Figure 1: In a patient with acromegaly (a) a macroadenoma with suprasellar and left cavernous sinus extension; (b) the endoscopic operative view showing the fibrous tumor infiltrating within cavernous sinus behind the internal carotid artery. The internal carotid artery is being located using the Doppler probe; and, (c) postoperative scan showing residual tumor in the left cavernous sinus. Growth hormone levels remained 3.8 ng/ml prompting further adjuvant treatment using a gamma-knife