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Overview of vascular complications of pituitary surgery with special emphasis on unexpected abnormality

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Abstract

Arterial bleeding during transsphenoidal surgery for pituitary adenoma is known complication. This usually happens due to rupture of intracavernous carotid or delayed hemorrhage due to the carotico-cavernous fistula and/or pseudoaneurysm. There is also evidence that cavernous carotid aneurysms may occur with pituitary tumors, yet largest series failed to demonstrate any link between aneurysm formation and pituitary tumors. Usually such an aneurysm rupture results in formation of carotico-cavernous fistula. However, pituitary apoplexy and even epistaxis have been reported. In this paper we present a patient with recurrent pituitary adenoma and cavernous carotid artery aneurysm, which caused significant hemorrhage during the surgery. Although retrospective analysis of MRI disclosed that the patient had the aneurysm before the first surgery, it remained silent until the second operation. Therefore neurosurgeons should be very susceptive to any signal changes on preoperative MR images, especially in recurrent cases, where normal anatomical relations are disturbed by fibrotic tissue. Also, we reviewed the vascular complication of pituitary surgery based on the literature.

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References

  1. Ahuja A, Guterman LR, Hopkins LN (1992) Carotid cavernous fistula and false aneurysm of the cavernous carotid artery: complications of transsphenoidal surgery. Neurosurgery 31:774–779

    Article  PubMed  CAS  Google Scholar 

  2. Bavinzski G, Killer M, Knosp E, Ferraz-Leite H, Gruber A, Richling B (1997) False aneurysm of the intracavernous carotid artery: report of 7 cases. Acta Neurochir (Wien) 139:37–43

    Article  CAS  Google Scholar 

  3. Bonneville F, Cattin F, Marsot-Dupuch K, Dormont Didier, Bonneville J, Chiras J (2006) T1 signal hyperintensity in the sellar region: spectrum of findings. Radiographics 26:93–113

    Article  PubMed  Google Scholar 

  4. Bulsara K, Karavadia SS, Powers CJ, Paulus WC (2007) Association between pituitary adenomas and intracranial aneurysms: an illustrative case and review of the literature. Neurol India 55:410–412

    Article  PubMed  Google Scholar 

  5. Camp PE, Paxton HD, Buchan GC, Gahbauer H (1980) Vasospasm after transsphenoidal hypophysectomy. Neurosurgery 7:382–386

    Article  PubMed  CAS  Google Scholar 

  6. Cappabianca P, Cavallo LM, Colao AM, de Divitiis E (2002) Surgical complications associated with endoscopic endonasal trassphenoidal approach for pituitary adenomas. J Neurosurg 97:293–298

    Article  PubMed  Google Scholar 

  7. Chen D, Concus AP, Halbach VV, Cheung SW (1998) Epistaxis originating from traumatic pseudoaneurysm of the internal carotid artery: diagnosis and endovascular therapy. Laryngoscope 108:326–331

    Article  PubMed  CAS  Google Scholar 

  8. Chuang C, Chen Y, Pai P (2006) A giant intracavernous carotid artery aneurysm embedded in pituitary macroadenoma presenting with pituitary apoplexy. Cerebrovasc Dis 21:142–144

    Article  PubMed  Google Scholar 

  9. Chung T, Joo J, Lee S, Chien D, Laub G (1999) Evaluation of cerebral aneurysms with high-resolution MR angiography using a section-interpolation technique: correlation with digital subtraction angiography. Am J Neuroradiol 20:229–235

    PubMed  CAS  Google Scholar 

  10. Ciric I, Ragin A, Baumgartner C, Pierce D (1997) Complications of transsphenoidal surgery: results of national survey, review of the literature and personal experience. Neurosurgery 40:225–237

    Article  PubMed  CAS  Google Scholar 

  11. Destrieux C, Kakou MK, Velut S, Leffrancq T, JAN M (1998) Microanatomy of the hypophyseal fossa boundaries. J Neurosurg 88:743–752

    Article  PubMed  CAS  Google Scholar 

  12. Dolenc VV, Lipovsek M, Slokan S (1999) Traumatic aneurysm and carotid-cavernous fistula following transsphenoidal approach to a pituitary adenoma: treatment by transcranial operation. Br J Neurosurg 13:185–188

    Article  PubMed  CAS  Google Scholar 

  13. Fujiwara S, Fuji K, Nishio S, Fukui M (1991) Diagnosis and treatment of pituitary adenoma with adjacent carotid artery aneurysm. J Neurosurg Sci 35(1):41–46

    PubMed  CAS  Google Scholar 

  14. Hermann M, Bobek-Billewicz B, Sloniewski P (2000) Heavily T2-weighted magnetic resonance landmarks of the cavernous sinus and paracavernous region. Skull Base Surg 10(2):75–80

    Article  PubMed  CAS  Google Scholar 

  15. Imamura J, Okuzono T, Okuzono Y (1998) Fatal epistaxis caused by rupture of an intratumoral aneurysm enclosed by a large prolactinoma. Neurol Med Chir 38:654–656

    Article  CAS  Google Scholar 

  16. Jakubowski J, Kendall B (1978) Coincidental aneurysms with tumors of pituitary origin. J Neurol Neurosurg Psychiatr 41:972–979

    Article  PubMed  CAS  Google Scholar 

  17. Kadyrov NA, Friedman JA, Nichols DA, Cohen-Gadol AA, Link M, Piepgras DG (2002) Endovascular treatment of an internal carotid artery pseudoaneurysm following transsphenoidal surgery. Case report. J Neurosurg 96:624–627

    Article  PubMed  Google Scholar 

  18. Kai Y, Hamada J, Nishi T, Ushio Y (2001) Successful treatment with bypass and interventional surgery for a ruptured pseudo carotid artery aneurysm after transsphenoidal surgery: a case report. No Shinkei Geka 29:241–245

    PubMed  CAS  Google Scholar 

  19. Kouskouras C, Charitanti A, Giavroglou C, Foroglou N, Selviaridis P, Kontopoulos V (2004) Intracranial aneurysms: evaluation using CTA and MRA. Correlation with DSA and intraoperative findings. Neuroradiology 46:842–850

    Article  PubMed  CAS  Google Scholar 

  20. Kulseng B, Myhre HO (2006) Is insulin like growth factor-1 (IGF-1) playing a role in aneurysm formation in patients with pituitary adenoma? Int Angiol 25(4):433–435

    PubMed  CAS  Google Scholar 

  21. Laws E (1999) Vascular complications of transsphenoidal surgery. Pituitary 2:163–170

    Article  PubMed  Google Scholar 

  22. Mallouhi A, Felber S, Chemelli A, Dessl A, Auer A, Schocke M, Jaschke W, Waldenberger P (2003) Detection and characterization of intracranial aneurysms with MR angiography: comparison of volume-rendering and maximum-intensity-projection algorithms. Am J Roentgenol 180:55–64

    Google Scholar 

  23. Metens T, Rio F, Baleriaux D, Roger T, David P, Rodesch G (2000) Intracranial aneurysms: detection with gadolinium-enhanced dynamic three-dimensional MR angiography—initial results. Radiology 216:39–46

    PubMed  CAS  Google Scholar 

  24. Okahara M, Kiyosue H, Yamashita M, Nagatomi H, Hata H, Saginoya T, Sagara Y, Mori H (2002) Diagnostic accuracy of magnetic resonance angiography for cerebral aneurysms in correlation with 3D digital subtraction angiographic images: a study of 133 Aneurysms. Stroke 33:1803–1808

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  26. Paullus WS Jr, Norwood CW, Morgan HW (1979) False aneurysm of the cavernous carotid artery and progressive external ophthalmoplegia after transsphenoidal hypophysectomy: case report. J Neurosurg 51:707–709

    Article  PubMed  CAS  Google Scholar 

  27. Pigott TJD, Holland IM, Punt JAG (1989) Carotico-cavernous fistula after transsphenoidal hypophysectomy. Br J Neurosurg 3:613–616

    Article  PubMed  CAS  Google Scholar 

  28. Pinker K, Ba-Ssalamah A, Wolfsberger S, Mlynarik V, Knosp E, Trattnig S (2005) The value of high-field MRI (3T) in the assessment of sellar lesions. Eur J Radiol 54:327–334

    Article  PubMed  CAS  Google Scholar 

  29. Piotin M, Gailloud P, Bidaut L, Mandai S, Muster M, Moret J, Rüfenacht DA (2003) CT angiography, MR angiography and rotational digital subtraction angiography for volumetric assessment of intracranial aneurysms. An experimental study. Neuroradiology 45:404–409

    Article  PubMed  CAS  Google Scholar 

  30. Raymond J, Hardy J, Czepko R, Roy D (1997) Arterial injuries in transsphenoidal surgery for pituitary adenoma: the role of angiography and endovascular treatment. Am J Neuroradiol 18:655–665

    PubMed  CAS  Google Scholar 

  31. Reddy K, Lesiuk H, West M, Fewer D (1990) False aneurysm of the cavernous carotid artery: a complication of transsphenoidal surgery. Surg Neurol 33:142–145

    Article  PubMed  CAS  Google Scholar 

  32. Rinkel G (2005) Intracranial aneurysm screening: indications and advice for practice. Lancet Neurol 4:122–128

    Article  PubMed  Google Scholar 

  33. Romano A, Chibbaro S, Marsella M, Ippolito S, Benericetti E (2006) Carotid cavernous aneurysm presenting as pituitary apoplexy. J Clin Neurosci 13:476–479

    Article  PubMed  CAS  Google Scholar 

  34. Salpietro E, Longo M, Alafaci C, Gervasio O, Tomasello F (1997) Co-existing pituitary tumour and intracavernous asymptomatic aneurysm: management implications. Acta Neurochir (Wien) 139:791–792

    Article  CAS  Google Scholar 

  35. Seda L, Cukiert A, Nogueira KC, Huayllas MK, Liberman B (2008) Intrasellar internal carotid artery aneurysm coexisting with GH-secreting pituitary adenoma in an acromegalic patient. Arq Neuropsiquiatr 66(1):99–100

    Google Scholar 

  36. Simpson RK Jr, Harper RL, Bryan RN (1998) Emergency balloon occlusion for massive epistaxis due traumatic carotid-cavernous aneurysm. Case report. J Neurosurg 68:142–144

    Google Scholar 

  37. Soni A, De Silva SR, Allen K, Byrne JV, Cudlip S, Wass JA (2008) A case of macroprolactinoma encasing an internal carotid artery aneurysm, presenting as pituitary apoplexy. Pituitary 11:307–311

    Article  PubMed  Google Scholar 

  38. Suzuki H, Muramatsu M, Murao K, Kawaguchi K, Shimizu T (2001) Pituitary apoplexy caused by ruptured internal carotid artery aneurysm. Stroke 32:567–569

    PubMed  CAS  Google Scholar 

  39. Takahashi M, Killeffer F, Wilson G (1969) Iatrogenic carotid cavernous fistula. Case report. Journal of Neurosurg 30:498–500

    Article  CAS  Google Scholar 

  40. Wakai S, Fukushima T, Furihata T, Sano K (1979) Association of cerebral aneurysm with pituitary adenoma. Surg Neurol 12(6):503–507

    PubMed  CAS  Google Scholar 

  41. Weir B (1992) Pituitary tumors and aneurysms: case report and review of the literature. Neurosurgery 30(4):585–590

    Article  PubMed  CAS  Google Scholar 

  42. White P, Wardlaw J, Easton V (2000) Can noninvasive imaging accurately depict intracranial aneurysms? A systematic review. Radiology 217:361–370

    PubMed  CAS  Google Scholar 

  43. Wilson CB, Dempsey LC (1978) Transsphenoidal microsurgical removal of 250 pituitary adenomas. J Neurosurg 48:13–28

    Article  PubMed  CAS  Google Scholar 

  44. Yang M, Chen C, Shen C (2005) Cavernous aneurysm and pituitary adenoma: management of dual intrasellar lesions. J Clin Neurosci 12(4):477–481

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Hacettepe School of Medicine, Ankara, Turkey

    Mustafa Berker, Kamran Aghayev & Selçuk Palaoğlu

  2. Department of Neuroradiology, Hacettepe School of Medicine, Ankara, Turkey

    Isil Saatci

  3. Department of Otorhinolaryngology, Hacettepe School of Medicine, Ankara, Turkey

    Metin Önerci

Authors
  1. Mustafa Berker
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  2. Kamran Aghayev
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  3. Isil Saatci
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  4. Selçuk Palaoğlu
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Correspondence to Mustafa Berker.

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Berker, M., Aghayev, K., Saatci, I. et al. Overview of vascular complications of pituitary surgery with special emphasis on unexpected abnormality. Pituitary 13, 160–167 (2010). https://doi.org/10.1007/s11102-009-0198-7

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