This patient presented with severe and progressive visual loss secondary to a large and recurrent pituitary tumor. To our surprise, he had an additional tumor, tubercullum sellae meningioma, also compressing the left optic nerve. The endoscopic endonasal approach was effective to remove both tumors, relieve brainstem compression and improve visual function. Patient, in spite of his advanced age and delicate health, had an excellent recovery with no complications, highlighting the multiple advantages of endoscopic endonasal surgery over traditional skull base approaches for lesions underneath the optic apparatus and in older patients.

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