Magnetic Resonance Imaging Finding of Coexistence of Bilateral Paraclinoid Aneurysms in a Patient with a Nonfunctioning Macroadenoma, Simultaneous Resection, and Clipping: Illustrative Case

Overview

Journal J Neurosurg Case Lessons

Specialty Neurology

Date 2022 Oct 23

PMID 36273858

Authors

Michel G Mondragon-Soto

Eliezer Villanueva-Castro

Leoncio A Tovar-Romero

Jorge F Aragon-Arreola

Marcos V Sangrador-Deitos

Gerardo Cano-Velazquez

Pedro L Villanueva-Solorzano

Juan L Gomez-Amador

Affiliations

Soon will be listed here.

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.

Citing Articles

Surgical treatment of pituitary neuroendocrine tumors with coexisting intracranial lesions: A case series and review of the literature.

Villalobos-Diaz R, Marian-Magana R, Sangrador-Deitos M, Vazquez-Gregorio R, Rodriguez-Hernandez L, Lopez-Valencia G Surg Neurol Int. 2024; 15:96.

PMID: 38628542 PMC: 11021101. DOI: 10.25259/SNI_22_2024.

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