Expanded endonasal endoscopic approach for resection of a growth hormone-secreting pituitary macroadenoma coexistent with a cavernous carotid artery aneurysm

Xia, Xin; Ramanathan, Murugappan; Orr, Brent A.; Salmasi, Vafi; Salvatori, Roberto; Reh, Douglas D.; Gallia, Gary L.

doi:10.1016/j.jocn.2011.11.032

Cited by 22 publications

(12 citation statements)

References 14 publications

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“…Thus, cUIA coiling and subsequent tumor surgery is an alternative option. However, only a few cases treated by this strategy are reported in literature (171819). To our knowledge, this study is the first case series collected over an 11-year period at a single large center, where the safety and efficacy of preoperative coiling and subsequent brain tumor surgery has been evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…This data emphasizes the importance of cUIA management before tumor treatment (121011121314). However, few studies have investigated treatment strategies for brain tumor with cUIA (1516171819). Preoperative coiling and subsequent tumor surgery is one strategic option for treating cUIA prior to brain tumor surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Preoperative coiling and subsequent tumor surgery is one strategic option for treating cUIA prior to brain tumor surgery. However, few cases exist in literature, which were treated by this strategy (171819). …”

Section: Introductionmentioning

confidence: 99%

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Preoperative Coiling of Coexisting Intracranial Aneurysm and Subsequent Brain Tumor Surgery

Park

Kim

2016

Korean J Radiol

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ObjectiveFew studies have investigated treatment strategies for brain tumor with a coexisting unruptured intracranial aneurysm (cUIA). The purpose of this study was to evaluate the safety and efficacy of preoperative coiling for cUIA, and subsequent brain tumor surgery.Materials and MethodsA total of 19 patients (mean age, 55.2 years; M:F = 4:15) underwent preoperative coiling for 23 cUIAs and subsequent brain tumor surgery. Primary brain tumors were meningiomas (n = 7, 36.8%), pituitary adenomas (n = 7, 36.8%), gliomas (n = 3, 15.8%), vestibular schwannoma (n = 1, 5.3%), and Rathke's cleft cyst (n = 1, 5.3%). cUIAs were located at the distal internal carotid artery (n = 9, 39.1%), anterior cerebral artery (n = 8, 34.8%), middle cerebral artery (n = 4, 17.4%), basilar artery top (n = 1, 4.3%), and posterior cerebral artery, P1 segment (n = 1, 4.3%). The outcomes of preoperative coiling of cUIA and subsequent brain tumor surgery were retrospectively evaluated.ResultsSingle-microcatheter technique was used in 13 cases (56.5%), balloon-assisted in 4 cases (17.4%), double-microcatheter in 4 cases (17.4%), and stent-assisted in 2 cases (8.7%). Complete cUIA occlusion was achieved in 18 cases (78.3%), while residual neck occurred in 5 cases (21.7%). The only coiling-related complication was 1 transient ischemic attack (5.3%). Neurological deterioration did not occur in any patient during the period between coiling and tumor surgery. At the latest clinical follow-up (mean, 29 months; range, 2–120 months), 15 patients (78.9%) had favorable outcomes (modified Rankin Scale, 0–2), while 4 patients (21.1%) had unfavorable outcomes due to consequences of brain tumor surgery.ConclusionPreoperative coiling and subsequent tumor surgery was safe and effective, making it a reasonable treatment option for patients with brain tumor and cUIA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preoperative Coiling of Coexisting Intracranial Aneurysm and Subsequent Brain Tumor Surgery

Park

Kim

2016

Korean J Radiol

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“…Some reports illustrated that pituitary apoplexy mimics an aneurysm [5,8]. Hypotheses for this phenomenon have been proposed, which include local circulatory mechanisms, growth hormone production that induces artery dilation, a direct mechanical effect resulting from the pituitary apoplexy on the vasculature, and/or direct infiltration by the tumor, predisposing to aneurysm formation [9,10]. …”

Section: Discussionmentioning

confidence: 99%

Coexistence of aneurysmal subarachnoid hemorrhage and surgically identified pituitary apoplexy: a case report and review of the literature

Song

Wang

et al. 2014

J Med Case Reports

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IntroductionA ruptured aneurysm associated with a pituitary apoplexy is rare. We present the first case report of the coexistence of a ruptured posterior communicating aneurysm with a surgically discovered pituitary apoplexy where the pituitary apoplexy had not been diagnosed by a pre-operative computerized tomography scan.Case presentationA 31-year-old right-handed Chinese woman began to experience severe headache, vomiting and blurred vision which continued for two days. On admission to the hospital, a brain computerized tomography scan demonstrated a small amount of increased signal in the basal cisterns; no evidence of intrasellar and suprasellar lesions was seen. The appearance of her brain suggested aneurysmal subarachnoid hemorrhage. She had nuchal rigidity and reduced vision. There was no extra-ocular palsy and no other neurological deficit. Our patient had no stigmata of Cushing’s syndrome or acromegaly. During an interview for further history, she reported normal menses and denied reduced vision.Cerebral digital subtraction angiography was subsequently performed, which revealed a 6mm left posterior communicating aneurysm. Urgent left pterional craniotomy was performed. The left ruptured posterior communicating artery aneurysm was completely dissected prior to clipping. At surgery, a suprasellar mass was discovered, the tumor bulging the diaphragma sella and projecting anteriorly under the chiasm raising suspicion of a pituitary tumor. The anterior part of the tumor capsule was opened and a necrotic tumor mixed with dark old blood was removed. The appearance suggested pituitary apoplexy.Histopathology revealed pituitary adenoma with evidence of hemorrhagic necrosis. Our patient made a good recovery.ConclusionOur case report proves that pituitary apoplexy can be coexistent with the rupture of a posterior communicating aneurysm. This association should be considered when evaluating any case of aneurysm. A normal computerized tomography scan does not exclude pituitary apoplexy. Pre-operative magnetic resonance imaging interpretation is required if a pituitary apoplexy is suspected. Craniotomy allows a coexisting aneurysm and pituitary apoplexy to be simultaneously treated.

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“…The coexistence of cerebral aneurysm and pituitary adenoma has been described and may be particularly frequent in acromegaly (34). An age-matched comparison of the prevalence of cerebral aneurysm showed a significant increase in patients with adenoma compared with the controls (18 18,21).…”

Section: Coexisting Cerebral Aneurysms and Pituitary Adenomasmentioning

confidence: 93%

Pituitary macroadenoma co-existent with a posterior circulation aneurysm leading to subarachnoidal hemorrhage during transsphenoidal surgery

Habibi¹,

Miri²,

Sheikhrezaei³

2013

Turkish Neurosurgery

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The coexistence of cerebral aneurysm and pituitary adenoma has been described previously. Most of such cases harbor functional tumors and anterior circulation aneurysms, with very rare cases of posterior circulation aneurysms.In this report, we present a case of subarachnoidal hemorrhage due to rupture of an undetected basilar apex aneurysm during microscopic transsphenoidal surgery for a nonfunctional pituitary adenoma. Subarachnoidal hemorrhage following transsphenoidal surgery is a rare event. The concurrence of posterior circulation aneurysm and nonfunctional adenoma is uncommon too.Neuroimaging of cerebrovascular circulation before surgical treatment of pituitary adenoma, although controversial, would be helpful to evaluate vascular involvement and rule out any potential concurrent cerebrovascular diseases. Open or endovascular treatment of unruptured intracranial aneurysms carries relatively low morbidity and may be considered prior to other elective intracranial procedures like transsphenoidal surgery. Bu raporda, fonksiyonel olmayan bir hipofiz adenomu için mikroskopik transsfenoidal cerrahi sırasında, önceden saptanmamış olan bir baziller apeks anevrizmasının rüptürü nedeniyle subaraknoid kanama olgusu sunuyoruz. Transsfenoidal cerrahi sonrasında subaraknoid kanama nadir bir olaydır. Posterior dolaşım anevrizması ve fonksiyonel olmayan adenomun birlikte bulunması da nadirdir.Hipofiz adenomunun cerrahi tedavisi öncesinde serebrovasküler dolaşım için nörogörüntüleme tartışmalı olsa da vasküler tutulumu değerlendirmek ve varsa eş zamanlı serebrovasküler hastalıkları ekarte etmek açısından faydalı olacaktır. Rüptüre olmamış intrakraniyal anevrizmaların açık veya endovasküler tedavisi nispeten düşük morbiditeye sahiptir ve transsfenoidal cerrahi gibi elektif intrakraniyal işlemler öncesinde düşünülebilir.

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Expanded endonasal endoscopic approach for resection of a growth hormone-secreting pituitary macroadenoma coexistent with a cavernous carotid artery aneurysm

Cited by 22 publications

References 14 publications

Preoperative Coiling of Coexisting Intracranial Aneurysm and Subsequent Brain Tumor Surgery

Preoperative Coiling of Coexisting Intracranial Aneurysm and Subsequent Brain Tumor Surgery

Coexistence of aneurysmal subarachnoid hemorrhage and surgically identified pituitary apoplexy: a case report and review of the literature

Pituitary macroadenoma co-existent with a posterior circulation aneurysm leading to subarachnoidal hemorrhage during transsphenoidal surgery

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