fig2

Figure 2. A 52-year-old woman presented with progressive bilateral vision loss, right worse than left, over three years. (Top row) Pre-operative imaging demonstrates a large tuberculum sellae/posterior planum meningioma with extension into the sella. Bilateral optic canal invasion is seen, right more than left (red arrow). There is no supraclinoid carotid artery encasement, or lateral extension. The pituitary infundibulum is displaced posteriorly. An endoscopic transtuberculum/transplanum approach was performed. (Bottom row) Post-operative imaging shows gross total resection. Sagittal CT and MRI demonstrates nasal packing up (“M”) to the bony buttress (posterior nasal septum graft; blue arrow) with fat graft and collagen sponge in the resection cavity and a well-vascularized nasoseptal flap is in place with pituitary gland and infundibulum enhancing normal. Within 2 weeks of surgery her visual field deficit resolved, and visual acuity remained stable. See Video 1.