Giant cavernous carotid aneurysm causing pituitary dysfunction: Pituitary function recovery with high-flow bypass

Abstract

Background:Giant internal carotid artery (ICA) aneurysms extending into the sellar region, mimicking pituitary tumors, and causing pituitary dysfunction are relatively rare. Open surgery or endovascular treatment can treat these aneurysms, but achieving recovery of endocrine function is difficult.Case Description:A 56-year-old man presented with giant aneurysm of the ICA causing pituitary impairment, leading to disturbance of consciousness due to hyponatremia. High-flow bypass from the cervical external carotid artery to the middle cerebral artery and ligation of the ICA at the cervical portion were performed. One year after the operation, his pituitary function recovered well; he was followed up as an outpatient without hormonal replacement therapy for 8 years after the operation.Conclusion:Giant ICA aneurysm causing pituitary dysfunction is relatively rare, but it is important to consider in the differential diagnosis for hypopituitarism. Treatment with high-flow bypass using radial artery graft can achieve both prevention of aneurysm rupture and recovery of pituitary function.

Two Cases of Hypopituitarism Caused by Intrasellar Aneurysm

“…Aneurysm rupture has been considered rare, but 15% of cases were reported to present with acute aneurysm rupture (3). To prevent aneurysm rupture and reduce the mass effect on the pituitary, open surgery or endovascular treatment may be employed to treat aneurysms (1). Open surgery methods are hazardous and technically challenging (10).…”

“…Hypopituitarism typically occurs because of the compression of the normal pituitary by pituitary adenomas or nonpituitary tumors. Giant internal carotid artery aneurysms sometimes extend into the sellar region and mimic pituitary tumors, resulting in hypopituitarism due to the compression of the normal pituitary or hypothalamus (1). Although it very rarely causes hypopituitarism, a previous study found that 7 (0.17%) of 4,087 patients with hypopituitarism were found to have hypopituitarism due to an intrasellar aneurysm (2).…”

Pituitary dysfunction from an unruptured ophthalmic internal carotid artery aneurysm with improved 2-year follow-up results: A case report

“…Conversely, a 1-month follow-up of another patient with a supradiaphragmatic aneurysm and pituitary insufficiency exhibited excellent recovery with hormone supplementation; however, serum hormone levels were not specified in the follow-up [ 3 ]. In addition, an 8-year follow-up of a patient with pituitary dysfunction caused by a giant cavernous carotid aneurysm treated with high-flow bypass demonstrated pituitary function recovery and shrinkage of the aneurysm [ 12 ]. In our case, a 2-year follow-up of serum hormone levels performed without an intermediate-stage examination revealed complete or partial improvement of levels of certain hormones such as TSH, FT3, FT4, and testosterone.…”

Recurrent embolic stroke caused by large cavernous carotid aneurysm: Stroke recurrence prevention with high-flow bypass followed by proximal occlusion

“…On the next day, high-flow bypass was conducted as described previously. [ 4 5 6 ] Neuroanesthesia was induced under the monitoring of somatosensory evoked potentials (SSEPs) of the left extremities. The right cervical carotid bifurcation was exposed, a curvilinear frontotemporal skin incision was made, and the superficial temporal artery (STA) was meticulously prepared under the operating microscope.…”