Internal carotid artery false aneurysm as a fatal complication of transsphenoidal surgery

Abstract

False aneurysm of internal carotid artery (ICA) is a rare but serious vascular complication observed after transsphenoidal pituitary surgery. Here, we present a 41-year-old woman with a pseudoaneurysm in the ophthalmic 1 segment of the left ICA after exoscopic transsphenoidal pituitary surgery. The initially uneventful procedure was complicated by a subarachnoidal hemorrhage 10 days after the surgery, which was confirmed by cranial computed tomography scan. The emergency angiography revealed a pseudoaneurysm of the ophthalmic 1 part of the left ICA. Despite repeated endovascular treatments with a flow diverter and coiling, the patient experienced a re-bleeding with consecutive vasospasms, occlusion hydrocephalus and finally bifrontal intracerebral hemorrhage with fatal outcome. As a conclusion in irregular post-operative courses with for example headache, a post-operative magnetic resonance imaging with vessel presentation using TOF sequence and contrast-enhanced MRA might be recommended in order to detect a possible pseudoaneurysm in an early stage.

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

“…The prevalence of ICA pseudoaneurysm associated with TSS is around 0.12%–0.3% 3 4 17. It usually occurs in the first few days or weeks after surgery, and mostly, but not exclusively, in cases with significant intraoperative bleeding 5 6 12 18–20. Rare reports of ICA pseudoaneurysms occurring several years after surgery have been described,6 12 15 21 mainly in patients who also underwent adjuvant radiotherapy or radiosurgery 12 21.…”

“…Adjuvant medical treatment leads to remission in approximately half of these patients but the remainder may require radiotherapy or radiosurgery for biochemical control 2. Injury to the cavernous internal carotid artery (ICA) and pseudoaneurysm formation is a rare but well-described acute complication of TSS 3–7. A pseudoaneurysm or false aneurysm is an encapsulated haematoma that results from the disruption of the vessel wall and communicates with the ruptured artery.…”

Internal Carotid Artery Pseudoaneurysm After Transsphenoidal Pituitary Tumor Resection: A Case Report

“…The risk factors for developing ICAP after transsphenoidal surgery include a history of hypertension, previous radiation therapy, tumor invasion of the cavernous sinus, prior treatment with bromocriptine, acromegaly, and extensive surgical resection of the sellar region [2,5]. The clinical presentation of ICAP can vary from an asymptomatic finding on imaging to life-threatening complications such as subarachnoid hemorrhage, carotid-cavernous fistula, or even death [6]. Mortality rates from rupture of ICAP have been reported up to 50% [1,2].…”