Giant pituitary macroadenoma with apoplexy presenting with isolated bilateral hypoglossal nerve palsy: illustrative case

Prolactinomas presenting with acute neurological decline, including bilateral hypoglossal nerve palsy, can benefit from urgent endoscopic transsphenoidal surgical decompression and safe debulking. Bilateral condylar tumor invasion may not always require craniocervical surgical fixation in the acute setting. Patients should be followed up and monitored clinically and radiographically for any signs of craniocervical instability after the initiation of medical therapy. https://thejns.org/doi/10.3171/CASE24326.