Intrasellar internal carotid aneurysm coexisting with GH-secreting pituitary adenoma in an acromegalic patient

Sedá, L; Cukiert, Arthur; Nogueira, Kátia Camarano; Huayllas, Martha Katherine Paniagua; Liberman, Bernardo

doi:10.1590/s0004-282x2008000100026

Cited by 28 publications

(42 citation statements)

References 12 publications

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“…16 Growth hormone-secreting adenomas have been implicated as causing local vascular changes that may be associated with deterioration of vessel endothelium and parasellar or intrasellar ICA aneurysm formation. 1,3,11,25,28 It should be remembered that ICA injury may be more likely to occur in patients with GH-secreting adenomas than in those with any other kind of pituitary adenoma as a result of the anatomical and microvascular changes mentioned. For this reason, use of the Doppler microprobe and intraoperative neuronavigation are useful intraoperative adjuncts for improving the safety profile associated with dural opening and tumor resection in some patients with acromegaly undergoing transsphenoidal surgery.…”

Section: The Sellar Phase: Identification Of Key Vascularmentioning

confidence: 99%

Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations

Zada

Cavallo

Esposito

et al. 2010

FOC

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Object In addition to difficulties with anesthetic and medical management, transsphenoidal operations in patients with longstanding acromegaly are associated with inherent intraoperative challenges because of anatomical variations that occur frequently in these patients. The object of this study was to review the overall safety profile and anatomical/technical challenges associated with transsphenoidal surgery in patients with acromegaly. Methods The authors performed a retrospective analysis of 169 patients who underwent endoscopic transsphenoidal operations for growth hormone–secreting adenomas to assess the incidence of surgical complications. A review of frequently occurring anatomical challenges and operative strategies employed during each phase of the operation to address these particular issues was performed. Results Of 169 cases reviewed, there was no perioperative mortality. Internal carotid artery injury occurred in 1 patient (0.6%) with complex sinus anatomy, who remained neurologically intact following endovascular unilateral carotid artery occlusion. Other complications included: significant postoperative epistaxis (5 patients [3%]), transient diabetes insipidus (5 patients [3%]), delayed symptomatic hyponatremia (4 patients [2%]), CSF leak (2 patients [1%]), and pancreatitis (1 patient [0.6%]). Preoperative considerations in patients with acromegaly should include a cardiopulmonary evaluation and planning regarding intubation and other aspects of the anesthetic technique. During the nasal phase of the transsphenoidal operation, primary challenges include maintaining adequate visualization and hemostasis, which is frequently compromised by redundant, edematous nasal mucosa and bony hypertrophy of the septum and the nasal turbinates. During the sphenoid phase, adequate bony removal, optimization of working space, and correlation of imaging studies to intraoperative anatomy are major priorities. The sellar phase is frequently challenged by increased sellar floor thickness, distinct patterns of tumor extension and bony invasion, and anatomical variations in the caliber and course of the internal carotid artery. Specific operative techniques for addressing each of these intraoperative challenges are discussed. Conclusions Transsphenoidal surgery in patients with longstanding acromegaly frequently poses greater challenges than operations for other types of sellar lesions, yet these challenges may be safely and effectively overcome with the anticipation of specific issues and implementation of various intraoperative techniques.

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Section: The Sellar Phase: Identification Of Key Vascularmentioning

confidence: 99%

Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations

Zada

Cavallo

Esposito

et al. 2010

FOC

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“…Cerebral aneurysms can be treated by endovascular or microsurgical techniques [16-18]. In the present case, the patient experienced typical symptoms and signs due to the pituitary tumour and optic chiasma compression.…”

Section: Discussionmentioning

confidence: 76%

Pituitary macroadenoma co-existent with supraclinoid internal carotid artery cerebral aneurysm: a case report and review of the literature

Wang

Yeh

et al. 2009

Cases J

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With improved angiographic techniques and magnetic resonance angiography available today, an increasing number of incidental aneurysms are being detected. Occurrence of an intracranial aneurysm together with a pituitary adenoma presents tremendous risk to the patient, particularly when the aneurysm lies near the operative field.A 61-year-old woman presented with a progressive visual field defect. Neurological examination revealed bi-temporal haemianopia. Cerebral magnetic resonance imaging and angiography revealed a pituitary macroadenoma co-existent with a cerebral aneurysm near the sellar region. The patient underwent an endovascular procedure for aneurysm embolisation and then underwent surgery for removal of the pituitary adenoma via a trans-sphenoidal approach.We report our experience and emphasize the need for critical evaluation of neuroradiological examinations for precise diagnosis for avoiding a possible life-threatening situation.

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“…Coincidence of intracranial aneurysm and pituitary adenoma had been reported previously [4,8,15,25,[33][34][35][36][37][38][40][41][42]. Some series demonstrated an increased incidence of aneurysm in patients with pituitary adenoma [15,40].…”

Section: Discussionmentioning

confidence: 88%

“…Possible mechanisms had been proposed, such as direct mechanical influence, infiltration by the tumor, GH and IGF-1 effect on arterial wall [8,15,20,35,41]. However, Pant B. et al in their largest retrospective study of 467 cases did not find any association between these pathologies [25].…”

Section: Discussionmentioning

confidence: 99%

Overview of vascular complications of pituitary surgery with special emphasis on unexpected abnormality

et al. 2009

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Arterial bleeding during transsphenoidal surgery for pituitary adenoma is known complication. This usually happens due to rupture of intracavernous carotid or delayed hemorrhage due to the carotico-cavernous fistula and/or pseudoaneurysm. There is also evidence that cavernous carotid aneurysms may occur with pituitary tumors, yet largest series failed to demonstrate any link between aneurysm formation and pituitary tumors. Usually such an aneurysm rupture results in formation of carotico-cavernous fistula. However, pituitary apoplexy and even epistaxis have been reported. In this paper we present a patient with recurrent pituitary adenoma and cavernous carotid artery aneurysm, which caused significant hemorrhage during the surgery. Although retrospective analysis of MRI disclosed that the patient had the aneurysm before the first surgery, it remained silent until the second operation. Therefore neurosurgeons should be very susceptive to any signal changes on preoperative MR images, especially in recurrent cases, where normal anatomical relations are disturbed by fibrotic tissue. Also, we reviewed the vascular complication of pituitary surgery based on the literature.

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Intrasellar internal carotid aneurysm coexisting with GH-secreting pituitary adenoma in an acromegalic patient

Abstract: aneurIsma Intraselar da carótIda Interna coexIstIndo com adenoma secretor de gh em pacIente acromegálIco

Cited by 28 publications

References 12 publications

Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations

Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations

Pituitary macroadenoma co-existent with supraclinoid internal carotid artery cerebral aneurysm: a case report and review of the literature

Overview of vascular complications of pituitary surgery with special emphasis on unexpected abnormality

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