Fig. 4

Example of a 43-year-old male patient with GIPitNETs who underwent EES. A, B Preoperative MR coronal and sagittal MR images showing GIPitNETs extending toward the suprasaddle, with the suprasaddle portion of the tumor extending upward to the right. C, D Three-month postoperative MR coronal and sagittal enhancements showing a residual tumor in the suprasaddle (yellow circle). E Removal of the intrasaddle portion of the tumor. F The part of the tumor adhering to the diaphragma sellae was removed. G Further upward removal of the suprasaddle portion of the tumor. H A breach in the right diaphragma sellae (yellow arrow) can be seen after resection of the suprasaddle portion of the tumor. In combination with postoperative MR images, the residual tumor should be a right-sided extension of the tumor through the diaphragma sellae. T, tumor; DS, diaphragma sellae