Aneurysm formation after gamma-knife surgery for pituitary adenoma

Honda, Shunya; Tajima, Yosuke; Yoshida, Yasuhiko; Horiguchi, Kentaro; Iwadate, Yasuo

doi:10.1007/s13760-022-02057-1

Cited by 1 publication

(3 citation statements)

References 7 publications

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“…Moreover, intracranial pseudoaneurysms, following radiotherapy due to lesions such as nasopharyngeal carcinomas, medulloblastomas, gliomas, schwannomas and pituitary adenomas, have been diagnosed after a median latency of approximately 10 years 8. Various ICA lesions (pseudoaneurysm, aneurysm, stenosis and occlusion) have been described following radiosurgery for pituitary adenomas with a latency of 4–21 years after the procedure,10 11 22 and the prevalence of aneurysm formation after radiosurgery is suspected to be higher than previously thought 11. Although rare, ICA pseudoaneurysms are life-threatening and show a mortality of up to 50% due to delayed rupture and massive bleeding 9.…”

Section: Discussionmentioning

confidence: 99%

“…Although rare, ICA pseudoaneurysms are life-threatening and show a mortality of up to 50% due to delayed rupture and massive bleeding 9. Additionally, recent case reports suggested a greater instability in gamma-knife-induced aneurysms than in common sporadic aneurysms 10 11 23. The first sign of bleeding is usually epistaxis, possibly due to damage of the bone structure during previous surgery and potentially erosion by the tumour itself 11.…”

Section: Discussionmentioning

confidence: 99%

“…ICA pseudoaneurysm has also been recognised as a possible delayed complication of conventional radiotherapy or radiosurgery, presenting up to three decades after treatment 8 9. Endothelial dysfunction and inflammation are the proposed mechanisms for aneurysm development after radiotherapy,8 and radiation-induced aneurysms seem to have an especially high risk of rupture 8 10 11…”

Section: Introductionmentioning

confidence: 99%

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Beware of epistaxis: fatal pseudoaneurysm rupture 30 years after treatment of acromegaly

Carreira,

Muna,

Grossman

et al. 2024

BMJ Case Rep

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We present a fatal complication of treatment in a patient with early-onset acromegaly, treated with two transsphenoidal operations, radiotherapy, radiosurgery and pegvisomant. He was diagnosed in his 30s, and controlled from his 40s, with stable residual tumour within the left cavernous sinus. In his 60s, 30 years after surgery/radiotherapy and 14 years after radiosurgery, he developed recurrent episodes of mild epistaxis. A week later, he presented at his local hospital’s emergency department with severe epistaxis and altered consciousness. He was diagnosed with a ruptured internal carotid artery (ICA) pseudoaneurysm, but unfortunately died before treatment could be attempted.ICA pseudoaneurysms are rare complications of surgery or radiotherapy and can present with several years of delay, often with epistaxis. This case highlights the importance of life-long monitoring in patients with previous pituitary interventions and early recognition of epistaxis as a herald sign of a potentially catastrophic event, thus leading to timely treatment.

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Section: Discussionmentioning

confidence: 99%