Spontaneous subarachnoid hemorrhage due to ruptured cavernous internal carotid artery aneurysm after medical prolactinoma treatment

Abstract

Aneurysms of the cavernous segment of the internal carotid artery (ICA) are believed to have a low risk of subarachnoid haemorrhage (SAH), given the confines of the dural rings and the anterior clinoid process. The risk may be greater when the bony and dural protection has been eroded. We report a case of spontaneous SAH from rupture of a cavernous ICA aneurysm in a patient whose large prolactinoma had markedly decreased in size as the result of cabergoline treatment. After passing a balloon test occlusion, the patient underwent successful endovascular vessel deconstruction. This case suggests that an eroding skull base lesion may distort normal anterior cranial base anatomy and allow communication between the cavernous ICA and subarachnoid space. The potential for SAH due to cavernous ICA aneurysm rupture should be recognised in patients with previous pituitary or other skull base lesions adjacent to the cavernous sinus.

Single internal carotid cavernous sinus aneurysm presented as bilateral painful ophthalmoplegia: a case report

“…In conclusion, this case suggests that an internal carotid cavernous segment aneurysm can present with bilateral painful ophthalmoplegia. Given the potentially fatal outcome of aneurysmal rupture [13], any patient who presents with bilateral painful ophthalmoplegia should be promptly screened using CTA or MRA.…”

Subarachnoid Hemorrhage From Rupture of an Undiagnosed Posterior Circulation Aneurysm During Sellar Tumor Surgery

“…It is, therefore, possible to plan the treatment of both lesions, separate or during the same procedure, particularly when the aneurysm is the area and is accessible from the same surgical approach [ 3 ]. Besides serendipity, another reason for explaining this association is the direct mechanical effect of sellar tumors on the vasculature, direct infiltration by tumor, and growth hormone production leading to arteriosclerosis, hypertension, and diabetes [ 1 , 2 , 8 ].…”

“…Some studies report an incidence of 3.7%-7.4%, with 97% of the aneurysms located in the anterior circulation [1][2][3][4]. The occurrence of subarachnoid hemorrhage (SAH) caused by the rupture of a coexisting cerebral aneurysm is quite unusual, and SAH caused by the inadvertent rupture of a posterior circulation aneurysm during transsphenoidal surgery is out of the ordinary [5][6][7][8][9]. This work presents a case series of three patients operated on for a sellar tumor through a transsphenoidal route as scheduled cases.…”

Report of intradural aneurysm in the cavernous segment of the internal carotid artery presented with subarachnoid hemorrhage and oculomotor palsy

“…[8] ere are, however, some case reports of SAH from cavernous ICA aneurysms. [1,[4][5][6]7,9,10] In one report, spontaneous SAH due to rupture of a cavernous ICA aneurysm occurred in a patient whose large prolactinoma had shrunk following cabergoline treatment. [6] Dural erosion from giant intracavernous aneurysms has been reported during autopsy [9] and craniotomy.…”

“…[1,[4][5][6]7,9,10] In one report, spontaneous SAH due to rupture of a cavernous ICA aneurysm occurred in a patient whose large prolactinoma had shrunk following cabergoline treatment. [6] Dural erosion from giant intracavernous aneurysms has been reported during autopsy [9] and craniotomy. [5] Although intracavernous aneurysms smaller than 1.5 cm have been associated with SAH, dural erosion into the subarachnoid space is more likely to occur in cases of giant aneurysms and aneurysms arising from the anterior genu of the carotid siphon and those eroding into the sella turcica.…”