What would be the likely 'visual symptom' the patient presented with?
Bitemporal hemianopia due to compression and elevation of the optic chiasm.
What proportion of pituitary masses are adenomas?
30-50% of all masses are adenomas. They account for the vast majority of all pituitary tumours.
What is the usual approach to these tumours? Describe the approach.
Transphenoidal surgery. Instruments are passed up through the nasal cavity, the sphenoid sinus entered and the floor of the pituitary fossa opened.
Large sellar/suprasellar mass is of intermediate T1 signal and a little hyperintense in T2 signal and demonstrates moderate enhancement. A more focal area of more intense enhancement is seen posteroinferiorly. The floor of the sella is thinned, and the mass protrudes into sphenoid sinus. Suprasellar extension to, and elevation of, the floor of 3rd ventricle is noted. There are nodular protrusions into left perimesencephalic cistern close to left SCA and basilar trunk, as well as laterally contacting the left amygdala. No hydrocephalus.
Optic chiasm elevated and bowed over superior border. ACAs displaced superiorly with no encasement. There is tumour contacting left cavernous ICA with just under 180 degree involvement. Right cavernous sinus and right cavernous ICA do not appear involved.
Sphenoid sinus septum is left-sided with its superior edge pointing towards left carotid siphon.