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A rare case is described of acute disseminated intravascular coagulation (DIC) following isolated mild head injury with acute subdural haematoma, coagulopathy onset preceding craniotomy. Surgical treatment of the cause followed by swift diagnosis and treatment soon after surgery enabled a good outcome. Post-operative recollection of subdural and extadural blood was treated by further surgery. DIC following isolated mild head injury without axonal damage is rare, but fatal if missed. Thrombocytopaenia in head injured patients should be investigated expediently. Post-operative interim imaging (if not standard practice) should also be considered to exclude haemorrhagic recollection requiring further surgery.

Transsphenoidal surgery has evolved much over nearly 100 years. Initially operations were performed often without any input from endocrinology colleagues, and without preoperative imaging, operative magnification and illumination. Advances in the understanding of the biology of pituitary tumours, close co-operation between endocrinologists, surgeons and oncologists, and huge advances in imaging and surgical techniques have led to the evolution of the current transsphenoidal operation to the pituitary fossa to the point where a ‘cure’ is often possible with low complication rates. The indications, contraindications of transsphenoidal surgery will be discussed, together with nature of the surgical approach and how it can be applied to particular pituitary tumours and suprasellar lesions.