Acromegaly with Extension Tracking the Sympathetic Chain

This is a 42-year-old female, diagnosed with acromegaly. MRI brain demonstrated a presumed GH-secreting pituitary neuroendocrine tumor with extension into multiple compartments of the right cavernous sinus. The patient underwent an endoscopic transpterygoid approach for resection. This video demonstrates that all compartments of the cavernous sinus can be accessed, especially focusing on the inferior compartment. In this case, the tumor was tracking along the sympathetic chain, which was resected completely.