摘要：Surgical management of giant pituitary adenomas possess challenges due to presence of optic nerves, internal carotid arteries and hypothalamus in and around seller and para seller region. The extent of tumor resection governs the efficacy of surgical treatment. However surgical extent of resection depends on para seller extension, multiple compartmental extension, and relation with displaced and distorted neurovascular structures. However, phenomenon of extra diaphragmatic extension of giant pituitary adenoma as multiple nubbing of pituitary adenoma into subarachnoid space is extremely uncommon. To the best knowledge of authors current case represents first case in the western literature. In such situation, attempting microscopic transsphenoidal surgical approach may prove much hazardous but endoscopic surgery can offer best option. Authors discuss importance of extra diaphragmatic extension and possible role of various surgical modality and endoscopic surgery and pertinent literature is reviewed briefly as awareness of such pathology is very important for every emergency care physician, critical care team including neurosurgeons and, radiologist and allied team to make a sound management strategy.
