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P425: "CHOOSE YOUR OWN ADVENTURE!": ENDOSCOPIC TRANS-CAVERNOUS AND TRANS-PTERYGOID APPROACH FOR RECURRENT GH-SECRETING PITUITARY ADENOMA WITH SKULL BASE RECONSTRUCTION
Satyan B Sreenath, MD¹; Chad Purcell, MD²; Joao Paulo Almeida, MD¹; ¹Indiana University; ²Queens University

This video demonstrates a unique case of an invasive, growth-hormone secreting pituitary adenoma that was managed primarily via a trans-cavernous and trans-pterygoid expanded endoscopic approach with nasoseptal flap reconstruction.  The tumor demonstrated unique features of extra-sellar extension, bony invasion, and para-sellar involvement, requiring a combined, expanded endoscopic approach.  Secondary surgery, required due to sustained acromegaly, posed a unique surgical challenge involving re-use of a prior nasoseptal flap reconstruction and focused resection of para-sellar residual disease.

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