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Background: Internal carotid artery (ICA) aneurysms extending into the intrasellar region that mimics pituitary tumors and leads to pituitary dysfunction are relatively rare. The treatment for aneurysms includes surgery and endovascular procedures. However, functional recovery of the pituitary gland is difficult. Case Description: We report a case of a 43-year-old woman who presented with severe headaches and generalized malaise. Magnetic resonance imaging (MRI) revealed a giant unruptured cavernous ICA aneurysm that pushed the pituitary stalk contralaterally. A baseline endocrinological examination suggested panhypopituitarism. Hypopituitarism was treated with hormone replacement therapy, which improved the patient’s symptoms of headaches and malaise after 4 days. The aneurysm was treated using a pipeline flow-diverting stent. Two years later, the aneurysm had reduced to half of its maximum diameter, and the pituitary stalk was visible on MRI. Hormone loading tests 1 week postoperatively showed almost no response. At postoperative 6 months, there was a trend toward improvement. Conclusion: Flow-diverting stent deployment is useful for large or giant carotid artery aneurysms with pituitary gland compression.

Background Meningiomas and unruptured cerebral aneurysms (UCAs) rarely coexist. However, the treatment strategy remains to be fully elucidated. This report is a first report that UCA related to the tumor feeder intraoperatively ruptured when the meningioma was resected. Case presentation Herein, we present a case of meningioma coexisting with contralateral UCA related to a tumor feeder. Immediately after the meningioma was resected, intraoperative acute brain swelling due to rupture of the contralateral aneurysm appeared. The swollen brain protruding into the epidural space was resected, following contralateral ruptured aneurysm was performed by endovascular surgery. Intensive neurological treatment was administered and the patient gradually recovered. Conclusion This report highlights the possibility of intraoperative UCA rupture related to the tumor feeder when the meningioma is resected.

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