Pituitary macroadenoma co-existent with a posterior circulation aneurysm leading to subarachnoidal hemorrhage during transsphenoidal surgery

Habibi, Zohreh; Miri, Seyyed Mohammad; Sheikhrezaei, Abdolreza

doi:10.5137/1019-5149.jtn.8314-13.0

Cited by 7 publications

(5 citation statements)

References 16 publications

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“…Pituitary adenoma associated with intracranial aneurysms requires complex and individual case discussions to establish the therapeutic strategies, and pituitary adenoma is reported to coexist with intracranial aneurysms in the anterior circulation of the circle of Willis in 2.3-3.6% of cases [1][2][3][4], but in the posterior circulation in much lower percentages [5][6]. Such rates of coexistence may be higher in acromegaly patients [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Pituitary Adenomas Associated with Intracranial Aneurysms: the Clinical Characteristics, Therapeutic Strategies, and Possible Effects of Vascular Remodeling Factors

Ogawa

Watanabe

Tominaga

2021

J Neurol Surg A Cent Eur Neurosurg

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Background Pituitary adenoma coexists with intracranial aneurysms in 2.3 to 3.6% of cases, and intracranial aneurysms are thought to be incidental. On the other hand, older age and cavernous sinus invasion are reported to increase the rate of coexistence, so these two diseases may be related. Methods Ten males and 14 females with the coexistence of pituitary adenomas and intracranial aneurysms were retrospectively investigated among 923 patients (2.6%). Patients were subdivided into two groups: those with direct attachment of cerebral aneurysms to the pituitary adenomas and those without direct attachment. The clinical characteristics, therapeutic strategies, and possible effects of vascular remodeling factors were investigated. Results Twelve patients had functioning pituitary adenomas, and cavernous sinus invasion was identified in 7 of 24 patients. Five of these 7 patients were treated with priority for the cerebral aneurysm until 2007, whereas 14 of 17 patients without involvement of the aneurysm tip in the tumor were treated with priority for the pituitary adenoma in the later period. Among vascular remodeling factors, strong expression of vascular endothelial growth factor (VEGF) was significantly associated with the coexistence of pituitary adenoma and cerebral aneurysm (p < 0.05). Conclusion Intracranial aneurysms were found to coexist in 2.6% of cases of surgically treated pituitary adenomas. VEGF-induced arterial wall remodeling may be part of the mechanism of association between pituitary adenomas and cerebral aneurysms, suggesting possible causative mechanism.

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Section: Introductionmentioning

confidence: 99%

Pituitary Adenomas Associated with Intracranial Aneurysms: the Clinical Characteristics, Therapeutic Strategies, and Possible Effects of Vascular Remodeling Factors

Ogawa

Watanabe

Tominaga

2021

J Neurol Surg A Cent Eur Neurosurg

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“…On the contrary, the occurrence with posterior circulation aneurysms is unusual and has been reported only twice. One was an autopsy case where a pituitary adenoma was associated with a giant vertebrobasilar aneurysm, and the other described a fatal SAH from a basilar apex aneurysm in the postoperative period [ 7 , 14 ]. Rupture of a posterior circulation aneurysm during craniopharyngioma removal has never been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies report an incidence of 3.7%-7.4%, with 97% of the aneurysms located in the anterior circulation [1][2][3][4]. The occurrence of subarachnoid hemorrhage (SAH) caused by the rupture of a coexisting cerebral aneurysm is quite unusual, and SAH caused by the inadvertent rupture of a posterior circulation aneurysm during transsphenoidal surgery is out of the ordinary [5][6][7][8][9]. This work presents a case series of three patients operated on for a sellar tumor through a transsphenoidal route as scheduled cases.…”

Section: Introductionmentioning

confidence: 99%

Subarachnoid Hemorrhage From Rupture of an Undiagnosed Posterior Circulation Aneurysm During Sellar Tumor Surgery

Nathal¹,

Mormandi²,

Cervio³

et al. 2022

Cureus

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Association between cerebral aneurysms and sellar tumors has been previously reported. Rupture of anterior circulation aneurysms during a transsphenoidal surgery causing massive subarachnoid hemorrhage (SAH) is uncommon, but rupture of a posterior circulation aneurysm is an infrequent event.We present three cases of SAH secondary to rupture of an undetected posterior circulation aneurysm during transsphenoidal surgery to treat a sellar tumor. The common factor in these cases was the adverse outcome despite treatment.The fatal outcome seen in all these cases questions whether to include a (magnetic resonance) MR angiography or (computed tomography) CT angiography during preoperative evaluation for sellar tumors in order to identify inadvertently associated aneurysms.

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“…10 Additionally, aneurysms in the posterior circulation have also been described which may confer increased surgical morbidity during pituitary surgery. 11 Cavernous carotid artery aneurysms located proximal to the distal dural ring present a decreased risk for rupture-associated morbidity and mortality due to their extradural origin and are therefore less commonly treated surgically or endovascularly. 5 Rupture of aneurysms extending within pituitary adenomas, however, may present as pituitary apoplexy with visual, cranial nerve, and endocrine dysfunction.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Pituitary macroadenoma co-existent with a posterior circulation aneurysm leading to subarachnoidal hemorrhage during transsphenoidal surgery

Cited by 7 publications

References 16 publications

Pituitary Adenomas Associated with Intracranial Aneurysms: the Clinical Characteristics, Therapeutic Strategies, and Possible Effects of Vascular Remodeling Factors

Pituitary Adenomas Associated with Intracranial Aneurysms: the Clinical Characteristics, Therapeutic Strategies, and Possible Effects of Vascular Remodeling Factors

Subarachnoid Hemorrhage From Rupture of an Undiagnosed Posterior Circulation Aneurysm During Sellar Tumor Surgery

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

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