Pituitary apoplexy is an uncommon phenomenon typically characterized by vascular insufficiency or acute hemorrhage into a pituitary adenoma. The overall incidence of pituitary apoplexy ranges between 1 and 25% of all pituitary adenomas. With the widespread use of MRI technology, the diagnosis of asymptomatic intratumoral hemorrhage is closer to 10%. The authors report a case of a 27-year-old female in her 36th week of pregnancy who presented with severe onset headache and acute left-sided vision loss. MRI of the brain revealed a large hemorrhagic mass occupying the sella turcica. The patient underwent an emergent endoscopic endonasal transsphenoidal resection for pituitary apoplexy. Postoperatively, the patient’s neurologic deficit resolved. Minimally invasive endoscopic endonasal transsphenoidal resection of pituitary apoplexy can be safely utilized in third trimester pregnant women presenting with acute severe neurologic deficits. 1. Introduction Schloffer and Hochenegg performed the first successful transsphenoidal surgery in 1908 while in Vienna [1]. Soon thereafter, Harvey Cushing perfected the transsphenoidal approach for sellar lesions in 1910, but he later abandoned it secondary to its limited exposure. In the 1960s, the introduction of the operative microscope by Hardy and the advent of fluoroscopy by Giout resulted in the resurgence of the approach [1, 2]. While the introduction of endoscopic techniques in several surgical fields have become the standard of care for many pathologies, only recently, neurosurgeons have become more interested in applying this technology in the management of some unique disease entities. Over the last decade, neurosurgeons have advanced minimally invasive endoscopic techniques in dealing with pituitary lesions. There have been a number of studies comparing more traditional “open” approaches to the sella, with endoscopic assisted and with purely endoscopic surgeries. In most of these studies, there are no statistically significant differences between the three different types of treatments with regards to outcome [3–10]. Herein, we present the case of a 27-year-old pregnant female who developed acute vision loss during her third trimester, secondary to pituitary apoplexy. She successfully underwent a minimally invasive endoscopic endonasal transsphenoidal resection of the pituitary apoplexy. 2. Case Report 2.1. History and Examination This 27-year-old pregnant woman, presented initially at 19 weeks gestation with intermittent headaches, nausea, and vomiting for two months duration. She was admitted to an outside
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