Fig. 3

A 48-year-old male patient presented with visual loss and subsequently underwent CECS. A, B Preoperative MR image revealing GIPitNETs with significant anterior skull base and suprasellar extension. C, D Postoperative MR image showing GTR of the tumor. E–H Intraoperative images of patients who underwent surgery via the endoscopic endonasal approach. E Endscopic endonasal excision of the sellar portion of the tumor. F Excision of the tumor with diaphragma sellae adhesions. G Excision of the suprasaddle portion of the tumor pushed into the saddle by the transcranial surgeon. H Repair of the saddle base with a nasoseptal flap. I–L A simultaneous subfrontal approach was used. The tumor was dissected from adjacent lobe (I, K) and neurovascular (J) structures and was completely removed under direct intracranial observation or mechanically delivered into the sella to be removed during endonasal surgery (L). T, tumor; ON, optic nerve; DS, diaphragma sellae; Nf, nasoseptal flap; Front. lobes, frontal lobes; Hyp, hypothalamus