Illustrative case of a Type 3 sec. Barazi PA suitable for ETTA. (A–C) Midsagittal (A), coronal (B) and axial (C) pre-operative contrast-enhanced T1-weighted MR images of a 40-year-old male patient complaining of cognitive decline and urinary incontinence. Imaging and laboratory exams reported a non-functioning macroadenoma with a significant suprasellar portion, obliterating the third ventricle and causing hydrocephalus (Type 3). Visual examination revealed bitemporal hemianopsia. He underwent ETTA, which achieved near-radical resection (a small remnant was revealed with post-operative imaging near the left cavernous sinus). The patient experienced severe panhypopituitarism and diabetes insipidus, which required persistent complete substitution therapy; conversely, a complete resolution of pre-operative visual field deficit, as well as cognitive and urinary symptomatology was observed. (D–F) Coronal (D,E) and axial (F) post-operative contrast-enhanced T1-weighted MR images.