A 43-YEAR-OLD white man was admitted to the hospital with a 1-year history of severe headache, extraocular muscle paresis, upper airway obstruction, and blindness. Eight years previously, a nonfunctioning pituitary adenoma was diagnosed and the patient underwent 2 transsphenoidal resections and radiation therapy for recurrent tumor. Eight months prior to admission, the patient underwent an attempted third transsphenoidal resection for recurrent headache, followed 1 month later by an attempted resection via an open craniotomy. Postoperatively, the patient lost all vision; steroid therapy failed to restore his sight. A magnetic resonance image scan showed a large pituitary tumor extending into the paranasal sinuses (Figure 1). During the patient's final admission, endoscopic resection was again attempted. The procedure was complicated by intraoperative bilateral internal carotid artery compression, which occurred during attempts to lift and remove the interposing tumor mass. Subarachnoid hemorrhage and bihemispheric stroke also developed. Life support measures were withdrawn the following day and the patient died, after which the next of kin donated the heart for transplantation and the liver for research.
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Magnetic resonance imaging scan showing a large, partly calcified sellar mass with extension into the suprasellar cistern.
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