Pituitary Apoplexy Caused by Ruptured Internal Carotid Artery Aneurysm

Abstract

Background and Purpose-We report the first case of pituitary apoplexy caused by the rupture of an intracavernous carotid artery aneurysm embedded in a pituitary adenoma. Case Description-A 46-year-old man presented with clinical and CT findings typical of pituitary apoplexy. MRI showed an unusual flow-void protrusion into the intratumoral hematoma, which, however, was not diagnosed as a ruptured aneurysm until severe intraoperative bleeding occurred. Angiography after surgery revealed an intracavernous carotid artery aneurysm. Conclusions-The

Intra-Operative Rupture of Remote Aneurysm during Transphenoidal Resection of Pituitary Macroadenoma

“…We have only been able to identify one other report of intra-operative hemorrhage during transphenoidal surgery due to rupture of an unknown ACOM aneurysm [13]. Other reports of intra-op aneurysm rupture during macroadenoma removal have been described, however the bulk of these are ICA aneurysms directly manipulated during hypophesectomy [14] [15]. In the three previous cases the aneurysms were found in the anterior circulation.…”

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

“…However, different clinical presentations may occur, such as fatal epistaxis 10 or pituitary apoplexy 11 , as a result of aneurismal bleeding into the adenoma. Misdiagnosis of this condition may have hazardous hemorrhagic consequences.…”

A Giant Intracavernous Carotid Artery Aneurysm Embedded in Pituitary Macroadenoma Presenting with Pituitary Apoplexy

“…Only a few cases of unruptured intrasellar aneurysms contiguous to pituitary adenomas have been described [8,9] , and to our knowledge, only one case of pituitary apoplexy caused by aneurysmal bleeding into a pituitary adenoma has been reported [2] . In that case, intraoperative massive bleeding was noted and postoperative angiography revealed an intracavernous carotid artery aneurysm.…”

“…The suprasellar component exhibits eccentric growth with heterogenous enhancement (double arrowheads in C , D ), presumably a coexistent pituitary macroadenoma. coils ( fi g. 2 ). No new neurological defi cit developed after this procedure.…”

“…Thus, craniotomy for tumor resection and trapping of the ICA immediately distal to the aneurysm were performed simultaneously. We discussed this treatment method and reviewed the literature [1,2] . …”