58-year-old female with visual field defect, history of pituitary apoplexy, and mass resection. There is an enhancing lesion centered in the pituitary fossa extending superiorly which contains scattered areas of susceptibility effect likely related to prior hemorrhage. The mass measures up to 30 mm overall, but contains a cavity centrally that measures up to approximately 15 mm. The lesion extends into the bilateral cavernous sinuses, right more than left, completely encasing the right internal carotid artery. The lesion also likely encases the right optic nerve and the optic chiasm is atrophic and displays T2 hyperintensity. There are postsurgical findings related to right frontal craniotomy with high T2 signal in the right frontal lobe adjacent to the craniotomy defect, likely representing encephalomalacia and gliosis with mild ex vacuo dilatation of the right frontal horn of the lateral ventricle. There is no evidence of acute intracranial hemorrhage. Additional scattered subcortical T2 hyperintensities may reflect minimal small vessel ischemic disease. There are bilateral choroid plexus cysts. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
Postoperative findings in the sell with residual macroadenoma that extends into the bilateral cavernous sinuses, right more than left, and compromise of the optic apparatus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.