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Huang Z, Yang Z, Xu L, Leng H, Yang K, Ding W, Xie B, Chen F, Liu Z, Li Z. Clinical characteristics and treatment strategies for pituitary adenoma associated with intracranial aneurysm. Chin Neurosurg J 2024; 10:18. [PMID: 38835088 PMCID: PMC11149326 DOI: 10.1186/s41016-024-00370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/26/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND This study aimed to investigate clinical features and treatment strategies for intracranial aneurysm (IA) associated with pituitary adenoma (PA). METHODS We enrolled patients with lesions in the sellar region and age-matched general population who were confirmed with IA from two hospitals. Four types of treatment strategies were performed, which included Type I (both IA and PA were treated with surgery), Type II (IA was treated with surgery and PA was performed by non-surgical treatment), Type III (PA was performed with surgery and observation was available for IA) and Type IV (both IA and PA were performed with non-surgical treatment). RESULTS The incidence of IA was 2.2% in the general population, 6.1% in patients with PA, 4.3% in patients with Rathke cleft cyst, 2.8% in patients with meningioma and none were found with IA in patients with craniopharyngioma. Age over 50 years (OR, 2.69; 95% CI, 1.20-6.04; P = 0.016), female (OR, 3.83, P = 0.003), and invasive tumor (OR, 3.26, P = 0.003) were associated with a higher incidence of IA in patients with PA. During the mean follow-up of 49.2 months, no patients experienced stroke, and recurrence of aneurysms and aneurysms treated with observation were stable. Of four patients with recurrence of PA, three patients were treated for type I and one patient for type III. CONCLUSIONS Preoperative evaluation for aneurysm screening is necessary due to the high incidence of IA in PA patients. Our current treatment strategies may provide a benefit for these patients.
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Affiliation(s)
- Zheng Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China
- Research Center for Cerebrovascular Disease, Central South University, Changsha, 410008, China
| | - Zeng Yang
- Department of Neurosurgery, The First People's Hospital of Changde City, Changde, 415003, China
| | - Lixin Xu
- Department of Neurosurgery, The First People's Hospital of Changde City, Changde, 415003, China
| | - Haibin Leng
- Department of Neurosurgery, The First People's Hospital of Changde City, Changde, 415003, China
| | - Kui Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Wei Ding
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Bo Xie
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Fenghua Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China
- Research Center for Cerebrovascular Disease, Central South University, Changsha, 410008, China
| | - Zhixiong Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Zhenyan Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China.
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Alnaaim SA, Al-Kuraishy HM, Zailaie MM, Alexiou A, Papadakis M, Saad HM, Batiha GES. The potential link between acromegaly and risk of acute ischemic stroke in patients with pituitary adenoma: a new perspective. Acta Neurol Belg 2024; 124:755-766. [PMID: 37584889 PMCID: PMC11139727 DOI: 10.1007/s13760-023-02354-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023]
Abstract
Acromegaly is an endocrine disorder due to the excess production of growth hormone (GH) from the anterior pituitary gland after closed epiphyseal growth plates. Acromegaly is mainly caused by benign GH-secreting pituitary adenoma. Acute ischemic stroke (AIS) is one of the most common cardiovascular complications. It ranks second after ischemic heart disease (IHD) as a cause of disability and death in high-income countries globally. Thus, this review aimed to elucidate the possible link between acromegaly and the development of AIS. The local effects of acromegaly in the development of AIS are related to the development of pituitary adenoma and associated surgical and radiotherapies. Pituitary adenoma triggers the development of AIS through different mechanisms, particularly aneurysmal formation, associated thrombosis, and alteration of cerebral microcirculation. Cardiovascular complications and mortality were higher in patients with pituitary adenoma. The systemic effect of acromegaly-induced cardio-metabolic disorders may increase the risk for the development of AIS. Additionally, acromegaly contributes to the development of endothelial dysfunction (ED), inflammatory and oxidative stress, and induction of thrombosis that increases the risk for the development of AIS. Moreover, activated signaling pathways, including activator of transcription 3 (STAT3), nuclear factor kappa B (NF-κB), nod-like receptor pyrin 3 (NLRP3) inflammasome, and mitogen-activated protein kinase (MAPK) in acromegaly may induce systemic inflammation with the development of cardiovascular complications mainly AIS. Taken together, acromegaly triggers the development of AIS through local and systemic effects by inducing the formation of a cerebral vessel aneurysm, the release of pro-inflammatory cytokines, the development of oxidative stress, ED, and thrombosis correspondingly.
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Affiliation(s)
- Saud A Alnaaim
- Clinical Neurosciences Department, College of Medicine, King Faisal University, Hofuf, Saudi Arabia
| | - Hayder M Al-Kuraishy
- Department of Pharmacology, Toxicology and Medicine, Medical Faculty, College of Medicine, Al-Mustansiriyah University, PO Box 14132, Baghdad, Iraq
| | | | - Athanasios Alexiou
- Department of Science and Engineering, Novel Global Community Educational Foundation, Hebersham, NSW, 2770, Australia
- AFNP Med, 1030, Vienna, Austria
| | - Marios Papadakis
- Department of Surgery II, University Hospital Witten-Herdecke, University of Witten-Herdecke, Heusnerstrasse 40, 42283, Wuppertal, Germany.
| | - Hebatallah M Saad
- Department of Pathology, Faculty of Veterinary Medicine, Matrouh University, Marsa Matruh, 51744, Egypt
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, 22511, Egypt
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He W, Xu C, Zheng D, Jie D, Xu J, Zheng S. Simultaneous resection of pituitary adenoma and clipping of aneurysm through endoscopic endonasal approach: a case report. Front Oncol 2024; 14:1341688. [PMID: 38854715 PMCID: PMC11162107 DOI: 10.3389/fonc.2024.1341688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Pituitary adenomas and intracranial aneurysms are prevalent neurosurgical conditions, but their simultaneous presence is uncommon, affecting only 0.5%-7.4% of those with pituitary adenomas. The strategy of treating aneurysms endovascularly before removing pituitary adenomas is widely adopted, yet reports on addressing both conditions at once through an endoscopic endonasal approach (EEA) are scarce. We present a case involving a pituitary adenoma coupled with an anterior communicating artery aneurysm. Utilizing the EEA, we excised the adenoma and clipped the aneurysm concurrently. The patient recovered well post-surgery, with follow-up assessments confirming the successful resolution of both the adenoma and aneurysm. We proved the feasibility of the EEA in the treatment of pituitary adenomas with anterior communicating artery aneurysms under specific anatomical relationships and close intraoperative monitoring.
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Affiliation(s)
- Wenbo He
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Chongxi Xu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Datong Zheng
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Danyang Jie
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Songping Zheng
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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4
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Villalobos-Diaz R, Marian-Magaña R, Sangrador-Deitos MV, Vazquez-Gregorio R, Rodriguez-Hernandez LA, Lopez-Valencia G, Aragon-Arreola JF, Lara-Olivas JA, Guinto-Nishimura GY, Eguiluz-Melendez AG, Gomez-Amador JL. Surgical treatment of pituitary neuroendocrine tumors with coexisting intracranial lesions: A case series and review of the literature. Surg Neurol Int 2024; 15:96. [PMID: 38628542 PMCID: PMC11021101 DOI: 10.25259/sni_22_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/13/2024] [Indexed: 04/19/2024] Open
Abstract
Background Pituitary neuroendocrine tumors (PitNETs) are a diverse group of benign neoplasms that account for a significant proportion of intracranial tumors (13%). The coexistence of PitNET with other intracranial lesions, such as meningiomas and intracranial aneurysms, has been constantly reported in the literature; yet, the pathophysiological mechanisms remain unknown, and the appropriate management is controversial. This study aims to describe the clinical characteristics, surgical treatment, and outcomes of patients with PitNET with coexisting intracranial lesions in a single healthcare center. Methods A retrospective analysis was conducted on 12 patients who underwent surgical treatment for PitNET and another intracranial lesion at our single tertiary referral center over 15 years from January 2008 to May 2023. Results Among these coexisting lesions, aneurysms were the most commonly found (41.67%), followed by meningiomas (33.33%). Surgical intervention for both lesions was performed in a single-stage procedure for most cases (75%), employing transcranial, endoscopic endonasal, and combined approaches. We found low preoperative Karnofsky Performance Scale scores in three patients, with significant differences in functional outcomes. Conclusion These findings contribute to the limited knowledge about PitNET coexisting with other intracranial lesions and emphasize the importance of patient-tailored, multidisciplinary management in these unusual scenarios.
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Affiliation(s)
- Rodolfo Villalobos-Diaz
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Ricardo Marian-Magaña
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Rafael Vazquez-Gregorio
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - German Lopez-Valencia
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | | | | | - Aldo Gabriel Eguiluz-Melendez
- Department of Neurosurgery, Salvador Zubirán National Institute of Health Sciences and Nutrition, Mexico City, Mexico
| | - Juan Luis Gomez-Amador
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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Albahrani FH, Alturaiki JA, Alahmed AY, Aljasem JM, Alshammari MM, Alali AS, Aldabbab AY, Alhelal AA, Alkhairy A. Co-occurrence of Meningioma and Intracranial Aneurysm: A Systematic Review. Cureus 2024; 16:e52919. [PMID: 38406094 PMCID: PMC10893881 DOI: 10.7759/cureus.52919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
A complete understanding of the rare neurosurgical phenomenon of co-occurring meningioma and intracranial aneurysm is important to improve the quality of life and decrease future complications in these patients. In this review, we searched the literature for cases of this rare phenomenon to highlight the most important historical, investigation, and treatment-related factors to improve the accuracy of intraoperative procedural decisions. We searched the PubMed database for case reports on this neurological rare phenomenon to create organized data for our review. Then, we extracted information from these cases and organized it in a table. We identified 19 cases in the literature. In the published studies, there was a predominance of the female sex (73.68%). The mean age of the patients was 54.11 years, with the cases relatively evenly distributed among patients in their 30s, 40s, 50s, 60s, and 70s. Posterior communicating artery aneurysm was the most common among the 19 cases. For meningioma, the frontal lobe and clinoid were the two most affected locations, and the meningothelial histopathology was the most common. Complete tumor resection and aneurysmal clipping were done for the majority of the cases (57.8%) unless there was a complication that deferred simultaneous intervention. Fortunately, most patients (78.95%) recovered completely after surgery. The coexistence of meningioma and intracranial aneurysm has a very high cure rate, postoperative symptom resolution, and a very low recurrence rate. For most cases, neuroimaging investigations are recommended for simultaneous management. This imaging can also highlight other potentially suspicious findings.
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Affiliation(s)
| | | | | | | | | | | | | | - Ali A Alhelal
- Medical School, King Faisal University, Al-Ahsa, SAU
| | - Abdu Alkhairy
- Skull Base and Vascular Neurosurgery, General Directorate of Health Affairs, Aseer, SAU
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Yamano A, Matsuda M, Hosoo H, Ishikawa E. Disappearance of a Ruptured Feeding Artery Fusiform Aneurysm After the Resection of a Large Subependymoma: A Case Report. Cureus 2023; 15:e48873. [PMID: 38106698 PMCID: PMC10724701 DOI: 10.7759/cureus.48873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Aneurysm formation on the tumor-feeding artery is rare, and its treatment strategies are not yet settled. We herein report the case of a 49-year-old female with a large subependymoma in the left lateral ventricle presenting remote intracerebral hemorrhage at the left posterior cingulate gyrus. Digital subtraction angiography (DSA) revealed the presence of a 5.5 mm fusiform tumor-feeding artery aneurysm on the left parieto-occipital branch of the posterior cerebral artery, considered to be the source of the hemorrhage. Three months after total tumor resection, the aneurysm subsequently disappeared on the follow-up angiography. Subependymomas are generally known as tumors with low vascularity and seldom present with symptoms such as intracerebral hemorrhage. From the subsequent disappearance of the aneurysm after the complete tumor resection, the pathophysiological cause of the aneurysm formation is assumed to be flow-related hemodynamic vessel wall stress of the feeding artery. Tumor resection alone may be a favorable first treatment strategy to avoid unnecessary brain damage since subsequent disappearance of the aneurysm can be expected. The coexistence of feeding artery aneurysms should be kept in mind, especially in cases with remote hemorrhage.
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Affiliation(s)
- Akinari Yamano
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Masahide Matsuda
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Hisayuki Hosoo
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Eiichi Ishikawa
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
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Christodoulides A, Burket NJ, Virtanen P, Lane BC. Subarachnoid haemorrhage associated with pituitary apoplexy and radiographically occult supraclinoid internal carotid artery aneurysms. BMJ Case Rep 2023; 16:e254123. [PMID: 37723095 PMCID: PMC10510930 DOI: 10.1136/bcr-2022-254123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/20/2023] Open
Abstract
In patients with pituitary adenomas, incidental intracranial aneurysms have been documented. Previous studies have highlighted the importance of preoperative imaging in these patients. However, imaging may be limited and fail to show the presence of vascular abnormalities. In this report, we discuss a case of a man in his 30s presenting with a newly diagnosed pituitary adenoma. CT and MRI, on admission, showed a pituitary mass with extension into the right cavernous sinus. After a sudden neurological deterioration, emergent CT/CT angiography revealed pituitary apoplexy with subarachnoid extension without vascular abnormalities. Successful emergency transsphenoidal hypophysectomy was followed by digital subtraction angiography which revealed the presence of two right supraclinoid internal carotid artery aneurysms. With this case, we aim to highlight the need for further vascular imaging in patients with pituitary apoplexy and subarachnoid haemorrhage, as preoperative imaging may be negative for vascular abnormalities especially in the setting of cavernous sinus invasion.
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Affiliation(s)
- Alexei Christodoulides
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Noah J Burket
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Piiamaria Virtanen
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brandon C Lane
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Yamashita S, Saito A, Jokura H, Kawaguchi T, Fujimura M, Ogawa Y, Tominaga T. Formation of internal carotid artery aneurysms following gamma knife radiosurgery for pituitary adenomas: a case series and literature review. Acta Neurochir (Wien) 2023; 165:2257-2265. [PMID: 37344734 DOI: 10.1007/s00701-023-05690-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 06/15/2023] [Indexed: 06/23/2023]
Abstract
Only two aneurysm formations in the internal carotid artery after gamma knife radiosurgery (GKRS) for pituitary adenomas are reported so far. Here, out of the 482 patients who underwent GKRS for pituitary adenomas at our institute, at least five developed aneurysms within the area of high single-dose irradiation. Three patients presented with epistaxis due to aneurysmal rupture and one presented with abducens paralysis due to nerve compression, while one was asymptomatic. The interval between irradiation and aneurysmal detection ranged from 14 to 21 years. Aneurysm formation in those conditions may be higher than previously thought.
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Affiliation(s)
- Shota Yamashita
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Atsushi Saito
- Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hidefumi Jokura
- Jiro Suzuki Memorial Gamma House, Furukawa Seiryo Hospital, Osaki, Japan
| | | | - Miki Fujimura
- Department of Neurosurgery, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshikazu Ogawa
- Department of Neurosurgery, Senseki Hospital, Ishinomaki, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Luzzi S, Giotta Lucifero A, Rabski J, Kadri PAS, Al-Mefty O. The Party Wall: Redefining the Indications of Transcranial Approaches for Giant Pituitary Adenomas in Endoscopic Era. Cancers (Basel) 2023; 15:cancers15082235. [PMID: 37190164 DOI: 10.3390/cancers15082235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/14/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023] Open
Abstract
The evolution of endoscopic trans-sphenoidal surgery raises the question of the role of transcranial surgery for pituitary tumors, particularly with the effectiveness of adjunct irradiation. This narrative review aims to redefine the current indications for the transcranial approaches for giant pituitary adenomas in the endoscopic era. A critical appraisal of the personal series of the senior author (O.A.-M.) was performed to characterize the patient factors and the tumor's pathological anatomy features that endorse a cranial approach. Traditional indications for transcranial approaches include the absent pneumatization of the sphenoid sinus; kissing/ectatic internal carotid arteries; reduced dimensions of the sella; lateral invasion of the cavernous sinus lateral to the carotid artery; dumbbell-shaped tumors caused by severe diaphragm constriction; fibrous/calcified tumor consistency; wide supra-, para-, and retrosellar extension; arterial encasement; brain invasion; coexisting cerebral aneurysms; and separate coexisting pathologies of the sphenoid sinus, especially infections. Residual/recurrent tumors and postoperative pituitary apoplexy after trans-sphenoidal surgery require individualized considerations. Transcranial approaches still have a critical role in giant and complex pituitary adenomas with wide intracranial extension, brain parenchymal involvement, and the encasement of neurovascular structures.
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Affiliation(s)
- Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Alice Giotta Lucifero
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Jessica Rabski
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Paulo A S Kadri
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Medical School, Federal University of Mato Grosso do Sul, Campo Grande 79070-900, Brazil
| | - Ossama Al-Mefty
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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10
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Spille DC, Vorona E, Catalino MP, Reuter G, Beckers A, Holling M, Fava A, Stummer W, Laws ER, Suero-Molina E. Vascular anomalies in patients with growth hormone-secreting pituitary adenomas: illustrative case report and systematic review of the literature. Pituitary 2023; 26:132-143. [PMID: 36508085 PMCID: PMC9908726 DOI: 10.1007/s11102-022-01291-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Endonasal resection is the first-line treatment for patients harboring growth hormone (GH)-secreting pituitary adenomas. The complexity of the parasellar neurovascular structures makes pre-operative diagnostic imaging essential to understanding the anatomy of this region. We aimed to describe vascular anomalies in acromegalic patients and emphasize their relevance for surgery and preoperative planning. METHODS A systematic review following the PRISMA statement was performed in July 2021. RESULTS Thirty-three studies were evaluated. Elevated GH and insulin-like growth factor-1 (IGF-1) levels are linked to the occurrence of cardiovascular risk factors. This is attributed to endothelial dysfunction, mainly caused by changes in flow-mediated dilatation (FMD), which is probably the main cause of vascular anomalies in acromegaly. The occurrence of protrusions of the internal carotid artery (ICA) (35-53%), a narrow intercarotid distance, and an asymmetrical course was described. In 13-18% of acromegalic patients, the presence of an intracerebral aneurysm could be reported (incidence in the general population:0.8-1.3%). The selected studies were however performed with a small patient sample (range:1-257). We present a case report of a 57y/o male patient with anomalies of the ICA ("kissing carotid arteries") harboring a GH-secreting adenoma, which was resected via an endoscopic endonasal approach. CONCLUSIONS There is an association between acromegaly and endothelial dysfunction, which increases cardiovascular risk factors and vascular anomalies. Preoperative vascular imaging, e.g., CT angiography, should be implemented as a standard to identify patients at risk and estimate surgical morbidity. However, no evidence-based recommendations exist so far, so future studies are necessary.
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Affiliation(s)
- Dorothee Cäcilia Spille
- Department of Neurosurgery, University Hospital of Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
| | - Elena Vorona
- Department of Medicine B of Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology Division for Endocrinology and Diabetes, 48149, Münster, Germany
| | | | - Gilles Reuter
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium
| | - Albert Beckers
- Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Markus Holling
- Department of Neurosurgery, University Hospital of Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
| | - Arianna Fava
- Department of Neurosurgery, I.R.C.C.S. Neuromed, Pozzilli, IS, Italy
| | - Walter Stummer
- Department of Neurosurgery, University Hospital of Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
| | - Edward R Laws
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Eric Suero-Molina
- Department of Neurosurgery, University Hospital of Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany.
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11
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Komatsu F, Sasaki K, Tanaka R, Miyatani K, Yamada Y, Kato Y, Hirose Y. Coexistence of neurovascular compression syndrome and unruptured cerebral aneurysm. J Clin Neurosci 2022; 105:22-25. [PMID: 36057158 DOI: 10.1016/j.jocn.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/16/2022] [Accepted: 08/25/2022] [Indexed: 11/19/2022]
Abstract
Unruptured cerebral aneurysms (UCAs) are usually asymptomatic and detected incidentally by intracranial examinations. The coexistence of neurovascular compression syndrome (NVCS) and UCAs has not been well described. The aim of this study was to clarify the characteristics of UCAs with the NVCS. A total of 103 cases that underwent microvascular decompression (MVD) for trigeminal neuralgia (TN) or hemifacial spasm (HFS) were assigned to the NVCS group. The prevalence of UCAs in the NVCS group was compared retrospectively to that in 110 control cases (a control group) by neuro-imaging. Overall treatment courses for NVCS and UCAs were investigated in the NVCS group. Sixteen (15.3%; TN 11 cases, HFS 5 cases) of 103 MVD cases had 19 UCAs, a significantly higher prevalence than the 3.6% in the control group. Binomial logistic regression showed that NVCS is a significant factor for predicting the presence of UCAs, with an odds ratio of 4.80. In the NVCS group, 18 UCAs (94.7%) were supratentorial aneurysms, and 17 UCAs (89.5%) were less than 5 mm in size. Nine UCAs were surgically treated with clipping or coiling. Of the surgical cases, 2 UCAs were treated before MVD for NVCS, whereas the other 7 UCAs were treated after MVD. No aneurysms ruptured during the treatment course. The NVCS occurred with UCAs at a significantly higher rate than in the control group. Most UCAs with the NVCS were supratentorial, small aneurysms that did not affect the surgical treatment of NVCS.
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Affiliation(s)
- Fuminari Komatsu
- Department of Neurosurgery, Fujita Health Unversity Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ward, Nagoya, Aichi 454-8509, Japan.
| | - Kento Sasaki
- Department of Neurosurgery, Fujita Health Unversity Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ward, Nagoya, Aichi 454-8509, Japan
| | - Riki Tanaka
- Department of Neurosurgery, Fujita Health Unversity Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ward, Nagoya, Aichi 454-8509, Japan
| | - Kyosuke Miyatani
- Department of Neurosurgery, Fujita Health Unversity Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ward, Nagoya, Aichi 454-8509, Japan
| | - Yasuhiro Yamada
- Department of Neurosurgery, Fujita Health Unversity Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ward, Nagoya, Aichi 454-8509, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health Unversity Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ward, Nagoya, Aichi 454-8509, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University, 1-98 Kutsukakechodengakugakubo, Toyoake, Aichi 470-1192, Japan
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12
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Mercuri V, Armocida D, Paglia F, Patrizia G, Santoro A, D'Angelo L. Giant Prolactinoma Embedded by Pseudoaneurysm of the Cavernous Carotid Artery Treated with a Tailored Therapeutic Scheme. J Neurosci Rural Pract 2022; 13:358-369. [PMID: 35945997 PMCID: PMC9357472 DOI: 10.1055/s-0042-1749662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
AbstractThe coexistence of intracranial aneurysm (IA) is generally thought to be highest in patients with pituitary adenomas (PAs). Different mechanisms may play a role in aneurysm formation, but whether the PA contributes to aneurysm formation is still unclear. In the literature, there are numerous reported cases of this association; however, the analyses of the characteristics of PAs, aneurysms, and treatment management are rare and limited to a restricted number of case reports. We report a rare case of an embedded aneurysm in a macroprolactinoma treated with therapeutic management tailored to the clinical, neurological, and radiological characteristics of the patient. To select the best treatment, we reviewed the literature and reported the only cases in which the radiological characteristics of aneurysms, PAs, therapeutic management, and patient outcome are described. We aimed to understand what are the variables that determine the best therapeutic management with the best possible outcome. The presence of a large pseudoaneurysm of the internal carotid artery completely embedded in a giant macroprolactinoma is rare and needs a tailored treatment strategy. The importance of the preoperative knowledge of asymptomatic IA coexisting with PA can avoid accidental rupture of the aneurysm during surgical resection and may lead to planning the best treatment. A high degree of suspicion for an associated aneurysm is needed, and if magnetic resonance imaging shows some atypical features, digital subtraction angiography must be performed prior to contemplating any intervention to avoid iatrogenic aneurysmal rupture. Our multimodal approach with the first-line therapy of low-dose cabergoline to obtain prolactin normalization with minimum risks of aneurysms rupture and subsequent endovascular treatment with flow diverter has not been described elsewhere to our knowledge. In the cases, we suggest adopting a tailored low-dose cabergoline therapy scheme to avoid rupture during cytoreduction and initiate a close neuroradiological follow-up program.
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Affiliation(s)
- Valeria Mercuri
- Endocrinology Unit, Department of Experimental Medicine, 'Sapienza' University of Rome, Rome, Italy
| | - Daniele Armocida
- Department of Human Neurosciences, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Francesco Paglia
- Department of Human Neurosciences, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Gargiulo Patrizia
- Endocrinology Unit, Department of Experimental Medicine, 'Sapienza' University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Human Neurosciences, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Luca D'Angelo
- Department of Human Neurosciences, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
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13
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Gu Y, Zhong X, Gao Y, He L. Endoscopic endonasal approach for simultaneously treating a pituitary adenoma coexisting with a paraclinoid aneurysm: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 3:CASE22130. [PMID: 35733842 PMCID: PMC9210266 DOI: 10.3171/case22130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/15/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a certain incidence of pituitary adenomas coexisting with intracranial aneurysms, but a concurrent therapeutic strategy of tumor removal and aneurysm clipping via endoscopic endonasal approach is rarely reported. The indications and limitations of endoscopic endonasal approach surgery for this type of lesions are worth discussing. OBSERVATIONS The case of a pituitary tumor coexisting with a paraclinoid aneurysm was reviewed. Using an endoscopic endonasal approach, the pituitary adenoma was completely excised with extrapseudocapsular separation technique, the aneurysm was clipped at the same time, and the skull base defect was reconstructed in multilayer fashion. No tumor recurrence was found, and aneurysm clipping was complete at the 6-month follow-up after surgery. LESSONS For patients harboring a pituitary adenoma with a selected paraclinoid aneurysm, simultaneous tumor resection and aneurysm clipping via endoscopic endonasal approach are feasible. This strategy has the advantages of saving medical resources, promoting the patient’s rapid postoperative recovery, and reducing possible antiplatelet therapy after interventional therapy. However, surgery needs to strictly follow the indications in experienced hands, and the therapeutic effect needs to be verified by more cases and longer follow-up results.
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Affiliation(s)
- Ye Gu
- Department of Neurosurgery and Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention, Fudan University, Shanghai, People's Republic of China; and
| | - Xiangping Zhong
- Department of Neurosurgery, Yongzhou Central Hospital, Yongzhou City, Hunan Province, People's Republic of China
| | - Yikuan Gao
- Department of Neurosurgery, Yongzhou Central Hospital, Yongzhou City, Hunan Province, People's Republic of China
| | - Lijin He
- Department of Neurosurgery, Yongzhou Central Hospital, Yongzhou City, Hunan Province, People's Republic of China
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14
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Siroya HL, Devi BI, Aripirala P, Ramesh SS, Bhat DI, Shukla DP, Konar SK, Christopher R. Patients with Invasive Tumors and eNOS Gene Polymorphisms with Subarachnoid Hemorrhage Tend to Have Poorer Prognosis. Asian J Neurosurg 2022; 17:199-208. [PMID: 36120623 PMCID: PMC9473864 DOI: 10.1055/s-0042-1750784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Context
Endothelial nitric oxide synthase (
eNOS)
gene polymorphisms are found to predict predisposition to aneurysmal rupture and development of vasospasm in a patient of subarachnoid hemorrhage (SAH).
eNOS
gene polymorphisms are also found to predict invasiveness of malignant cells. Studies are not available in literature to describe the effect of
eNOS
gene polymorphisms and correlation between aneurysm and carcinoma. This study aims to investigate whether positive cancer history influences clinical outcome following SAH and
eNOS
gene polymorphisms.
Materials and Methods
The
eNOS
gene polymorphisms were analyzed in seven consecutive patients (mean age, 52.28 ± 20 years) with a diagnosis of invasive systemic tumors from 2011 to 2017. The
eNOS
4a/4b
eNOS
-786T>
eNOS
894G > T polymorphisms of the
eNOS
gene were determined by polymerase chain reaction and restriction fragment length polymorphism.
Results
Seven patients of aneurysmal SAH in association with malignancies were studied for
eNOS
polymorphisms expression and outcome. Three patients had carcinoma cervix: one patient of carcinoma breast and one each of transitional cell carcinoma of urinary bladder, spindle cell carcinoma of left kidney, and untreated patient of atypical pituitary (adenoma). A genotype study of
eNOS
gene polymorphisms in these patients shows common polymorphisms are involved in the determination of disease progression in malignancies and aneurysmal SAH.
Conclusion
Patients who expressed 4ab,
eNOS
-786T > TT/CC/TC,
eNOS
894G > T GG/GT polymorphisms did better than patients who expressed only 4bb, though both were associated with poor prognosis.
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Affiliation(s)
- Hardik Lalit Siroya
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Prasanthi Aripirala
- Department of Pediatrics, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Shruthi Shimoga Ramesh
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Dhananjaya Ishwar Bhat
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Dhaval Prem Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Subhash Kanti Konar
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Rita Christopher
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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15
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Mondragón-Soto MG, Villanueva-Castro E, Tovar-Romero LA, Aragón-Arreola JF, Sangrador-Deitos MV, Cano-Velázquez G, Villanueva-Solórzano PL, Gómez-Amador JL. Magnetic resonance imaging finding of coexistence of bilateral paraclinoid aneurysms in a patient with a nonfunctioning macroadenoma, simultaneous resection, and clipping: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21720. [PMID: 36273858 PMCID: PMC9379769 DOI: 10.3171/case21720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/28/2022] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Michel G. Mondragón-Soto
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía “Dr. Manuel Velasco Suárez,” Mexico City, Mexico
| | - Eliezer Villanueva-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía “Dr. Manuel Velasco Suárez,” Mexico City, Mexico
| | - Leoncio A. Tovar-Romero
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía “Dr. Manuel Velasco Suárez,” Mexico City, Mexico
| | - Jorge F. Aragón-Arreola
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía “Dr. Manuel Velasco Suárez,” Mexico City, Mexico
| | - Marcos V. Sangrador-Deitos
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía “Dr. Manuel Velasco Suárez,” Mexico City, Mexico
| | - Gerardo Cano-Velázquez
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía “Dr. Manuel Velasco Suárez,” Mexico City, Mexico
| | - Pedro L. Villanueva-Solórzano
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía “Dr. Manuel Velasco Suárez,” Mexico City, Mexico
| | - Juan L. Gómez-Amador
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía “Dr. Manuel Velasco Suárez,” Mexico City, Mexico
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16
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Nathal E, Mormandi R, Cervio AE, Navarro-Garcia de Llano JP, Ceja-Espinosa A. Subarachnoid Hemorrhage From Rupture of an Undiagnosed Posterior Circulation Aneurysm During Sellar Tumor Surgery. Cureus 2022; 14:e21609. [PMID: 35228966 PMCID: PMC8873431 DOI: 10.7759/cureus.21609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/24/2022] Open
Abstract
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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17
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Ding C, Chen W, Hu Y, Zhang L, Li P. Bilateral aneurysms, one of which is embedded in a meningioma: a rare case report and literature review. Br J Neurosurg 2021:1-6. [PMID: 34939519 DOI: 10.1080/02688697.2021.2020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/04/2021] [Accepted: 12/14/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although the coexistence of primary brain neoplasms with intracranial aneurysms is rare, this phenomenon has become more recognized. Meningioma is the most frequently occurring type of tumor associated with an aneurysm. However, meningiomas encasing aneurysms are extremely rare, posing a diagnostic and therapeutic challenge to healthcare providers. CASE DESCRIPTION We report a case of a 46-year-old female patient admitted to our hospital with headache and dizziness for ten years. Enhanced magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) indicated a mass in the right sphenoid ridge, surrounding a posterior communicating artery aneurysm of the right internal carotid artery. Digital subtraction angiography (DSA) revealed left ophthalmic segment aneurysm and right posterior communicating artery aneurysm. We first clipped the aneurysm and then removed intracranial tumor during the same operation. The postoperative pathological diagnosis of tumor was meningioma (World Health Organization grade I). The patient's postoperative course was uneventful, with only a mild reduction in lateral vision of both eyes. CONCLUSIONS We reported a rare case in which an intracranial aneurysm was encased in a meningioma and could be safely treated during the same operation. Notably, embolizing or clipping aneurysm first and then removing intracranial tumor appears to enhance the safety of patients. This is the best treatment option if the aneurysm and meningioma can be treated concurrently in the hybrid operating room. Additionally, it may be necessary to carefully evaluate preoperative MRA or computed tomography angiography (CTA), and it is critical to confirm the existence of any vascular lesions in patients with brain tumors using MRA or CTA.
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Affiliation(s)
- Chang Ding
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Wei Chen
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Yanjia Hu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Lifeng Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Peng Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
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18
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Lubomirsky B, Jenner ZB, Jude MB, Shahlaie K, Assadsangabi R, Ivanovic V. Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches. Neuroradiol J 2021; 35:269-283. [PMID: 34856828 DOI: 10.1177/19714009211055195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The sellar, suprasellar, and parasellar space contain a vast array of pathologies, including neoplastic, congenital, vascular, inflammatory, and infectious etiologies. Symptoms, if present, include a combination of headache, eye pain, ophthalmoplegia, visual field deficits, cranial neuropathy, and endocrine manifestations. A special focus is paid to key features on CT and MRI that can help in differentiating different pathologies. While most lesions ultimately require histopathologic evaluation, expert knowledge of skull base anatomy in combination with awareness of key imaging features can be useful in limiting the differential diagnosis and guiding management. Surgical techniques, including endoscopic endonasal and transcranial neurosurgical approaches are described in detail.
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Affiliation(s)
- Bryan Lubomirsky
- Department of Radiology, Section of Neuroradiology, 21772University of California Davis Medical Center, Sacramento, CA, USA
| | - Zachary B Jenner
- Department of Radiology, Diagnostic and Interventional Radiology Residency, 21772University of California Davis Medical Center, Sacramento, CA, USA
| | - Morgan B Jude
- School of Medicine, 21772University of California Davis Medical Center, Sacramento, CA, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, 21772University of California Davis Medical Center, Sacramento, CA, USA
| | - Reza Assadsangabi
- Department of Radiology, Section of Neuroradiology, 21772University of California Davis Medical Center, Sacramento, CA, USA
| | - Vladimir Ivanovic
- Department of Radiology, Section of Neuroradiology, 21772University of California Davis Medical Center, Sacramento, CA, USA
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19
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Piper KJ, Karsy M, Barton B, Rabinowitz M, Rosen MR, Nyquist GG, Evans JJ, Tjoumakaris S, Farrell CJ. Management of Coincident Pituitary Macroadenoma and Cavernous Carotid Aneurysm: A Systematic Literature Review. J Neurol Surg Rep 2021; 82:e25-e31. [PMID: 34603930 PMCID: PMC8481005 DOI: 10.1055/s-0041-1735904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 05/26/2021] [Indexed: 02/04/2023] Open
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.
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Affiliation(s)
- Keenan J Piper
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Michael Karsy
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Blair Barton
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Mindy Rabinowitz
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Marc R Rosen
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Gurston G Nyquist
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - James J Evans
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Christopher J Farrell
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
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20
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Wang T, Hu Y, Qiu Y. A Giant Pituitary Adenoma Can Coexist with an Incidental Aneurysm: Look Beyond the Pituitary Adenoma and Don't Miss the Diagnosis. World Neurosurg 2021; 156:92-94. [PMID: 34583003 DOI: 10.1016/j.wneu.2021.09.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/26/2022]
Abstract
An intracranial aneurysm in a pituitary adenoma (PA) is not uncommon; however, preoperative angiography is not clinically used as a routine screening test for PA patients. Therefore an intracranial aneurysm is often missed while diagnosing PA patients. When an aneurysm is missed in patients with pituitary tumors, the supporting power by the tumor to the blood vessels or aneurysm will disappear when the tumor is removed and patients may suffer intraoperative or postoperative aneurysm rupture, which may lead to fatal, catastrophic hemorrhage. Herein, we report a case of a PA patient with the signal shadow of vessel flow void, observed vaguely in the right internal carotid artery cavernous segment on magnetic resonance imaging, and a small aneurysm was found via digital subtraction angiography. In order to ensure the safety of surgery, we first performed embolization of the aneurysm and then resected the tumor.
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Affiliation(s)
- Tianwei Wang
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yaomin Hu
- Department of Geriatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yongming Qiu
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
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21
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Zhu JD, Xie S, Xu L, Xie MX, Xiao SW. The surgical management of pituitary apoplexy with occluded internal carotid artery and hidden intracranial aneurysm: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE20115. [PMID: 36131582 PMCID: PMC9563650 DOI: 10.3171/case20115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Approximately 0.6% to 12% of cases of pituitary adenoma are complicated by apoplexy, and nearly 6% of pituitary adenomas are comorbid aneurysms. Occlusion of the internal carotid artery (ICA) with hidden intracranial aneurysm due to compression by an apoplectic pituitary adenoma is extremely rare; thus, the surgical strategy is also unknown. OBSERVATIONS The authors reported the case of a 48-year-old man with a large pituitary adenoma with coexisting ICA occlusion. After endoscopic transnasal surgery, repeated computed tomography angiography (CTA) demonstrated reperfusion of the left ICA but with a new-found aneurysm in the left posterior communicating artery; thus, interventional aneurysm embolization was performed. With stable recovery and improved neurological condition, the patient was discharged for rehabilitation training. LESSONS For patients with pituitary apoplexy accompanied by a rapid decrease of neurological conditions, emergency decompression through endoscopic endonasal transsphenoidal resection can achieve satisfactory results. However, with occlusion of the ICA by enlarged pituitary adenoma or pituitary apoplexy, a hidden but rare intracranial aneurysm may be considered when patients are at high risk of such vascular disease as aneurysm, and gentle intraoperative manipulations are required. Performing CTA or digital subtraction angiography before and after surgery can effectively reduce the missed diagnosis of comorbidity and thus avoid life-threatening bleeding events from the accidental rupture of an aneurysm.
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Affiliation(s)
- Jian-Dong Zhu
- Department of Neurosurgery, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Sungel Xie
- Department of Neurosurgery, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Ling Xu
- Department of Neurosurgery, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Ming-Xiang Xie
- Department of Neurosurgery, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Shun-Wu Xiao
- Department of Neurosurgery, Affiliated Hospital of Zunyi Medical University, Guizhou, China
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22
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Yoshida M, Hiu T, Baba S, Morikawa M, Horie N, Ujifuku K, Yoshida K, Matsunaga Y, Niino D, Xie A, Izumo T, Anda T, Matsuo T. Ruptured aneurysm–induced pituitary apoplexy: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE21169. [PMID: 35854902 PMCID: PMC9245750 DOI: 10.3171/case21169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pituitary apoplexy associated with aneurysmal rupture is extremely rare and may be misdiagnosed as primary pituitary adenoma apoplexy. The authors present a case of a patient with pituitary apoplexy caused by rupture of an anterior cerebral artery aneurysm embedded within a giant pituitary adenoma, and they review the relevant literature. OBSERVATIONS A 78-year-old man experienced sudden headache with progressive vision loss. Magnetic resonance imaging (MRI) revealed a giant pituitary tumor with abnormal signal intensity. Magnetic resonance angiography immediately before surgery showed a right A1 segment aneurysm, suggesting coexisting pituitary apoplexy and ruptured aneurysm. The patient underwent urgent transsphenoidal surgery for pituitary apoplexy. The tumor was partially removed, but the perianeurysmal component was left behind. Subsequent cerebral angiography showed a 5-mm right A1 aneurysm with a bleb that was successfully embolized with coils. Retrospective review of preoperative dynamic MRI showed extravasation of contrast medium from the ruptured aneurysm into the pituitary adenoma. Histopathologic examination showed gonadotroph adenoma with hemorrhagic necrosis. Postoperatively, the patient’s visual function improved. LESSONS MRI identification of pituitary apoplexy caused by aneurysmal rupture has not been reported previously. Aneurysmal rupture should be considered in the differential diagnosis of pituitary apoplexy. When a ruptured aneurysm is encountered, the authors recommend treating it before addressing pituitary apoplexy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Daisuke Niino
- Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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23
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Comparative analysis of pituitary adenoma with and without apoplexy in pediatric and adolescent patients: a clinical series of 80 patients. Neurosurg Rev 2021; 45:491-498. [PMID: 33914243 DOI: 10.1007/s10143-021-01551-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
Pituitary adenomas (PAs) have a low incidence in pediatric and adolescent patients, and their clinical characteristics remain unclear. As a severe complication of PA, apoplexy was investigated in young patients in the present study. Eighty patients younger than 20 years with PAs who underwent surgery were included and divided into an apoplexy group and non-apoplexy group. The clinical data of these two groups were statistically analyzed and compared. The study included 33 boys and 47 girls, with a mean age of 16.9 years. There were six (7.5%) adrenocorticotropic hormone-secreting, 13 (16.3%) growth hormone-secreting, 47 (58.7%) prolactin-secreting, and 14 (17.5%) non-functioning PAs. There were 34 (42.5%) patients in the apoplexy group and 46 (57.5%) patients in the non-apoplexy group. Pre-operatively, patients in the apoplexy group were more likely to have visual impairment (hazard ratio: 2.841, 95% confidence interval: 1.073-7.519; P = 0.033) and had poorer visual impairment scores than those in the non-apoplexy group (P = 0.027). Furthermore, a longer duration of symptoms before surgery was significantly correlated with a poorer visual outcome in the apoplexy group (R = - 1.204; P = 0.035). However, apoplexy was not associated with tumor type, tumor size, resection rate, or tumor recurrence. Tumor apoplexy is common in pediatric and adolescent patients with PAs and is associated with more severe preoperative visual deficits. Hence, the appropriate timing of surgical treatment may be important for rescuing visual function in young PA patients.
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Chernov IV, Kutin MA, Kheyreddin AS, Konovalov AN, Shekhtman OD, Eliava SS, Kalinin PL. [Combination of pituitary adenomas and intracranial aneurysms]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:94-103. [PMID: 33560625 DOI: 10.17116/neiro20218501194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The combination of intracranial tumors and asymptomatic brain aneurysms is an urgent problem, since it can significantly affect surgical intervention. Aneurysms are common in patients with meningioma, glioma and pituitary adenoma. According to certain authors, combination of aneurysms with pituitary adenomas is 7 times more common than with other tumors. In these cases, a comprehensive examination of the patient and decision-making on surgical strategy are required. This review is devoted to epidemiology, diagnosis and treatment of patients with a combination of pituitary adenomas and intracranial aneurysms detected intraoperatively or at the preoperative stage. The manuscript is illustrated by cases observed at the Burdenko Neurosurgery Center.
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Affiliation(s)
- I V Chernov
- Burdenko Neurosurgery Center, Moscow, Russia
| | - M A Kutin
- Burdenko Neurosurgery Center, Moscow, Russia
| | | | | | | | | | - P L Kalinin
- Burdenko Neurosurgery Center, Moscow, Russia
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Yan S, Liu Y, Liu C, Yang L, Qin Y, Liu R, Wang S, Li X, Yang W, Ma L, You C, Zhou L, Tian R. Sellar Region Lesions and Intracranial Aneurysms in the Era of Endoscopic Endonasal Approach. Front Endocrinol (Lausanne) 2021; 12:802426. [PMID: 35058885 PMCID: PMC8763682 DOI: 10.3389/fendo.2021.802426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
In the clinical practice of neurosurgery, the endoscopic endonasal approach (EEA) has been the mainstream approach in the management of sellar region diseases. However, clinicians have come to realize that EEA procedure is associated with intraoperative hemorrhage. Due to the limited surgical field and poor proximal control under endoscope, massive hemorrhage always leads to severe complication or even perioperative death. Previously, intraoperative hemorrhage used to be attributed to endoscopic intervention of cavernous sinus or internal carotid artery, but our recent understanding of EEA indicated that preoperatively complicated intracranial aneurysms (IAs) may play a role. In this article, we retrospectively reviewed the baseline characteristics, treatment strategy, pathology, intraoperative findings, as well as radiological profiles of sellar region lesions complicated with IAs. With the focus put on the high comorbidity rate of sellar region lesions and IAs, we did further statistical analysis to sketch the outline of this coexisting circumstance and to emphasize the importance of computed tomography angiography (CTA) as routine EEA preoperative examination. Thorough patient-surgeon communication should be proceeded before the formulation of an individualized treatment strategy.
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Affiliation(s)
- Siyu Yan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yifan Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chang Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Qin
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ran Liu
- 4Engineering Research Center of Medical Information Technology, Ministry of Education, West China Hospital, Sichuan University, Chengdu, China
| | - Shan Wang
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Xue Li
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjie Yang
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Liangxue Zhou
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Rui Tian, ; Liangxue Zhou,
| | - Rui Tian
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Rui Tian, ; Liangxue Zhou,
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KAKIZAKI S, SAGUCHI T, ICHI S, MURAYAMA Y, SUZUKI I. Development of a Carotid Cavernous Aneurysm after Medical Treatment of a Prolactinoma: A Case Report. NMC Case Rep J 2021; 8:733-738. [PMID: 35079541 PMCID: PMC8769458 DOI: 10.2176/nmccrj.cr.2021-0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/18/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shota KAKIZAKI
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Shunsuke ICHI
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yuichi MURAYAMA
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
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Emanuelli E, Baldovin M, Zanotti C, Munari S, Denaro L, Saratziotis A. Rare Clinical Onset of Nontraumatic Intracavernous Aneurysm of the Internal Carotid Artery: A Diagnostic and Therapeutic Challenge. INDIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1055/s-0040-1718989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractWhile the so-called pseudoaneurysms can result from arterial injury during trans-sphenoidal surgery or after a trauma, spontaneous aneurysms of cavernous–internal carotid artery (CICA) are rare. Symptoms vary and the differential diagnosis with other, more frequent, sellar lesions is difficult. We describe three cases of misdiagnosed CICA spontaneous aneurysm. In two cases the onset was with neuro-ophthalmological manifestations, classifiable as “cavernous sinus syndrome.” The emergency computed tomography scan did not show CICA aneurysm and the diagnosis was made by surgical exploration. The third patient came to our attention with a sudden severe unilateral epistaxis; endonasal surgery revealed also in this case a CICA aneurysm, eroding the wall and protruding into the sphenoidal sinus. When the onset was with a cavernous sinus syndrome, misdiagnosis exposed two patients to potential serious risk of bleeding, while the patient with epistaxis was treated with embolization, using coils and two balloons. Intracavernous nontraumatic aneurysms are both a diagnostic and therapeutic challenge, because of their heterogeneous onset and risk of rupture, potentially lethal. Intracavernous aneurysms can be managed with radiological follow-up, if asymptomatic or clinically stable, or can be surgically treated with endovascular or microsurgical techniques.
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Affiliation(s)
- Enzo Emanuelli
- Unit of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
| | - Maria Baldovin
- Unit of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
| | - Claudia Zanotti
- Unit of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
| | - Sara Munari
- Unit of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
| | - Luca Denaro
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Athanasios Saratziotis
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Larissa, Larisa, Greece
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de Souza MR, Fagundes CF, Rabelo NN, Teixeira MJ, Figueiredo EG. Association between intracranial aneurysm and meningiomas: An integrative survival Analysis with identification of prognostic factors. Clin Neurol Neurosurg 2020; 198:106128. [PMID: 32810762 DOI: 10.1016/j.clineuro.2020.106128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/06/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To analyze prognostic factors in clinical association between intracranial aneurysm (IA) and meningioma. Prognostic factors on overall survival (OS) were evaluated. METHODS We selected articles, published from January 1944 to December 2018 on the Medical databases (Web of Sciences, Medline and EMBASE) and included case series and reports. Clinical information was obtained and variables associated with the primary outcome of 27-mo survival were identified through Cox regression models. RESULTS The study evaluated 77 patients. Female represented 76.6 % (n = 59), a ratio of 3.27 female: 1 male. The age range was 7-84 years old, with an average of 54.74 (SD: 14.30). Age and sex were not significant statistically different between the two groups for overall survival (OS) (log-rank P = 0.806), (log-rank P = 0.983) respectively. 77.9 % (n = 60) were ipsilateral, the same side was 4 times more common in univariate analysis (P = 0.052; 95 % CI, 0.924-17.319). Most aneurysms were detected in the internal carotid artery, 29.87 %. In Clinical data, 62.33 % (n = 48) had exclusive tumor symptoms, while 25.97 % (n = 20) presented exclusively subarachnoid hemorrhage (SAH). In multivariate analysis, although there is an independent protective factor for those who did not have SAH (HR; 0.099; CI; 0.010-0.986; P = 0.049) and the treatment is an independent predictor for OS (HR, 42.096; CI, 4.270-415.056; P = 0.01). CONCLUSION This is the first study to approach this association. This is not just an occasional finding, but it seems to have a shared pathophysiology. Unruptured aneurysms and treatment modality were protective independent factors for OS. Prospective studies are warranted to provide definitive answers.
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Affiliation(s)
- Matheus Rodrigues de Souza
- Mato Grosso State University, Mato Grosso, Tancredo Neves Avenue, 1095, Cáceres, State of Mato Grosso, 78200-000, Brazil
| | - Caroline Ferreira Fagundes
- Mato Grosso State University, Mato Grosso, Tancredo Neves Avenue, 1095, Cáceres, State of Mato Grosso, 78200-000, Brazil
| | - Nicollas Nunes Rabelo
- Department of Neurosurgery, Santa Casa Hospital, Saudade Avenue, 456, Ribeirão Preto, State of São Paulo, 14085-000, Brazil
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Kino H, Ito Y, Akutsu H, Tanaka S, Hara T, Ishikawa E, Miyamoto H, Matsumaru Y, Matsumura A. Combined Endoscopic Endonasal and Bilateral Subfrontal Approach for a Nonfunctioning Pituitary Adenoma Associated with an Internal Carotid Artery-Superior Hypophyseal Artery Aneurysm. World Neurosurg 2019; 134:297-301. [PMID: 31698130 DOI: 10.1016/j.wneu.2019.10.159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND An aneurysm embedded in a pituitary adenoma is rare, and treatment for both the aneurysm and pituitary adenoma is complex and controversial. CASE DESCRIPTION A 53-year-old woman presented with a visual field defect. Magnetic resonance imaging showed a pituitary adenoma and coexistence of an aneurysm located at the orifice of the superior hypophyseal artery (SHA) from the internal carotid artery (ICA). The aneurysm was embedded in the pituitary adenoma; therefore, obliteration of the aneurysm was needed prior to tumor removal to prevent intraoperative rupture of the aneurysm. Although endovascular coil embolization was tried first, it was not successful. A combined endoscopic endonasal approach and transcranial approach was performed for simultaneous tumor removal and aneurysm clipping. A bilateral subfrontal approach was selected for aneurysm clipping because, using this approach, the parent artery was safely controlled from the ipsilateral trajectory, whereas exposure and clipping of the aneurysm were easily done from the contralateral trajectory. Additionally, the supine head position without rotation is comfortable for endoscopic endonasal surgery. The tumor was totally removed, and the aneurysm was safely and completely obliterated with a clip. The patient's postoperative course was uneventful, and her visual disturbance improved. CONCLUSIONS A combined endoscopic endonasal and bilateral subfrontal approach is effective for a pituitary adenoma associated with an ICA-SHA aneurysm.
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Affiliation(s)
- Hiroyoshi Kino
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
| | - Hiroyoshi Akutsu
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shuho Tanaka
- Department of Otolaryngology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Takuma Hara
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hidetaka Miyamoto
- Department of Otolaryngology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Prevalence of Unruptured Intracranial Aneurysms Coexisting with Pituitary Adenomas. World Neurosurg 2019; 126:e526-e533. [DOI: 10.1016/j.wneu.2019.02.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 12/20/2022]
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Serra C, Sebök M, Widmer L, Neidert MC, Regli L. Clipping of a superior hypophyseal artery aneurysm during endoscopic transnasal removal of a Rathke cleft cyst: a case report. Acta Neurochir (Wien) 2019; 161:197-201. [PMID: 30478712 DOI: 10.1007/s00701-018-3728-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022]
Abstract
The concomitant presence of an aneurysm in contact with a sellar lesion usually contraindicates a transsphenoidal approach (TSS). Clipping of an intracranial aneurysm is however possible in highly selected cases also through an endoscopic TSS approach, as long as the basic principles of cerebrovascular surgery are respected. We report thus on a case of a patient harboring a Rathke cleft cyst (RCC) and an aneurysm of the carotid artery (ICA) in close contact with the RCC. The anatomical characteristics of both lesions warranted an endoscopic TSS for removal of the RCC and clipping of the aneurysm during the same approach.
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32
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Krug RG, Chang AY, Raghunathan A, Van Gompel JJ. Apoplectic Silent Crooke Cell Adenoma with Adjacent Pseudoaneurysms: Causation or Bystander? World Neurosurg 2018; 122:480-484. [PMID: 30465959 DOI: 10.1016/j.wneu.2018.10.232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Crooke cell adenomas (CCAs) are rare and potentially aggressive pituitary tumors that often invade the cavernous sinuses. Although clinical presentations of pituitary tumors may include the development of accompanying intracranial aneurysms, there are no documented cases of coexistent intracranial aneurysms and CCAs to date. Herein we describe an apoplectic silent CCA that presented with adjacent cavernous internal carotid artery (ICA) aneurysms. CASE DESCRIPTION A 45-year old male patient presented for evaluation of headaches and diplopia. Subsequent imaging series revealed a hemorrhagic pituitary macroadenoma that had invaded the left cavernous sinus and circumferentially involved the ICA. Two pseudoaneurysms were visualized along regions of the ICA directly attached to the tumor. A transnasal transsphenoidal endoscopic approach was used for resection of the tumor, which was identified histologically as a CCA. Endocrine evaluations characterized the tumor as nonfunctional. The patient experienced an excellent recovery with resolution of related symptoms. A pseudoaneurysm was treated with a Pipeline embolization device; however, it persisted at last follow-up. CONCLUSIONS CCAs are a poorly characterized and rare pituitary tumor type. In this case, an apoplectic silent CCA invaded the left cavernous sinus and presented with pseudoaneurysms along its involvement of the ICA. Accordingly, the authors speculated that the invasive qualities of this silent corticotroph adenoma may have directly contributed to the development of these aneurysms.
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Affiliation(s)
- Randall G Krug
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Alice Y Chang
- Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van Gompel
- Departments of Neurosurgery and Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
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33
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Zheng SF, Zhang YB, He YY, Shang-Guan HC, Kang DZ, Chen GR, Lin YX, Yao PS. Cerebellopontine Angle Tumors Are Associated with a Greater Incidence of Unruptured Intracranial Aneurysms. World Neurosurg 2018; 122:e561-e568. [PMID: 31108072 DOI: 10.1016/j.wneu.2018.10.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 10/14/2018] [Accepted: 10/16/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We tested the hypothesis that cerebellopontine angle (CPA) tumors are associated with a greater incidence of unruptured intracranial aneurysms (IAs). METHODS Patients with intracranial tumors (ITs) undergoing computed tomography angiography and magnetic resonance imaging were enrolled in an observational cohort study that prospectively collected age, sex, hypertension, diabetes, cerebral arteriosclerosis, tumor type, tumor location, hydrocephalus, smoking, alcohol intake, CPA tumor size, cerebral aneurysms, and cerebral arteriosclerosis. Patients with the coexistence of IA and ITwere classified as group II, whereas the others with IT as group I. RESULTS We included 1218 patients with IT for analysis. The incidence of IA was 7.1% (86/1218). A total of 31% of patients with aneurysms had CPA tumors. In a multivariate logistic regression model, a greater incidence of IA was found in female patients (odds ratio [OR] 1.726, 95% confidence interval [CI] 1.050-2.836, P=0.031) and in patients with CPA tumors (OR 3.002, 95% CI 1.822-4.947, P=0.000) after adjustment for tumor type, cerebral arteriosclerosis, and age. In female patients, CPA tumors were a unique independent risk factor of a greater incidence of IA (OR 2.270, 95% CI 1.194-4.317, P=0.012). Furthermore, cerebral arteriosclerosis was a unique independent risk factor of IA in patients with CPA tumors (OR 7.626, 95% CI 2.928-19.860, P=0.000). CONCLUSIONS These data support the hypothesis that CPA tumors are associated with a greater incidence of unruptured IAs, especially in female patients. Cerebral arteriosclerosis contributed to elevated risk of IA in patients with CPA tumors.
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Affiliation(s)
- Shu-Fa Zheng
- Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yi-Bin Zhang
- Department of Neurosurgery, Dehua County Hospital, Quanzhou, China
| | - Yan-Yan He
- Department of Radiology, Affiliated People's of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huang-Cheng Shang-Guan
- Department of Critical Care Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - De-Zhi Kang
- Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guo-Rong Chen
- Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuan-Xiang Lin
- Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Pei-Sen Yao
- Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
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Agarwal H, Chugh C, Singh S, Singh P. Neurosurgical image: giant pituitary adenoma and multiple aneurysms. Br J Neurosurg 2018; 33:312-314. [PMID: 29373931 DOI: 10.1080/02688697.2018.1429571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pituitary adenomas are associated with intracranial aneurysms. Giant non-functioning pituitary adenomas with aneurysms in their vicinity pose technical surgical challengesas aneurysm rupture can be catastrophic during surgery. We present the case of a middle aged women who presented with progressive visual loss in both eyes caused by a giant pituitary adenoma compressing the optic chiasma. She also had associated mirror image carotid aneurysms embedded in the tumour. They were successfully coiled preoperatively and the tumour was removed safely with improvement of her symptoms.
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Affiliation(s)
- Himanshu Agarwal
- a Department of Neurosciences , Max Superspeciality Hospital Saket , New Delhi , India
| | - Chandril Chugh
- a Department of Neurosciences , Max Superspeciality Hospital Saket , New Delhi , India
| | - Saraj Singh
- a Department of Neurosciences , Max Superspeciality Hospital Saket , New Delhi , India
| | - Prakash Singh
- a Department of Neurosciences , Max Superspeciality Hospital Saket , New Delhi , India
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35
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Unruptured medial paraclinoid internal carotid artery aneurysm embedded within symptomatic nonfunctioning pituitary giant adenoma: A high-risk comorbid pathology in transsphenoidal surgery and its countermeasures. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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36
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Raper DM, Ding D, Evans E, Starke RM, Crowley RW, Liu KC, Oldfield EH, Jane JA. Clinical Features, Management Considerations and Outcomes in Case Series of Patients with Parasellar Intracranial Aneurysms Undergoing Anterior Skull Base Surgery. World Neurosurg 2017; 99:424-432. [DOI: 10.1016/j.wneu.2016.11.150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
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37
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Satyarthee GD, Raheja A. Unruptured Internal Carotid Artery Aneurysm Associated with Functional Pituitary Adenoma: A True Association. Asian J Neurosurg 2017; 12:701-704. [PMID: 29114287 PMCID: PMC5652099 DOI: 10.4103/1793-5482.215760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Detection of incidental intracranial aneurysm on neuroimaging can be associated with pituitary adenoma; however, such association is extremely rare. However, aneurysm with extension into the sella is extremely rare, and increases the risk of inadvertent intraoperative rupture, if trans-sphenoidal decompression is attempted either using endoscopic or microscopic surgical approach. Hanak et al. in a literature review of intrasellar noniatrogenic aneurysms over PubMed search in 2012 could only collect 31 studies, of which only eight cases had pituitary adenoma associated with aneurysm extending into sella. Authors report an interesting case of 52-year-old male diagnosed as case of acromegaly, was put on dopamine agonist, bromocriptine and responding well to therapy, however the magnetic resonance imaging raised suspicion of vascular pathology, and underwent digital subtraction angiography at our center revealed presence of right supracliniod internal carotid aneurysm, which was coiled using endovascular technique with resultant good outcome.
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Affiliation(s)
| | - Amol Raheja
- Department of Neurosurgery, Neurosciences Centre, AIIMS, New Delhi, India
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38
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Zhang RC, Mu YF, Dong J, Lin XQ, Geng DQ. Complex effects of apoplexy secondary to pituitary adenoma. Rev Neurosci 2017; 28:59-64. [PMID: 27802176 DOI: 10.1515/revneuro-2016-0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/15/2016] [Indexed: 11/15/2022]
Abstract
AbstractPituitary adenoma apoplexy is a well-known clinical syndrome induced by insulin infusion, cardiac surgery, trauma, and hypothalamic releasing factors. Pituitary apoplexy can cause secondary cerebral infarct and internal carotid artery occlusion. With blockade of tumor perfusion, apoplexy triggers a sudden onset of headache, visual impairment, cranial nerve palsy, disturbances of consciousness, eyelid ptosis, and hemiparesis. However, pituitary adenoma cells with high metabolic demand cannot survive with deficient blood supply and glucose concentrations. Moreover, a number of case reports have shown that spontaneous remission of syndromes, such as acromegaly, may be caused by pituitary adenoma after apoplexy. Therefore, understanding mechanism that underlies the balance between pituitary adenoma apoplexy and subsequent spontaneous remission of syndromes may suggest new approaches for treatment of pituitary adenoma apoplexy.
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Affiliation(s)
- Rui-Cheng Zhang
- 1Center of Clinical Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu, China
| | - Ying-Feng Mu
- 2Department of Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu, China
| | - Jing Dong
- 1Center of Clinical Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu, China
| | - Xiao-Qian Lin
- 1Center of Clinical Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu, China
| | - De-Qin Geng
- 3Center of Clinical Neurology, Affiliated Hospital of Xuzhou Medical University, 99 West Huai-hai Road, Xuzhou 221002, Jiangsu, China
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Park KY, Kim BM, Kim DJ. Preoperative Coiling of Coexisting Intracranial Aneurysm and Subsequent Brain Tumor Surgery. Korean J Radiol 2016; 17:931-939. [PMID: 27833409 PMCID: PMC5102921 DOI: 10.3348/kjr.2016.17.6.931] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/01/2016] [Indexed: 11/15/2022] Open
Abstract
Objective Few studies have investigated treatment strategies for brain tumor with a coexisting unruptured intracranial aneurysm (cUIA). The purpose of this study was to evaluate the safety and efficacy of preoperative coiling for cUIA, and subsequent brain tumor surgery. Materials and Methods A total of 19 patients (mean age, 55.2 years; M:F = 4:15) underwent preoperative coiling for 23 cUIAs and subsequent brain tumor surgery. Primary brain tumors were meningiomas (n = 7, 36.8%), pituitary adenomas (n = 7, 36.8%), gliomas (n = 3, 15.8%), vestibular schwannoma (n = 1, 5.3%), and Rathke's cleft cyst (n = 1, 5.3%). cUIAs were located at the distal internal carotid artery (n = 9, 39.1%), anterior cerebral artery (n = 8, 34.8%), middle cerebral artery (n = 4, 17.4%), basilar artery top (n = 1, 4.3%), and posterior cerebral artery, P1 segment (n = 1, 4.3%). The outcomes of preoperative coiling of cUIA and subsequent brain tumor surgery were retrospectively evaluated. Results Single-microcatheter technique was used in 13 cases (56.5%), balloon-assisted in 4 cases (17.4%), double-microcatheter in 4 cases (17.4%), and stent-assisted in 2 cases (8.7%). Complete cUIA occlusion was achieved in 18 cases (78.3%), while residual neck occurred in 5 cases (21.7%). The only coiling-related complication was 1 transient ischemic attack (5.3%). Neurological deterioration did not occur in any patient during the period between coiling and tumor surgery. At the latest clinical follow-up (mean, 29 months; range, 2–120 months), 15 patients (78.9%) had favorable outcomes (modified Rankin Scale, 0–2), while 4 patients (21.1%) had unfavorable outcomes due to consequences of brain tumor surgery. Conclusion Preoperative coiling and subsequent tumor surgery was safe and effective, making it a reasonable treatment option for patients with brain tumor and cUIA.
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Affiliation(s)
- Keun Young Park
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Byung Moon Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Dong Joon Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
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Kim DH, Hong CK. Recurrent Giant Cell Tumor of Skull Combined with Multiple Aneurysms. Brain Tumor Res Treat 2016; 4:13-6. [PMID: 27195256 PMCID: PMC4868811 DOI: 10.14791/btrt.2016.4.1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/23/2015] [Accepted: 12/15/2015] [Indexed: 11/25/2022] Open
Abstract
Giant cell tumors are benign but locally invasive and frequently recur. Giant cell tumors of the skull are extremely rare. A patient underwent a surgery to remove a tumor, but the tumor recurred. Additionally, the patient developed multiple aneurysms. The patient underwent total tumor resection and trapping for the aneurysms, followed by radiotherapy. We report this rare case and suggest some possibilities for treating tumor growth combined with aneurysm development.
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Affiliation(s)
- Dae Hwan Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Ki Hong
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Pure Endoscopic Endonasal Clipping of an Incidental Anterior Communicating Artery Aneurysm. J Craniofac Surg 2016; 26:1378-81. [PMID: 26080201 DOI: 10.1097/scs.0000000000001760] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Anterior communicating artery (AcoA) aneurysm is the most common form of intracranial aneurysm. It occurs rarely together with other intracranial lesion. Today, microsurgical techniques and endovascular methods are used in the treatment of these aneurysms. Endoscopic endonasal approach is a useful technique for midline lesions of the skull base and is underpinned with extensive experience. In this article, we present a 72-year-old female patient who underwent endoscopic endonasal transplanum-transtubercular surgery for tuberculum sellae meningioma followed by clipping of the incidental AcoA aneurysm. After complete removal of a tuberculum sellae meningioma via an endoscopic endonasal approach, an anterior and superior projected saccular AcoA aneurysm in the gyrus rectus area was totally clipped successfully via pure endoscopic endonasal transplanum-transtubercular approach, without any damage to parent arteries. The patient was discharged from the hospital within a short period of time without any postoperative complication. Endoscopic endonasal approach is a new paradigm in the treatment of aneurysm. Although this technique cannot be routinely used due to lack of experience, it is an effective and safe method in selected and anatomically appropriate cases. We believe that increased knowledge and experience will create successful results in this approach, and it can offer an alternative method for selected aneurysm cases.
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To CY, Rajah G, Klein E, McNaughton M, Ham S, Haridas A, Kupsky W, Marin H, Sood S. Desmoplastic infantile ganglioglioma with associated giant aneurysm—case report. Childs Nerv Syst 2015; 31:1413-8. [PMID: 25922053 DOI: 10.1007/s00381-015-2722-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 04/20/2015] [Indexed: 11/26/2022]
Abstract
Desmoplastic infantile ganglioglioma (DIG) and supratentorial giant cerebral aneurysm are each extremely rare entities in infants. Here, we present the case of an 8-day old boy who had both of these conditions concurrently. To our knowledge, there is no previous case reported of a patient with coexisting DIG and giant aneurysm.
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Affiliation(s)
- Chiu Yuen To
- Department of Neurosurgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA,
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Kim YH, Lee YJ, Han JH, Ahn S, Lee J, Kim JH, Choi BS, Bang JS, Kim CY, Hwang G, Kwon OK, Oh CW. Association of intracranial aneurysms and meningiomas: a case-control study. J Neurosurg 2015; 123:357-61. [DOI: 10.3171/2014.10.jns14710] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECT
The authors aimed to assess whether the prevalence of intracranial aneurysms in patients with intracranial meningiomas was higher than that in a healthy population.
METHODS
The authors performed a hospital-based case-control study of 300 patients with newly diagnosed intracranial meningiomas and 900 age- and sex-matched controls without a history of brain tumors to evaluate any associations between intracranial aneurysms and intracranial meningiomas. Unconditional multivariate logistic regression models were used for case-control comparisons.
RESULTS
Intracranial aneurysms were identified in 23 patients (7.7%) and 24 controls (2.7%; p < 0.001). There was a significant association between intracranial aneurysms and intracranial meningiomas (OR 2.913, 95% CI 1.613–5.261) and hypertension (OR 1.905, 95% CI 1.053–3.446). In a subgroup analysis of the patients with newly diagnosed intracranial meningiomas, there was a significant association between intracranial aneurysms and hypertension (OR 2.876, 95% CI 1.125–7.352) and tumor volume (OR 1.012, 95% CI 1.001–1.024). These patients were also more likely than controls to have other intracranial vascular diseases (p < 0.001), such as isolated occlusion of the intracranial vessels, excluding intracranial aneurysms.
CONCLUSIONS
The prevalence of intracranial aneurysms was higher in patients with intracranial meningiomas. Hypertension and tumor volume appear to be associated with the formation of intracranial aneurysms in these patients.
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Affiliation(s)
- Young-Hoon Kim
- 1Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
- 2Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young Jin Lee
- 3Cerebrovascular Center, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Jung Ho Han
- 1Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
- 2Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Soyeon Ahn
- 4Medical Research Collaborating Center and
| | | | - Jae Hyoung Kim
- 5Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Byung Se Choi
- 5Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Jae Seung Bang
- 1Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
- 2Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chae-Yong Kim
- 1Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
- 2Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Gyojun Hwang
- 1Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - O-Ki Kwon
- 1Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
- 2Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wan Oh
- 1Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
- 2Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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Xu K, Yuan Y, Zhou J, Yu J. Pituitary adenoma apoplexy caused by rupture of an anterior communicating artery aneurysm: case report and literature review. World J Surg Oncol 2015. [PMID: 26220796 PMCID: PMC4518590 DOI: 10.1186/s12957-015-0653-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pituitary adenoma combined with intracranial aneurysm is not rare. Some aneurysms are located inside pituitary adenomas, and most do not rupture. Pituitary apoplexy caused by aneurysm rupture is rare and is easily misdiagnosed as simple pituitary adenoma apoplexy. CASE PRESENTATION In this study, we report one case of rare pituitary adenoma apoplexy caused by the rupture of an anterior communicating artery aneurysm. The patient was a 49-year-old male who had an untreated pituitary adenoma for 3 years. The patient experienced a sudden headache; computed tomography (CT) and magnetic resonance imaging (MRI) revealed pituitary adenoma apoplexy and significant subarachnoid hemorrhage. Cranial CT angiography (CTA) showed a communicating artery aneurysm. Supratentorial intracranial aneurysm clipping and pituitary adenoma resection were performed. The aneurysm was a ruptured aneurysm located inside the pituitary adenoma. During the surgery, the aneurysm was clipped, and the majority of the tumor was resected. The patient recovered well after the surgery and received radiotherapy. CONCLUSIONS This rare case demonstrates that when pituitary adenoma apoplexy is combined with subarachnoid hemorrhage, the possibility of a combined intrasellar aneurysm should be considered. During transsphenoidal tumor resection, aneurysm rupture should be avoided to prevent disastrous consequences.
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Affiliation(s)
- Kan Xu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Avenue, Changchun, 130021, China.
| | - Yongjie Yuan
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Avenue, Changchun, 130021, China.
| | - Jing Zhou
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Avenue, Changchun, 130021, China.
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Avenue, Changchun, 130021, China.
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Boellis A, di Napoli A, Romano A, Bozzao A. Pituitary apoplexy: an update on clinical and imaging features. Insights Imaging 2014; 5:753-62. [PMID: 25315035 PMCID: PMC4263799 DOI: 10.1007/s13244-014-0362-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 09/08/2014] [Accepted: 09/23/2014] [Indexed: 11/29/2022] Open
Abstract
Pituitary apoplexy (PA) is a rare and potentially fatal clinical condition presenting acute headache, vomiting, visual impairment, ophthalmoplegia, altered mental state and possible panhypopituitarism. It mostly occurs in patients with haemorrhagic infarction of the pituitary gland due to a pre-existing macroadenoma. Although there are pathological and physiological conditions that may share similar imaging characteristics, both clinical and imaging features can guide the radiologist towards the correct diagnosis, especially using magnetic resonance imaging (MRI). In this review, we will describe the main clinical and epidemiological features of PA, illustrating CT and MRI findings and discussing the role of imaging in the differential diagnosis, prognosis and follow-up. Teaching points • Headache, ophtalmoplegia and visual impairment are frequent symptoms of pituitary apoplexy. • CT is often the first imaging tool in PA, showing areas of hyperdensity within the sellar region. • MRI could confirm haemorrhage within the pituitary gland and compression on the optic chiasm. • Frequent simulating conditions are aneurysms, Rathke cleft cysts, craniopharingioma and mucocele. • The role of imaging is still debated and needs more studies.
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Affiliation(s)
- Alessandro Boellis
- Neuroradiology NESMOS Department, University of Rome "La Sapienza" and Azienda Ospedaliera Sant'Andrea, Via di Grottarossa, 1035/1039, Rome, Italy,
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Akutsu N, Hosoda K, Ohta K, Tanaka H, Taniguchi M, Kohmura E. Subarachnoid Hemorrhage Due to Rupture of an Intracavernous Carotid Artery Aneurysm Coexisting with a Prolactinoma under Cabergoline Treatment. J Neurol Surg Rep 2014; 75:e73-6. [PMID: 25083394 PMCID: PMC4110122 DOI: 10.1055/s-0033-1364166] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 11/16/2013] [Indexed: 11/03/2022] Open
Abstract
We report an unusual case of subarachnoid hemorrhage caused by intraoperative rupture of an intracavernous carotid artery aneurysm coexisting with a prolactinoma. A 58-year-old man presenting with diplopia was found to have a left intracavernous carotid artery aneurysm encased by a suprasellar tumor on magnetic resonance imaging. His serum prolactin level was 5036 ng/mL. Proximal ligation of the left internal carotid artery with a superficial temporal artery to middle cerebral artery anastomosis was scheduled. Because the patient's diplopia had deteriorated, we started him on cabergoline at a dose of 0.25 mg once a week. One month after administration of cabergoline, the diplopia was improved to some extent and serum prolactin was decreased to 290 ng/ml. Six weeks after starting the cabergoline, the patient underwent a left frontotemporal craniotomy to treat the aneurysm. When the dura mater was opened, abnormal brain swelling and obvious subarachnoid hemorrhage were observed. Postoperative computed tomography demonstrated a thick subarachnoid hemorrhage. This case suggests that medical therapy for a pituitary adenoma should be started after treatment for a coexisting intracavernous aneurysm is completed.
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Affiliation(s)
- Nobuyuki Akutsu
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Kohkichi Hosoda
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Kohei Ohta
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Hirotomo Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Masaaki Taniguchi
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan
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Musleh W, Sonabend AM, Lesniak MS. Role of craniotomy in the management of pituitary adenomas and sellar/parasellar tumors. Expert Rev Anticancer Ther 2014; 6 Suppl 9:S79-83. [PMID: 17004861 DOI: 10.1586/14737140.6.9s.s79] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The transphenoidal procedure has become the preferred approach in the surgical management of sellar/parasellar tumors. Nevertheless, specific indications remain for the transcranial approach and the objective of this review is to evaluate the available data on outcomes following transcranial or transphenoidal approaches to sellar/parasellar tumors. We assess the indications used for each approach and parameters that favor one over the other. Factors such as tumor size, consistency and configuration are important variables in choosing the transcranial approach. Other important considerations include persistent visual loss after incomplete decompression via the transphenoidal route, ectatic midline carotid arteries, co-existent intracranial aneurysms and sphenoid sinusitis. We review the data on visual and endocrinological outcomes following the transcranial or transphenoidal approach and provide an argument that, while there appears to be a trend towards greater visual improvement after transcranial surgery for large-to-giant pituitary adenomas, this benefit is offset by a greater risk of postoperative pituitary dysfunction. There is no difference in the rate of recurrence between the two procedures in the published literature. Overall, craniotomies will continue to play a role in the management of patients with sellar/parasellar tumors, although patient selection and careful preoperative evaluation are key elements in choosing the most appropriate approach.
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Affiliation(s)
- Wael Musleh
- The University of Chicago, Division of Neurosurgery, Chicago, IL 60637, USA
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48
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Choi HS, Kim MS, Jung YJ, Kim OL. Incidental Superior Hypophygeal Artery Aneurysm Embedded within Pituitary Adenoma. J Korean Neurosurg Soc 2013; 54:250-2. [PMID: 24278658 PMCID: PMC3836936 DOI: 10.3340/jkns.2013.54.3.250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 05/28/2013] [Accepted: 08/19/2013] [Indexed: 11/29/2022] Open
Abstract
Intra-cranial aneurysm can be incidental findings in patients with pituitary adenomas, and are usually located outside the pituitary region. However, the coexistence of intrasellar (not intracranial) aneurysms with pituitary adenomas is extremely rare. We report a patient with an incidental superior hypophygeal aneurysm embedded within a non-functional pituitary adenoma which was treated by transsphenoidal surgery after endovascular coil embolization.
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Affiliation(s)
- Hong-Seok Choi
- Department of Neurosurgery, Yeungnam University College of Medicine, Daegu, Korea
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49
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Association of intracranial aneurysms with meningiomas, pituitary adenomas, and gliomas: review of possible interrelationships. ISRN NEUROLOGY 2013; 2013:383425. [PMID: 24167741 PMCID: PMC3791835 DOI: 10.1155/2013/383425] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 06/26/2013] [Indexed: 12/13/2022]
Abstract
Asymptomatic intracranial abnormalities are increasingly becoming a focus of attention with the utilization of high-resolution imaging. The concurrence of tumor and aneurysm has been described, largely, by case reports and single-surgeon experiences. Recent papers have outlined the ethics of incidental findings and possible treatment algorithms. Incidental finding of an aneurysm occurs most commonly in patients with meningiomas, pituitary adenomas, and gliomas. Such an association may explain the mechanisms of aneurysm formation, growth, and rupture in acromegalic patients; however, insufficient data are available to link aneurysm with either glioma or meningioma.
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50
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Almeida Silva JM, Campos RR, Souza RR, Sette Dos Santos ME, Aguiar GB. Spontaneous subarachnoid haemorrhage from rupture of an anterior communicating artery aneurysm in a patient with pituitary macroadenoma. Neurocirugia (Astur) 2013; 25:81-5. [PMID: 23845268 DOI: 10.1016/j.neucir.2013.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 01/31/2013] [Accepted: 03/14/2013] [Indexed: 10/26/2022]
Abstract
The presence of a cerebral aneurysm in patients with pituitary adenoma is a rare event. Diagnostic suspicion may stem from magnetic resonance imaging, which should lead to complementary investigation. As for treatment, even in conditions in which there has been no previous bleeding, the simultaneous approach should be considered, prioritising the aneurysm most of the time. The present report describes the case of a patient with a history of pituitary macroadenoma, who had undergone a partial transsphenoidal resection ten years earlier. Admission to our service occurred after a sudden headache followed by mental confusion. A cranial computed tomography showed subarachnoid haemorrhage and expansive suprasellar lesion. Cerebral angiography showed a saccular aneurysm of the anterior communicating complex. The patient underwent a surgical procedure for microsurgical clipping of the aneurysm and partial resection of the pituitary tumour. We have also included a brief review of the literature on this subject.
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Affiliation(s)
- J M Almeida Silva
- Division of Neurosurgery, Santa Marcelina de Itaquaquecetuba Hospital, São Paulo, Brazil
| | - R R Campos
- Division of Neurosurgery, Santa Marcelina de Itaquaquecetuba Hospital, São Paulo, Brazil
| | - R R Souza
- Division of Neurosurgery, Santa Marcelina de Itaquaquecetuba Hospital, São Paulo, Brazil
| | - M E Sette Dos Santos
- Division of Neurosurgery, Santa Marcelina de Itaquaquecetuba Hospital, São Paulo, Brazil
| | - G B Aguiar
- Division of Neurosurgery, Santa Marcelina de Itaquaquecetuba Hospital, São Paulo, Brazil.
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