Recovery of pituitary function following treatment of an unruptured giant cavernous carotid aneurysm using Surpass flow-diverting stents

Abstract

Giant aneurysms arising from the cavernous internal carotid artery (ICA) can mimic pituitary adenomas and may cause pituitary dysfunction due to their mass effect on the pituitary gland. We report a case of a 56-year-old man presenting with impotence, fatigue and panhypopituitarism who was found to have a giant unruptured aneurysm arising from the right cavernous ICA with severe mass effect on the pituitary gland. The patient underwent endovascular treatment of the giant aneurysm using two telescoping Surpass flow-diverting stents. At 6-month follow-up, repeat cerebral angiography showed Raymond grade II occlusion of the aneurysm with a small neck remnant. At the 10-month follow-up the patient showed full recovery of his pituitary function and clinical resolution of impotence and fatigue. This is the first report of occlusion of a giant cavernous carotid aneurysm using next generation Surpass flow-diverting stents leading to complete recovery of pituitary function.

Two Cases of Hypopituitarism Caused by Intrasellar Aneurysm

“…However, the endovascular coil embolization has been developed and is now available for application. Good occlusion of the aneurysm and partial recovery of the pituitary function has been reported in some cases of middle-aged and elderly patients (13,14). The accumulation of more details on cases of hypopituitarism due to intrasellar aneurysms will be required in order to clarify the treatment and nature of this disease.…”

“…Open surgery methods are hazardous and technically challenging (10). In addition, hypopituitarism is usually permanent, and improvement of the pituitary function is difficult to achieve, even after surgery (11,12). Therefore, hormone replacement therapy is required even after the operation.…”

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

“…[ 13 ] The mechanisms of endocrine dysfunction may involve either mechanical compression of the pituitary gland and stalk, or vascular compression of the artery supplying the pituitary gland resulting in pituitary ischemia. [ 26 27 ] Our present patient was first treated under a diagnosis of depression associated with hyponatremia induced by secondary adrenal insufficiency. Subsequently, our patient was referred to our hospital after discovery of the intracranial mass suggestive of tumor.…”

“…[ 7 11 ] Recently, flow diverting stents have offered treatment for formidable and complex aneurysms, but previous trials showed complete aneurysm occlusion of 73.6% at 6 months and 86.8% at 1 year, and 5.6% had major complications such as major ipsilateral thrombosis, intraparenchymal hemorrhage, and neurologic death. [ 2 3 ] Good occlusion of the aneurysm and recovery of pituitary function was reported in one case,[ 26 ] but pituitary hormone replacement therapy was necessary after aneurysm treatment in another case. [ 5 ] Delayed pan-hypopituitarism was observed after treatment of ICA aneurysm with flow diverting stent, partly caused by compromise to the blood supply of the pituitary gland as a result of the flow diversion to the ICA.…”

“…Giant internal carotid artery (ICA) aneurysms extending into the sellar region, mimicking pituitary tumors, and causing pituitary dysfunction are rare but occasionally reported. [ 5 7 11 16 17 23 25 26 28 ] Such aneurysms are the cause of hypopituitarism in 0.17% of patients. [ 13 ] Open surgery or endovascular treatment is indicated for these aneurysms, but achieving recovery of endocrine function is difficult.…”