The patient came to the clinic 29-June-2009 complaining of headache with acromegalic features for more than 2 years with starting impaired vision the last year.

MRI of the sella performed 21-June-2009 showing huge pituitary adenoma with massive supra and right parasellar extension.

On examination: the patient is right handed with acromegalic features and bitemporal hemianopsia. She has amenorrhea for 12 years with glactorrhea right breast. TSH was 8.4 µU/ml , GH was 61 ng/ml . She had also folic acid aneamea.

Bifrontal monoflap craniotomy with reflection of the bone flap to the right was performed. During that the frontal sinuses were violated to obtain flush level with the anterior fossa plane. The dura was opened parallel to the anterior edge of the bony defect. The falx cerebri was bisected interiorly with preservation of all draining veins. Mobilization of both olfactory tracts off the mediobasal of the frontal lobes down to the trigones. The tumor was pushing both optic nerves laterally. The tumor was attacked from the median plane and it was rubbery with cartilage consistency. Piecemeal resection of the tumor and the capsule of the tumor was detached from both optic nerves and the cavernous sinuses both sides. The capsule of the tumor was the pituitary gland and it was preserved and it was clear to see the pituitary stalk forming  after removing the suprasellar part of the tumor. Check of the right cavernous sinus showed no remnants and it was possible to see the basilar artery from the left. Routine closure of the wound.

Smooth postoperative recovery and the patient sent for ICU.

The patient has acromegalic features which must put the diagnosis from far.

Anatomical preservation of the olfactory tracts yield 85% functional preservation according to the materials during 29 years of practice.

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