Subarachnoid Hemorrhage Due to Rupture of an Intracavernous Carotid Artery Aneurysm Coexisting with a Prolactinoma under Cabergoline Treatment

Abstract

We report an unusual case of subarachnoid hemorrhage caused by intraoperative rupture of an intracavernous carotid artery aneurysm coexisting with a prolactinoma. A 58-year-old man presenting with diplopia was found to have a left intracavernous carotid artery aneurysm encased by a suprasellar tumor on magnetic resonance imaging. His serum prolactin level was 5036 ng/mL. Proximal ligation of the left internal carotid artery with a superficial temporal artery to middle cerebral artery anastomosis was scheduled. Because the patient's diplopia had deteriorated, we started him on cabergoline at a dose of 0.25 mg once a week. One month after administration of cabergoline, the diplopia was improved to some extent and serum prolactin was decreased to 290 ng/ml. Six weeks after starting the cabergoline, the patient underwent a left frontotemporal craniotomy to treat the aneurysm. When the dura mater was opened, abnormal brain swelling and obvious subarachnoid hemorrhage were observed. Postoperative computed tomography demonstrated a thick subarachnoid hemorrhage. This case suggests that medical therapy for a pituitary adenoma should be started after treatment for a coexisting intracavernous aneurysm is completed.

Preoperative Coiling of Coexisting Intracranial Aneurysm and Subsequent Brain Tumor Surgery

“…For cUIAs adjacent to brain tumors (Figs. 1, 2), the aneurysm should be treated prior to tumor surgery because the aneurysm may be inadvertently injured and rupture during or after tumor surgery (101112131415). The risk of rupturing a cUIA, especially a large one (Fig.…”

“…Previous studies reported that the incidence of cUIA associated with brain tumor ranged from 2.3% to 7.7% (3456789). Considering the variable incidence of cUIA associated with brain tumors (3456789), there are a considerable number of cases in literature documenting perioperative aneurysm rupture (1011121314). This data emphasizes the importance of cUIA management before tumor treatment (121011121314).…”

“…Considering the variable incidence of cUIA associated with brain tumors (3456789), there are a considerable number of cases in literature documenting perioperative aneurysm rupture (1011121314). 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).…”

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

“…2 3 There are, however, multiple case reports of SAH from cavernous ICA aneurysms. [4][5][6][7][8] In one report, 4 SAH occurred after the dura was opened during a craniotomy to treat a cavernous ICA aneurysm, which coexisted with a prolactinoma under cabergoline treatment; the authors suggested that an aperture to the subarachnoid space was created by shrinkage of the prolactinoma by cabergoline. We report a case of spontaneous SAH due to rupture of a cavernous ICA aneurysm in a patient whose large prolactinoma had shrunk following cabergoline treatment.…”

Oculomotor Paralysis, Postorbital Pain, and Hypopituitarism as First Presentations of Metastatic Gastric Cancer in the Pituitary Flourished by Internal Carotid Aneurysm

“…Intracranial aneurysm is found in only 0.3% of brain tumor patients, 9 and a coexisting aneurysm can trigger or exacerbate the disease course of tumors. 10 , 11 Tumors metastatic to the pituitary gland and parasellar aneurysms are usually misdiagnosed as pituitary adenoma. To date, the coexistence of MP and intracranial aneurysms has not been reported in literatures.…”