PMC9354695_01
(A) Preoperative photo showing left oculomotor palsy with partial ptosis and exaggerated abduction with downward deviation due to unopposed action of trochlear and abducens nerves. (B) Post-operative photo showing complete recovery of the left ptosis.
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Oculomotor testing revealed deficiency in the left eye adduction with partial paralysis of the oculomotor nerve  Figure 1 . Post-operatively, third cranial nerve palsy resolved  Figure 1 .
Pre-operative MRI Axial MR imaging focused on the sella at admission (A-C): The intra-sellar lesion (star) was heterogeneous on its anterior aspect. Some bloody components (orange arrows) that appeared slightly hyperintense on unenhanced T1 (A), hyperintense with an hypointense rim on T2 spin echo (B) and hypointense on susceptibility weighted images, SWI, (C) were intercalated between the bone and the rest of the lesion. (D) Coronal MR imaging showed pituitary adenoma with invasion of the left cavernous sinus, grade 3b according to Knosp classification.
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A heterogenous anterior aspect of the lesion compatible with hemorrhagic zones was in favor of PA and normal pituitary gland was displaced on the right side  Figure 2 .
Post-operative MRI. Sagittal MR Imaging T1 with Gadolinium showed a total resection of the pituitary adenoma.
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Immediate postoperative MRI showed no residual tumor  Figure 3 .