Intra cavernous aneurysm of internal carotid artery masquerading as a pituitary adenoma: a case report

Wijethunga, W. M. U. A.; Dissanayake, Harsha; Perera, S.; Katulanda, Prasad

doi:10.1186/s13104-018-3329-2

Cited by 11 publications

(7 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The prevalence of sellar region’s aneurysm among others is 1%–2%. 13 Usually they are unique lesions, unlike the case presented. In our literature review, only 3 patients have presented with multiple aneurysms associated with a pituitary tumor.…”

Section: Discussionmentioning

confidence: 75%

Magnetic resonance imaging finding of coexistence of bilateral paraclinoid aneurysms in a patient with a nonfunctioning macroadenoma, simultaneous resection, and clipping: illustrative case

Mondragón-Soto

Villanueva-Castro

Tovar-Romero

et al. 2022

Journal of Neurosurgery: Case Lessons

View full text Add to dashboard Cite

BACKGROUND Unruptured incidental intracranial aneurysm can coexist with pituitary adenoma, however, the occurrence is extremely rare. Timely diagnosis of asymptomatic intracranial aneurysms with pituitary adenoma may lead to planning a tailored surgical strategy to deal with both pathologies simultaneously. A case of a patient who underwent transcranial resection of a pituitary adenoma with clipping of two mirror aneurysms is reported. OBSERVATIONS A 55-year-old female presented with deterioration of visual acuity that progressed over 1 year, as well as presence of right eyelid ptosis. Magnetic resonance imaging of the head showed the presence of an intrasellar pituitary macroadenoma. Bilateral paraclinoid aneurysms were documented to be in contact with the pituitary tumor. The patient underwent surgery with simultaneous aneurysm clipping and tumor resection through a standard pterional approach with intradural clinoidectomy. The aneurysms were successfully clipped after the tumoral debulking. After clipping, the pseudocapsule was fully resected. LESSONS Various treatment options are available. Although endovascular securing of the aneurysms prior to the tumor resection would be ideal, in cases in which this resource is not readily available at all times, the surgeon must be prepared to solve pathologies with an elevated level of complexity.

show abstract

Section: Discussionmentioning

confidence: 75%

Magnetic resonance imaging finding of coexistence of bilateral paraclinoid aneurysms in a patient with a nonfunctioning macroadenoma, simultaneous resection, and clipping: illustrative case

Mondragón-Soto

Villanueva-Castro

Tovar-Romero

et al. 2022

Journal of Neurosurgery: Case Lessons

View full text Add to dashboard Cite

show abstract

“…However, in this case, there were no specific findings on routine MR of the brain that helped with such a distinction. There have been several reported cases of transsphenoidal surgery of pituitary adenomas leading to rupture of internal carotid aneurysms and subarachnoid hemorrhage or carotid-cavernous fistulae, though the incidence is rare [ 6 , 7 ]. Given this risk, we recommend preoperative studies of intracranial vasculature, such as CTA, to characterize large cavernous sinus lesions prior to transsphenoidal surgery to exclude ICA aneurysm.…”

Section: Discussionmentioning

confidence: 99%

Internal Carotid Artery Aneurysm Disguised as Pituitary Macroadenoma

Mulpuri,

Ghayee,

Abramowitz

et al. 2023

JCEM Case Reports

View full text Add to dashboard Cite

Hypopituitarism due to an internal carotid artery (ICA) aneurysm is rare. We present a case of hypopituitarism and hyperprolactinemia due to a giant right ICA aneurysm. A 56-year-old woman with a history of primary hypothyroidism presented with fatigue, right-sided headache, and blurred vision. Magnetic resonance (MR) of the brain revealed a sellar mass measuring 3.5 × 2.2 cm involving the right cavernous sinus. Initial neurologic examination was unremarkable, and her biochemical evaluation revealed secondary adrenal insufficiency, central hypogonadism, low serum free thyroxine, and mildly elevated serum prolactin, consistent with stalk effect. Hydrocortisone therapy was started for secondary adrenal insufficiency and her levothyroxine dose was adjusted. The patient was referred to neurosurgery for surgical management of her sellar lesion. Preoperative computed tomography angiography (CTA) of the brain revealed a right ICA aneurysm that contacted the optic chiasm and displaced the pituitary gland. The aneurysm was embolized and diverting stents were placed. Repeat laboratory tests showed resolution of the patient's secondary adrenal insufficiency, normalization of serum prolactin, and an increase in serum gonadotropin concentrations to the postmenopausal range. This case highlights that not all sellar lesions are pituitary adenomas, and CTA should be performed in the evaluation of large cavernous sinus lesions to exclude ICA aneurysm.

show abstract

“…Some theories suggest that hypertension, added to endothelial remodeling and alteration in collagen genesis along with elevated levels matrix metalloproteinases and endothelial growth factor could explain the increase in the prevalence of aneurysm in this population. [26][27][28][29][30] In our case, treatment of the AComA versus observation was chosen in consideration of high risk of rupture in the next 5 years due to a PHASES score of 9 points (4.3% bleeding at 5 years). The decision for clipping vs coiling was selected based on the risk of intraoperatively rupture due to sudden decrease in intracranial pressure and surgical limitation of management of a rupture complication by a transsphenoidal approach.…”

Section: Treatmentmentioning

confidence: 99%

Ectopic Intrasphenoidal Growth Hormone Releasing Pituitary Adenoma Associated with an Intracranial Aneurysm

Cifuentes-Lobelo,

Castañeda-Duarte,

Ruiz-Diaz

et al. 2024

Asian J Neurosurg

View full text Add to dashboard Cite

Pituitary adenomas are a type of of the most frequent intracranial tumors. These tumors can extend outside the sella, but very rarely originate ectopically to the sellar region. A 71-year-old patient presented to our institution, with prior clinical history of noncontrolled arterial hypertension and new-onset high-intensity pulsatile headache. Upon suspicion of a hypertensive emergency with probable brain compromise, a nonenhanced computed tomography of the head was performed. A mass within the sphenoid sinus was found. Endocrinological workup demonstrated a significant elevation of the growth hormone. As an incidental finding, a brain aneurysm was evidenced, which was treated endovascularly prior to the mass treatment. Subsequently, the patient successfully underwent a gross total resection through an endonasal transsphenoidal approach. Histopathological results were consistent with a pituitary ectopic adenoma. A postoperative improvement in levels of somatomedin C was documented postoperatively.

show abstract

Intra cavernous aneurysm of internal carotid artery masquerading as a pituitary adenoma: a case report

Cited by 11 publications

References 16 publications

Magnetic resonance imaging finding of coexistence of bilateral paraclinoid aneurysms in a patient with a nonfunctioning macroadenoma, simultaneous resection, and clipping: illustrative case

Magnetic resonance imaging finding of coexistence of bilateral paraclinoid aneurysms in a patient with a nonfunctioning macroadenoma, simultaneous resection, and clipping: illustrative case

Internal Carotid Artery Aneurysm Disguised as Pituitary Macroadenoma

Ectopic Intrasphenoidal Growth Hormone Releasing Pituitary Adenoma Associated with an Intracranial Aneurysm

Contact Info

Product

Resources

About