Skip to main content

Advertisement

SpringerLink
Log in

Clipping of a superior hypophyseal artery aneurysm during endoscopic transnasal removal of a Rathke cleft cyst: a case report

  • Case Report - Vascular Neurosurgery - Aneurysm
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bouthillier A, van Loveren HR, Keller JT (1996) Segments of the internal carotid artery: a new classification. Neurosurgery 38:425–432; discussion 432-423

  2. Dehdashti AR, Ganna A, Witterick I, Gentili F (2009) Expanded endoscopic endonasal approach for anterior cranial base and suprasellar lesions: indications and limitations. Neurosurgery 64:677–687 discussion 687-679

    Article  Google Scholar 

  3. Duan Y, Blackham K, Nelson J, Selman W, Bambakidis N (2015) Analysis of short-term total hospital costs and current primary cost drivers of coiling versus clipping for unruptured intracranial aneurysms. Journal of neurointerventional surgery 7:614–618

    Article  PubMed  Google Scholar 

  4. Fan J, Peng Y, Qi S, Zhang XA, Qiu B, Pan J (2013) Individualized surgical strategies for Rathke cleft cyst based on cyst location. J Neurosurg 119:1437–1446

    Article  PubMed  Google Scholar 

  5. Froelich S, Cebula H, Debry C, Boyer P (2011) Anterior communicating artery aneurysm clipped via an endoscopic endonasal approach: technical note. Neurosurgery 68:310–316 discussion 315-316

    Article  PubMed  Google Scholar 

  6. Frontera JA, Moatti J, de los Reyes KM, McCullough S, Moyle H, Bederson JB, Patel A (2014) Safety and cost of stent-assisted coiling of unruptured intracranial aneurysms compared with coiling or clipping. Journal of neurointerventional surgery 6:65–71

    Article  PubMed  Google Scholar 

  7. Gardner PA, Vaz-Guimaraes F, Jankowitz B, Koutourousiou M, Fernandez-Miranda JC, Wang EW, Snyderman CH (2015) Endoscopic endonasal clipping of intracranial aneurysms: surgical technique and results. World Neurosurg 84:1380–1393

    Article  PubMed  Google Scholar 

  8. Greving JP, Wermer MJ, Brown RD Jr, Morita A, Juvela S, Yonekura M, Ishibashi T, Torner JC, Nakayama T, Rinkel GJ, Algra A (2014) Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies. Lancet Neurol 13:59–66

    Article  PubMed  Google Scholar 

  9. Habibi Z, Miri SM, Sheikhrezaei A (2015) Pituitary macroadenoma coexistent with a posterior circulation aneurysm leading to subarachnoidal hemorrhage during transsphenoidal surgery. Turkish neurosurgery 25:469–474

    PubMed  Google Scholar 

  10. Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A (2006) A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116:1882–1886

    Article  Google Scholar 

  11. Han SJ, Rolston JD, Jahangiri A, Aghi MK (2014) Rathke’s cleft cysts: review of natural history and surgical outcomes. J Neuro-Oncol 117:197–203

    Article  Google Scholar 

  12. Jimbo H, Ichikawa M, Fukami S, Otsuka K, Tsurukiri J, Sunaga S, Ikeda Y (2016) Rapid de novo aneurysm formation after Rathke cleft cyst rupture. World Neurosurg 88(690):e611–e696

    Google Scholar 

  13. Kassam AB, Gardner PA, Mintz A, Snyderman CH, Carrau RL, Horowitz M (2007) Endoscopic endonasal clipping of an unsecured superior hypophyseal artery aneurysm. Technical note J Neurosurg 107:1047–1052

    Article  PubMed  Google Scholar 

  14. Kato T, Sawamura Y, Abe H, Nagashima M (1998) Transsphenoidal-transtuberculum sellae approach for supradiaphragmatic tumours: technical note. Acta Neurochir 140:715–718 discussion 719

    Article  CAS  PubMed  Google Scholar 

  15. Kitai R, Yamauchi T, Arai Y, Hosoda T, Hashimoto N, Tsunetoshi K, Higashino Y, Kikuta KI (2017) Deflation of a Rathke cleft cyst triggered rupture of a superior hypophyseal artery aneurysm: a case report. Br J Neurosurg:1–3

  16. Oh MC, Kim EH, Kim SH (2012) Coexistence of intracranial aneurysm in 800 patients with surgically confirmed pituitary adenoma. J Neurosurg 116:942–947

    Article  PubMed  Google Scholar 

  17. Pant B, Arita K, Kurisu K, Tominaga A, Eguchi K, Uozumi T (1997) Incidence of intracranial aneurysm associated with pituitary adenoma. Neurosurg Rev 20:13–17

    Article  CAS  PubMed  Google Scholar 

  18. Raper DM, Ding D, Evans E, Starke RM, Crowley RW, Liu KC, Oldfield EH, Jane JA, Jr. (2017) Clinical features, management considerations and outcomes in case series of patients with parasellar intracranial aneurysms undergoing anterior skull base surgery. World Neurosurg 99:424–432

  19. Rustagi T, Uy EM, Rai M, Kannan S, Senatus P (2011) Intracranial hemorrhage from undetected aneurysmal rupture complicating transphenoidal pituitary adenoma resection. Conn Med 75:393–398

    PubMed  Google Scholar 

  20. Takeuchi S, Wada K, Sakakibara F, Nawashiro H, Mori K (2013) Anterior cerebral artery dissecting aneurysm associated with untreated craniopharyngioma. Br J Neurosurg 27:102–104

    Article  PubMed  Google Scholar 

  21. Tsuchida T, Tanaka R, Yokoyama M, Sato H (1983) Rupture of anterior communicating artery aneurysm during transsphenoidal surgery for pituitary adenoma. Surg Neurol 20:67–70

    Article  CAS  PubMed  Google Scholar 

  22. Yamada S, Yamada SM, Hirohata T, Ishii Y, Hoya K, Murakami M, Matsuno A (2012) Endoscopic extracapsular removal of pituitary adenoma: the importance of pretreatment of an adjacent unruptured internal carotid artery aneurysm. Case Rep Neurol Med 2012:891847

  23. Yu K, Herwadkar A, Kearney T, Gnanalingham KK (2011) Pituitary adenoma and incidental superior hypophyseal aneurysm. Br J Neurosurg 25:432–433

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Clinical Neuroscience Center, University Hospital of Zürich, University of Zürich, Frauenklinikstrasse 10, 8006, Zürich, Switzerland

    Carlo Serra, Martina Sebök, Marian Christoph Neidert & Luca Regli

  2. Department of Neuroradiology, Clinical Neuroscience Center, University Hospital of Zürich, University of Zürich, Zürich, Switzerland

    Lukas Widmer

Authors
  1. Carlo Serra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martina Sebök
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lukas Widmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marian Christoph Neidert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luca Regli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlo Serra.

Additional information

Comments

The authors describe a case report of concomitant Rathke cyst removal and SHA aneurysm clipping. One could argue that the Acom aneurysm has a higher risk of bleed albeit small (and should have also been treated during the same setting). Then exposure of Acom is not quite more complicated once the suprasellar cistern is exposed. Also the addition of a binostril technique offers a much better maneuverability of instruments, and most importantly dealing with potential bleeding if it occurs. In larger medial carotid aneurysms, the best segment of carotid for proximal occlusion is the cavernous segment (C4). The presented case report has worked beautifully in their hand but attention to the criticism above is important for more complex cases.

Amir Dehdashti

NY, USA

This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

Electronic supplementary material

ESM 1

(MP4 182,821 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Serra, C., Sebök, M., Widmer, L. et al. Clipping of a superior hypophyseal artery aneurysm during endoscopic transnasal removal of a Rathke cleft cyst: a case report. Acta Neurochir 161, 197–201 (2019). https://doi.org/10.1007/s00701-018-3728-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-018-3728-0

Keywords

Search

Navigation