Management of Coincident Pituitary Macroadenoma and Cavernous Carotid Aneurysm: A Systematic Literature Review

Abstract

Introduction Pituitary adenomas are a common intracranial pathology with an incidence of 15 to 20% in the population while cerebral aneurysms are less common with a prevalence of 1:50 patients. The incidence of aneurysms in patients with pituitary adenoma has been estimated at 2.3 to 5.4% of patients; however, this remains unclear. Equally, the management of concomitant lesions lacks significant understanding. Methods A case report is presented of a concomitant cerebral aneurysm and pituitary adenoma managed by minimally invasive endovascular and endoscopic methods, respectively. A systematic review of the literature for terms “pituitary adenoma” and “aneurysm” yielded 494 studies that were narrowed to 19 relevant articles. Results We report a case of a 67-year-old patient with an enlarging pituitary macroadenoma, cavernous carotid aneurysm, and unilateral carotid occlusion. After successful treatment of the aneurysm by a pipeline flow diverter, the pituitary adenoma was surgically resected by an endoscopic transsphenoidal approach. Conclusion The use of a pipeline flow diverter and endonasal approach was feasible in the treatment of our patient. This is the first report to our knowledge of the use of pipeline flow diversion in the management of a cavernous carotid aneurysm prior to pituitary adenoma treatment.

Giant Prolactinoma Embedded by Pseudoaneurysm of the Cavernous Carotid Artery Treated with a Tailored Therapeutic Scheme

“… 12 In these procedures, antiplatelet therapy is generally not required and this intervention has been shown to provide aneurysm protection with low morbidity and facilitate transsphenoidal resection of the adenoma. 6 For these reason, the treatment of the coexistence pathology can be performed within the same procedure (in this study is reported in 19.35% of cases). In cases of direct clipping, 12 the surgical approach and the timing become problems (it was performed just in 11 cases reported).…”

“…The clinical symptoms are mainly caused by hormones secreted by PAs or by compression on the surrounding brain tissues and optic nerve, while for associated IA, the diagnosis is often incidental (51/94, 54.26%). 3 It seems that older age 9 and cavernous sinus invasion increase the rate of coexistence 6 ; some studies 9 have also hypothesized that female sex may be a risk factor for AIs in patients with pituitary tumors, but the reported data do not suggest this difference.…”

“…Management strategies for the treatment of cerebral aneurysms have greatly expanded, 6 and endovascular therapy has almost replaced direct clipping in the last years, but the strategy treatment for this occurrence partially depends on the angiographic features of the aneurysm and ability to tolerate single or dual antiplatelet agents to prevent thromboembolic complications 6 in the presence of a PA. In general, the preferred treatment for aneurysms associated with a PA was the endovascular coiling and, more recently, the FD device.…”

“…2 There is a general consensus that IAs occur more frequently in association with PAs than among the general patient population. 3 By mean of both autoptic and retrospective studies, with incidence rates ranging from 0.5 to 7.4%, [4][5][6] coincidental aneurysms are reported almost seven times more frequently in patients with PAs than in patients with other types of brain tumors. 3,7 Several mechanisms of aneurysm formation associated with PA have been proposed, including local circulatory stress, endocrine effect, mechanical effect, and direct invasion.…”

“…2 There is a general consensus that IAs occur more frequently in association with PAs than among the general patient population. 3 By mean of both autoptic and retrospective studies, with incidence rates ranging from 0.5 to 7.4%, 4 5 6 coincidental aneurysms are reported almost seven times more frequently in patients with PAs than in patients with other types of brain tumors. 3 7…”