fig3

Figure 3. A 39-year-old man presented with progressive left eye vision loss over several months. Pre-operative imaging demonstrates a large, calcified tuberculum sellae/planum meningioma with extension into the sella. Bilateral optic canal invasion is seen, left more than right (red arrows). The left internal carotid artery is encased, with significant encroachment upon the right carotid artery. An endoscopic transtuberculum/transplanum approach was performed without complication. Post-operative MRI demonstrates gross total resection. A fat graft is in the resection cavity with a well-vascularized nasoseptal flap over a bony buttress (posterior nasal septum graft; blue arrow). The pituitary gland and infundibulum enhance normally.