326077_01
case_images: Magnetic resonance imaging (MRI) images of the sella 3 months after the first endoscopic endonasal excision of a large pituitary macroadenoma demonstrating residual tumor (a-d). Residual tumor enlargement is noted in the follow-up MRI done 3 years later (e-h).
case_images: SNI-12-317-g001.jpg
case_images: PMC8326077_01_SNI-12-317-g001.jpg
case_images: F1
case_images: Pituitary tumor recurrence was documented in the available two postoperative magnetic resonance imaging (MRI) studies [Figure 1].
case_images: Magnetic resonance imaging (MRI) images of the current presentation. Preoperative T1-weighted images reveal a large recurrent pituitary macroadenoma with minimal patchy enhancement after gadolinium injection (a and b). Postoperative T1-weighted images with contrast revealed near total excision of the adenoma (c and d).
case_images: SNI-12-317-g002.jpg
case_images: PMC8326077_01_SNI-12-317-g002.jpg
case_images: F2
case_images: MRI was consistent with PA in a recurrent large pituitary adenoma [Figure 2a and b].
case_images: Intraoperative views during endoscopic endonasal transsphenoidal tumor excision. (a) Bluish discoloration of the dura caused by apoplexy of the underlying tumor is evident at the initial exposure. (b) Dark blood (asterisk) is seen on initial dural opening. (c) View of the necrotic purple adenoma tissue being resected from within the sella. (d) A pituitary ring curette elevates the downward bulging cistern and a pituitary Rongeur is used to excise the superior part of the tumor. (e) The uppermost tumor components (double asterisks) have been separated from the arachnoid of the suprasellar cistern. (f) Final view after tumor resection. Note the fat from previous surgery (arrowheads).
case_images: SNI-12-317-g003.jpg
case_images: PMC8326077_01_SNI-12-317-g003.jpg
case_images: F3
case_images: Intraoperative findings were similar to those usually seen in cases of PA and included dark blood mixed with purple-red adenoma tissues of variable consistencies [Figure 3].