Download PDF
CC BY-NC-ND 4.0 · J Neurol Surg Rep 2021; 82(03): e25-e31
DOI: 10.1055/s-0041-1735904
Case Report

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

Keenan J. Piper
1   Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Michael Karsy
2   Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Blair Barton
3   Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Mindy Rabinowitz
3   Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Marc R. Rosen
3   Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Gurston G. Nyquist
3   Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
James J. Evans
2   Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Stavropoula Tjoumakaris
2   Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Christopher J. Farrell
2   Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
› Author Affiliations Funding Publication made possible in part by support from the Thomas Jefferson University Open Access Fund.
› Further Information
   Permissions and Reprints

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.

Keywords

macroadenoma - cavernous carotid aneurysm - pipeline - endoscopic - transphenoidal - pituitary adenoma - intracranial aneurysm

Ethics Statement

Michael Karsy reports disclosure with Cyrus Surgical (part owner) and Thieme Medical Publishing (royalties).




Publication History

Received: 08 November 2020

Accepted: 26 May 2021

Article published online:
29 September 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Ezzat S, Asa SL, Couldwell WT. et al. The prevalence of pituitary adenomas: a systematic review. Cancer 2004; 101 (03) 613-619
    CrossrefPubMedGoogle Scholar
  • 2 Freda PU, Beckers AM, Katznelson L. et al; Endocrine Society. Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011; 96 (04) 894-904
    CrossrefPubMedGoogle Scholar
  • 3 Aghi MK, Chen CC, Fleseriu M. et al. Congress of neurological surgeons systematic review and evidence-based guidelines on the management of patients with nonfunctioning pituitary adenomas: executive summary. Neurosurgery 2016; 79 (04) 521-523
    CrossrefPubMedGoogle Scholar
  • 4 Chanson P, Raverot G, Castinetti F, Cortet-Rudelli C, Galland F, Salenave S. French Endocrinology Society non-functioning pituitary adenoma work-group. Management of clinically non-functioning pituitary adenoma. Ann Endocrinol (Paris) 2015; 76 (03) 239-247
    CrossrefPubMedGoogle Scholar
  • 5 Seinfeld J, Karim S. Cavernous sinus aneurysm. In: StatPearls. StatPearls Publishing; Treasure Island, FL: 2020
    Google Scholar
  • 6 Oh MC, Kim EH, Kim SH. Coexistence of intracranial aneurysm in 800 patients with surgically confirmed pituitary adenoma. J Neurosurg 2012; 116 (05) 942-947
    CrossrefPubMedGoogle Scholar
  • 7 Pant B, Arita K, Kurisu K, Tominaga A, Eguchi K, Uozumi T. Incidence of intracranial aneurysm associated with pituitary adenoma. Neurosurg Rev 1997; 20 (01) 13-17
    CrossrefPubMedGoogle Scholar
  • 8 Farrell CJ, Nyquist GG, Farag AA, Rosen MR, Evans JJ. Principles of pituitary surgery. Otolaryngol Clin North Am 2016; 49 (01) 95-106
    CrossrefPubMedGoogle Scholar
  • 9 Hanak BW, Zada G, Nayar VV. et al. Cerebral aneurysms with intrasellar extension: a systematic review of clinical, anatomical, and treatment characteristics. J Neurosurg 2012; 116 (01) 164-178
    CrossrefPubMedGoogle Scholar
  • 10 Choi HS, Kim MS, Jung YJ, Kim OL. Incidental superior hypophygeal artery aneurysm embedded within pituitary adenoma. J Korean Neurosurg Soc 2013; 54 (03) 250-252
    CrossrefPubMedGoogle Scholar
  • 11 Habibi Z, Miri SM, Sheikhrezaei A. Pituitary macroadenoma coexistent with a posterior circulation aneurysm leading to subarachnoidal hemorrhage during transsphenoidal surgery. Turk Neurosurg 2015; 25 (03) 469-474
    PubMedGoogle Scholar
  • 12 Peng Z, Tian D, Wang H. et al. Epistaxis and pituitary apoplexy due to ruptured internal carotid artery aneurysm embedded within pituitary adenoma. Int J Clin Exp Pathol 2015; 8 (11) 14189-14197
    PubMedGoogle Scholar
  • 13 Raymond J, Hardy J, Czepko R, Roy D. Arterial injuries in transsphenoidal surgery for pituitary adenoma; the role of angiography and endovascular treatment. AJNR Am J Neuroradiol 1997; 18 (04) 655-665
    PubMedGoogle Scholar
  • 14 Kino H, Ito Y, Akutsu H. et al. Combined endoscopic endonasal and bilateral subfrontal approach for a nonfunctioning pituitary adenoma associated with an internal carotid artery-superior hypophyseal artery aneurysm. World Neurosurg 2020; 134: 297-301
    CrossrefPubMedGoogle Scholar
  • 15 Hori T, Muraoka K, Hokama Y, Takami M, Saito Y. A growth-hormone–producing pituitary adenoma and an internal carotid artery aneurysm. Surg Neurol 1982; 18 (02) 108-111
    CrossrefPubMedGoogle Scholar
  • 16 Matsuyama T, Masuda A. A rare case of infraclinoid aneurysm accompanied with pituitary adenoma extending over the extrasellar space [in Japanese]. No Shinkei Geka 1993; 21 (02) 171-175
    PubMedGoogle Scholar
  • 17 Molyneux A, Kerr R, Stratton I. et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002; 360 (9342): 1267-1274
    CrossrefPubMedGoogle Scholar
  • 18 Yamada S, Yamada SM, Hirohata T. et al. Endoscopic extracapsular removal of pituitary adenoma: the importance of pretreatment of an adjacent unruptured internal carotid artery aneurysm. Case Rep Neurol Med 2012; 2012: 891847
    PubMedGoogle Scholar
  • 19 Chalouhi N, Tjoumakaris S, Starke RM. et al. Comparison of flow diversion and coiling in large unruptured intracranial saccular aneurysms. Stroke 2013; 44 (08) 2150-2154
    CrossrefPubMedGoogle Scholar
  • 20 Saber H, Kherallah RY, Hadied MO, Kazemlou S, Chamiraju P, Narayanan S. Antiplatelet therapy and the risk of ischemic and hemorrhagic complications associated with pipeline embolization of cerebral aneurysms: a systematic review and pooled analysis. J Neurointerv Surg 2019; 11 (04) 362-366
    CrossrefPubMedGoogle Scholar
  • 21 Stiebel-Kalish H, Kalish Y, Bar-On RH. et al. Presentation, natural history, and management of carotid cavernous aneurysms. Neurosurgery 2005; 57 (05) 850-857 , discussion 850–857
    CrossrefPubMedGoogle Scholar
  • 22 Salpietro FM, Longo M, Alafaci C, Gervasio O, Tomasello F. Co-existing pituitary tumour and intracavernous asymptomatic aneurysm: management implications. Acta Neurochir (Wien) 1997; 139 (08) 791-792
    CrossrefPubMedGoogle Scholar
  • 23 Sade B, Mohr G, Tampieri D, Rizzo A. Intrasellar aneurysm and a growth hormone-secreting pituitary macroadenoma. Case report. J Neurosurg 2004; 100 (03) 557-559
    CrossrefPubMedGoogle Scholar
  • 24 Wang CS, Yeh TC, Wu TC, Yeh CH. Pituitary macroadenoma co-existent with supraclinoid internal carotid artery cerebral aneurysm: a case report and review of the literature. Cases J 2009; 2: 6459
    CrossrefPubMedGoogle Scholar
  • 25 Yu K, Herwadkar A, Kearney T, Gnanalingham KK. Pituitary adenoma and incidental superior hypophyseal aneurysm. Br J Neurosurg 2011; 25 (03) 432-433
    CrossrefPubMedGoogle Scholar
  • 26 Xia X, Ramanathan M, Orr BA. et al. Expanded endonasal endoscopic approach for resection of a growth hormone-secreting pituitary macroadenoma coexistent with a cavernous carotid artery aneurysm. J Clin Neurosci 2012; 19 (10) 1437-1441
    CrossrefPubMedGoogle Scholar
  • 27 Yang MY, Chen C, Shen CC. Cavernous aneurysm and pituitary adenoma: management of dual intrasellar lesions. J Clin Neurosci 2005; 12 (04) 477-481
    CrossrefPubMedGoogle Scholar
  • 28 Chuang CC, Chen YL, Pai PC. A giant intracavernous carotid artery aneurysm embedded in pituitary macroadenoma presenting with pituitary apoplexy. Cerebrovasc Dis 2006; 21 (1,2): 142-144
    CrossrefPubMedGoogle Scholar
  • 29 Xiao LM, Tang B, Xie SH. et al. Endoscopic endonasal clipping of anterior circulation aneurysm: surgical techniques and results. World Neurosurg 2018; 115: e33-e44
    CrossrefPubMedGoogle Scholar
  • 30 Martinez-Perez R, Hardesty DA, Silveira-Bertazzo G, Albonette-Felicio T, Carrau RL, Prevedello DM. Safety and effectiveness of endoscopic endonasal intracranial aneurysm clipping: a systematic review. Neurosurg Rev 2021; 44 (02) 889-896
    CrossrefPubMedGoogle Scholar
  • 31 Ryu G, So YK, Seo MY. et al. Using the nasoseptal flap for reconstruction after endoscopic debridement of radionecrosis in nasopharyngeal carcinoma. Am J Rhinol Allergy 2018; 32 (01) 61-65
    CrossrefPubMedGoogle Scholar
  • 32 Imamura J, Okuzono T, Okuzono Y. Fatal epistaxis caused by rupture of an intratumoral aneurysm enclosed by a large prolactinoma–case report. Neurol Med Chir (Tokyo) 1998; 38 (10) 654-656
    CrossrefPubMedGoogle Scholar
  • 33 Ohki M, Sato K, Tuchiya D. et al. A case of TSH-secreting pituitary adenoma associated with an unruptured aneurysm: successful treatment by two-stage operation and gamma-knife [in Japanese]. No To Shinkei 1999; 51 (10) 895-899
    PubMedGoogle Scholar
  • 34 Curto L, Squadrito S, Almoto B. et al. MRI finding of simultaneous coexistence of growth hormone-secreting pituitary adenoma with intracranial meningioma and carotid artery aneurysms: report of a case. Pituitary 2007; 10 (03) 299-305
    CrossrefPubMedGoogle Scholar
  • 35 Seda Jr. L, Cukiert A, Nogueira KC, Huayllas MK, Liberman B. Intrasellar internal carotid aneurysm coexisting with GH-secreting pituitary adenoma in an acromegalic patient. Arq Neuropsiquiatr 2008; 66 (01) 99-100
    CrossrefPubMedGoogle Scholar
  • 36 Soni A, De Silva SR, Allen K, Byrne JV, Cudlip S, Wass JA. A case of macroprolactinoma encasing an internal carotid artery aneurysm, presenting as pituitary apoplexy. Pituitary 2008; 11 (03) 307-311
    CrossrefPubMedGoogle Scholar
  • 37 Khalsa SS, Hollon TC, Shastri R, Trobe JD, Gemmete JJ, Pandey AS. Spontaneous subarachnoid hemorrhage due to ruptured cavernous internal carotid artery aneurysm after medical prolactinoma treatment. BMJ Case Rep 2016; 2016: 2016
    PubMedGoogle Scholar
  • 38 Khachatryan T, Khachatryan M, Fanarjyan R, Grigoryan M, Grigorian A. Enlargement of an incidental internal carotid artery aneurysm embedded in pituitary adenoma associated with medical shrinkage of the tumor: Case report. Surg Neurol Int 2018; 9: 30
    CrossrefPubMedGoogle Scholar