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Vivancos Sánchez C, Navia Álvarez P, Alfonso Carrillo C, Parra Ramírez P, Pérez López C. Carotid pseudoaneurysms after endoscopic transsphenoidal surgery for acromegaly. ENDOCRINOL DIAB NUTR 2024; 71:35-37. [PMID: 38326177 DOI: 10.1016/j.endien.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 02/09/2024]
Affiliation(s)
| | - Pedro Navia Álvarez
- Departamento de Neuroradiología Intervencionista, Servicio de Radiología, Hospital Universitario La Paz, Madrid, Spain
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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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Sharma AK, Jagetia A, Singhal GD, Bodeliwala S, Srivastava AK, Singh D. Treatment Dilemma of Latrogenic Pseudoaneurysm of the Intracavernous Internal Carotid Artery in Young Girl Following Transnasal Transsphenoidal Surgery: A Case Report. Asian J Neurosurg 2022; 17:112-115. [PMID: 35873853 PMCID: PMC9298596 DOI: 10.1055/s-0042-1749178] [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: 11/10/2022] Open
Abstract
Epistaxis following transnasal transsphenoidal (TNTS) removal of pituitary adenoma can be massive and life-threatening. The intracranial source of bleeding is usually the intracavernous segment of the internal carotid artery (ICA) or adjacent branches. Injury to the cavernous ICA can lead to pseudoaneurysm (PA) or fistula formation. Management of PA is different from saccular aneurysms. A timely diagnosis and adequate management can restore vessel integrity and prevent associated morbidity. A young patient of growth hormone-secreting pituitary adenoma, who underwent microscopic TNTS excision of the tumour, presented with massive epistaxis. Pseudoaneurysm of the cavernous ICA was initially not seen on computed tomography angiography and was later diagnosed on digital subtraction angiography. The attempted management of PA with coils without stent could not stop aneurysm recurrence. The management of such complicated PAs is discussed, and a literature review is done regarding epistaxis in growth hormone secreting adenoma.
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Affiliation(s)
- Amit K. Sharma
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Anita Jagetia
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Ghanshyam D Singhal
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Shaam Bodeliwala
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Arvind K. Srivastava
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Daljit Singh
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Ngui JZ, Higginbotham G, Kanesen D, Lau JH, Tang IP, Liew DNS. A caroticocavernous fistula without vascular injury following endoscopic transsphenoidal excision of a tuberculum sellae meningioma-A case report. Clin Case Rep 2021; 9:e04117. [PMID: 34026157 PMCID: PMC8122126 DOI: 10.1002/ccr3.4117] [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: 12/22/2020] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
Caroticocavernous fistulae can occur following transsphenoidal surgery even without evidence of carotid artery injury. A role of vascularized flap reconstruction may be contributory.
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Affiliation(s)
- Jesse Zen Ngui
- Neurosurgery DepartmentSarawak General HospitalKuchingMalaysia
| | | | | | - Jia Him Lau
- Radiology DepartmentHospital Kuala LumpurKuala LumpurMalaysia
| | - Ing Ping Tang
- ENT DepartmentUniversiti Malaysia Sarawak Faculty of MedicineKuchingMalaysia
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Şimşek B, Yüksel V, Hüseyin S, Güçlü O, Canbaz S. Ruptured Internal Carotid Artery Pseudoaneurysm 10 Years after Cervical Spine Surgery. Vasc Specialist Int 2019; 35:111-113. [PMID: 31297362 PMCID: PMC6609019 DOI: 10.5758/vsi.2019.35.2.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/29/2019] [Accepted: 05/31/2019] [Indexed: 11/25/2022] Open
Abstract
An iatrogenic internal carotid artery (ICA) pseudoaneurysm is an extremely rare complication of cervical spine surgery. Here we report an extraordinary case of massive hematemesis due to a ruptured ICA pseudoaneurysm caused by the laminoplasty plate 10 years after cervical spine surgery. Computed tomography angiography revealed a ruptured 4×10-mm left extracranial ICA pseudoaneurysm probably connected to the pharynx. Emergent surgery was performed because of the uncontrolled massive bleeding. After complete resection of the injured segment, an interposition graft with a 6-mm polytetrafluoroethylene graft was placed and the fistula tract to the pharynx was repaired.
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Affiliation(s)
- Baran Şimşek
- Department of Cardiovascular Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Volkan Yüksel
- Department of Cardiovascular Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Serhat Hüseyin
- Department of Cardiovascular Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Orkut Güçlü
- Department of Cardiovascular Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Suat Canbaz
- Department of Cardiovascular Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
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Faden DL, Hughes MA, Lavigne P, Jankowitz BT, Wang EW, Fernandez-Miranda JC, Gardner PA, Snyderman CH. Diagnosis and endoscopic endonasal management of nontraumatic pseudoaneurysms of the cranial base. Int Forum Allergy Rhinol 2018; 8:641-647. [DOI: 10.1002/alr.22080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/05/2017] [Accepted: 12/12/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Daniel L. Faden
- Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh PA
| | - Marion A. Hughes
- Department of Radiology; University of Pittsburgh School of Medicine; Pittsburgh PA
| | - Philippe Lavigne
- Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh PA
| | - Brian T. Jankowitz
- Department of Neurological Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA
| | - Eric W. Wang
- Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh PA
| | | | - Paul A. Gardner
- Department of Neurological Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA
| | - Carl H. Snyderman
- Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh PA
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Sylvester PT, Moran CJ, Derdeyn CP, Cross DT, Dacey RG, Zipfel GJ, Kim AH, Uppaluri R, Haughey BH, Tempelhoff R, Rich KM, Schneider J, Chole RA, Chicoine MR. Endovascular management of internal carotid artery injuries secondary to endonasal surgery: case series and review of the literature. J Neurosurg 2016; 125:1256-1276. [PMID: 26771847 DOI: 10.3171/2015.6.jns142483] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Internal carotid artery (ICA) injury is a rare but severe complication of endonasal surgery. The authors describe their endovascular experience managing ICA injuries after transsphenoidal surgery; they review and summarize the current literature regarding endovascular techniques; and they propose a treatment algorithm based on the available evidence. METHODS A retrospective review of 576 transsphenoidal pituitary adenoma resections was performed. Cases of ICA injury occurring at our institution and transfers from other hospitals were evaluated. Endovascular treatments for ICA injury reported in the literature were also reviewed and summarized. RESULTS Seven cases were identified from the institutional cohort (mean age 46.3 years, mean follow-up 43.4 months [1-107 months]) that received endovascular treatment for ICA injury. Five injuries occurred at our institution (5 [0.9%] of 576), and 2 injuries occurred at outside hospitals. Three patients underwent ICA sacrifice by coil placement, 2 underwent lesion embolization (coil or stent-assisted coil placement), and 2 underwent endoluminal reconstruction (both with flow diversion devices). Review of the literature identified 98 cases of ICA injury treated with endovascular methods. Of the 105 total cases, 46 patients underwent ICA sacrifice, 28 underwent lesion embolization, and 31 underwent endoluminal reconstruction. Sacrifice of the ICA proved a durable solution in all cases; however, the rate of persistent neurological complications was relatively high (10 [21.7%] of 46). Lesion embolization was primarily performed by coil embolization without stenting (16 cases) and stent-assisted coiling (9 cases). Both techniques had a relatively high rate of at least some technical complication (6 [37.5%] of 16 and 5 [55.6%] of 9, respectively) and major technical complications (i.e., injury, new neurological deficit, or ICA sacrifice) (5 [31.3%] of 16 and 2 [22.2%] of 9, respectively). Endoluminal reconstruction was performed by covered stent (24 cases) and flow diverter (5 cases) placement. Covered stents showed a reasonably high rate of technical complications (10 [41.7%] of 24); however, 8 of these problems were resolved, leaving a small percentage with major technical complications (2 [8.3%] of 24). Flow diverter placement was also well tolerated, with only 1 minor technical complication. CONCLUSIONS Endovascular treatments including vessel sacrifice, coil embolization (with or without stent assistance), and endoluminal reconstruction offer a tailored approach to ICA injury management after endonasal surgery. Vessel sacrifice remains the definitive treatment for acute, uncontrolled bleeding; however, vessel preservation techniques should be considered carefully in select patients. Multiple factors including vascular anatomy, injury characteristics, and risk of dual antiplatelet therapy should guide best treatment, but more study is needed (particularly with flow diverters) to refine this decision-making process. Ideally, all endovascular treatment options should be available at institutions performing endonasal surgery.
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Affiliation(s)
| | - Christopher J Moran
- Division of Neuroradiology, Mallinckrodt Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Colin P Derdeyn
- Departments of 1 Neurosurgery.,Division of Neuroradiology, Mallinckrodt Institute, Washington University School of Medicine, St. Louis, Missouri
| | - DeWitte T Cross
- Division of Neuroradiology, Mallinckrodt Institute, Washington University School of Medicine, St. Louis, Missouri
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Moon TH, Kim SH, Lee JW, Huh SK. Clinical Analysis of Traumatic Cerebral Pseudoaneurysms. Korean J Neurotrauma 2015; 11:124-30. [PMID: 27169077 PMCID: PMC4847513 DOI: 10.13004/kjnt.2015.11.2.124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 10/13/2015] [Accepted: 10/19/2015] [Indexed: 11/17/2022] Open
Abstract
Objective Traumatic pseudoaneurysms are rare but life-threatening lesions. We investigated the patients with these lesions to clarify their clinical characteristics and therapeutic strategies and we also reviewed the literatures on the treatment principles, possible options, and outcomes. Methods There were a total of 8 patients who were treated with traumatic intracranial pseudoaneurysms between April 1980 and January 2009. Medical charts and the imaging studies were reviewed for analysis. The outcome was measured with modified Rankin Scale (mRS) score at 6 months after treatment. Results All 8 patients were male and the mean age was 25 years old. Six of those were located at the cavernous segment of the internal carotid artery (ICA) and the other 2 was located at the M2 segment of middle cerebral artery. The causes of trauma were car accidents in 6, penetrating injury through the orbit in 1, and slip down injury in 1 patient. Massive epistaxis or hematemesis occurred in all patients with a pseudoaneurysm at the cavernous and ophthalmic segment of the ICA. All 6 patients of the cavernous and ophthalmic ICA group showed favorable outcome of mRS 0 to 1. The outcome of patients with middle cerebral artery pseudoaneurysm was mRS 2 to 3. Conclusion Upon prompt diagnosis and proper treatment planning, it is possible to achieve favorable outcome in these patients. Lesions located at the cavernous segment of the ICA favored endovascular treatment while those at the middle cerebral artery favored surgical treatment.
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Affiliation(s)
- Tae Hun Moon
- Department of Neurosurgery, Stroke Center, College of Medicine, Yonsei University, Severance Hospital, Seoul, Korea
| | - Sung Han Kim
- Department of Neurosurgery, Stroke Center, College of Medicine, Yonsei University, Severance Hospital, Seoul, Korea
| | - Jae Whan Lee
- Department of Neurosurgery, Stroke Center, College of Medicine, Yonsei University, Severance Hospital, Seoul, Korea
| | - Seung Kon Huh
- Department of Neurosurgery, Stroke Center, College of Medicine, Yonsei University, Severance Hospital, Seoul, Korea
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Abstract
PURPOSE OF REVIEW Skull base surgery has undergone a fundamental transformation with the development and rapid adoption of endoscopic endonasal expanded approaches. Defects created from these newer approaches have necessitated an evolution of novel reconstructive techniques, which are reviewed here. RECENT FINDINGS New reconstructive techniques continue to be developed for repairing surgical defects from endoscopic endonasal skull base resections. Improvisations also allow well known flaps to be used in these approaches. Long term outcomes from repair using some of these techniques are now becoming available. SUMMARY Endoscopic resection of previously unapproachable skull base lesions has become possible with advancements in technology, as well as reconstructive methods. These newer techniques may offer improved outcomes and lower morbidity over conventional surgery.
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Potter NJ, Graham SM, Chang EH, Greenlee JDW. Bioabsorbable plate cranial base reconstruction. Laryngoscope 2014; 125:1313-5. [DOI: 10.1002/lary.24991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Nicholas J. Potter
- Department of Otolaryngology-Head and Neck Surgery; The University of Iowa Hospitals and Clinics; Iowa City Iowa U.S.A
| | - Scott M. Graham
- Department of Otolaryngology-Head and Neck Surgery; The University of Iowa Hospitals and Clinics; Iowa City Iowa U.S.A
- Department of Neurosurgery; The University of Iowa Hospitals and Clinics; Iowa City Iowa U.S.A
| | - Eugene H. Chang
- Department of Otolaryngology-Head and Neck Surgery; The University of Iowa Hospitals and Clinics; Iowa City Iowa U.S.A
| | - Jeremy D. W. Greenlee
- Department of Otolaryngology-Head and Neck Surgery; The University of Iowa Hospitals and Clinics; Iowa City Iowa U.S.A
- Department of Neurosurgery; The University of Iowa Hospitals and Clinics; Iowa City Iowa U.S.A
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