Findings:
Interval transsphenoidal debulking of the known pituitary macroadenoma. Most of the adenoma has been excised and the optic chiasm has been restored to its customary position.
There is however a newly appreciated downward sloping of brain tissue (frontal lobes) into the enlarged pituitary sella.
Residual soft tissue density is seen overlaying the floor of the sella, as well as along and within the right cavernous sinus, encasing the right ICA and measuring approximately 2.5 x 2.1 cm on the axial images and 2 cm in craniocaudal dimension.
Bony defect of the posterior wall of the left sphenoid sinus with mild fluid within the sphenoid sinuses.
The pituitary infundibulum is deviated to the left.
The brain parenchyma is unremarkable.
The ventricles and sulcal spaces are within normal limits. There is no hydrocephalus or midline shift.The orbits and the mastoid air cells are clear.
Conclusion:
Interval transsphenoidal debulking of the known pituitary macroadenoma with residual tumour along the floor of the sella and within the right cavernous sinus.
Herniation of frontal lobes into the pituitary sella.
Bony defect of the posterior wall of the sphenoid sinus.