Endoscopic endonasal transcavernous approach for removal of pituitary macroadenoma with apoplexy: Technical nuances

Pseudocapsular apoplectic plane identification, extracapsular dissection, identification of parasellar ligaments, and understanding of adenoma-cavernous sinus ICA relationship are key surgical highlights that we discuss in our case. The combination of these techniques, along with the use of intraoperative Doppler, helped us to maximize pituitary gland preservation, CN improvement, and gross total resection of a large pituitary adenoma with cavernous sinus invasion presenting as apoplexy. Future studies with endoscopic endonasal transvenous approaches with cavernous sinus extension for large pituitary adenoma with apoplexy are warranted to study long-term CN outcomes.