Unilateral Tuberothalamic Artery Ischemia Caused by Pituitary Apoplexy

Abstract

PA can lead to compression of perforating arteries, for example, the tuberothalamic artery supplying the thalamus or lenticulostriate region, and thus cause hypoperfusion and subsequent focal cerebral ischemia. This may occur when perforating cerebral arteries are affected and compressed by the sudden increase in tumor volume due to hemorrhage or tumor swelling.

Outcome of giant pituitary tumors requiring surgery

“…During transcranial approach, the neurosurgeon has to alternate different steps of tumor resection in narrow working windows while preserving all perforating arteries. Some perforating arteries ( 43 , 50 ) could also be encased by the tumor, which explains the difficulty to preserve all arterial feeders during surgical dissection and the increased risk of postoperative ischemia ( 3 , 43 , 50 – 52 ). Finally, some trans-diaphragmatic extensions are not well encapsulated and small perforating arteries may run along the pseudo-capsule ( 24 , 50 , 53 , 54 ).…”

“…Some perforating arteries ( 43 , 50 ) could also be encased by the tumor, which explains the difficulty to preserve all arterial feeders during surgical dissection and the increased risk of postoperative ischemia ( 3 , 43 , 50 – 52 ). Finally, some trans-diaphragmatic extensions are not well encapsulated and small perforating arteries may run along the pseudo-capsule ( 24 , 50 , 53 , 54 ). In such cases, an extracapsular dissection may damage theses functional arterial feeders and we recommend to perform an intratumoral debulking only.…”

Unusual bifrontal cerebral infarction related to pituitary apoplexy. An uncommon presentation and literature review

“…e vasospasm can be a response to subarachnoid hemorrhage. [4,6,8,9] Because the PA is the initial cause, the above PA syndrome could be present, nevertheless, other major symptoms and signs were described as hemiparesis/hemiplegia, facial paresis, dysarthria, and other focal neurological deficits; however, all these presentations are unspecific because depends on the arterial specific area, but internal carotid artery is more commonly affected with 58.7% of cases, keep by anterior cerebral artery (ACA) (32.6%) and MCA (25%). e basilar artery was reported only in three cases.…”

“…With the relationship between PA and ischemic infarction confirmed, the treatment must be applied. [2,4,11,17] Because the cause is PA, neurosurgical emergency surgery is mandatory. Surgery must be performed early.…”

“…[8,16] e main symptoms are severe headache, visual impairment, nausea, ophthalmoplegia, hypopituitarism, and altered mental status including coma. [1,4,6,13] Because of these characteristics, this condition is a neurosurgical emergency with high mortality and morbidity indices. [2,11,15,16] Despite ischemic stroke being a common cause of disability, the relationship with PA is rare with few cases reported in the literature.…”