J Korean Neurosurg Soc.  2014 Mar;55(3):160-163. 10.3340/jkns.2014.55.3.160.

Large Intracranial Aneurysm after Transsphenoidal Surgery for Pituitary Macroadenoma

Affiliations
  • 1Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea. lsk999999@gmail.com

Abstract

Uncontrolled cerebrospinal fluid (CSF) leakage after transsphenoidal surgery (TSS) for pituitary adenoma can lead to meningitis. Intracranial mycotic pseudoaneurysm is a rare complication in central nervous system infection. Large single pseudoaneurysm is more uncommon. Most mycotic aneurysms occur due to endocarditis. The present patient had no heart problem and was infected by CSF leakage after transsphenoidal surgery. We present a case of large ruptured mycotic pseudoaneurysm as a complication of cerebral infection after TSS for pituitary macroadenoma.

Keyword

Intracranial aneurysm; Transsphenoidal surgery; Pituitary macroadenoma

MeSH Terms

Aneurysm, False
Aneurysm, Infected
Central Nervous System Infections
Cerebrospinal Fluid
Endocarditis
Heart
Humans
Intracranial Aneurysm*
Meningitis
Pituitary Neoplasms

Figure

  • Fig. 1 A : Preoperative sellar MRI (sagittal view) shows suprasella mass (1.4×1.0×1.6 cm) with heterogenous enhancement and fluid-fluid level, implying focal hemorrhage. B : Preoperative enhanced MRI (axial view) shows no evidence of right posterior cerebral artery aneurysm (arrow).

  • Fig. 2 Brain CT (axial view) presents an acute subarachnoid hemorrhage and intraventricular hemorrhage.

  • Fig. 3 Conventional cerebral angiography (anteroposterior and lateral view) shows a large pseudoaneurysm at right posterior cerebral artery.

  • Fig. 4 Postoperative cerebral angiography (anteroposterior and lateral view) shows total occlusion of pseudoaneurysm at right posterior cerebral artery.


Reference

1. Asai T, Usui A, Miyachi S, Ueda Y. Endovascular treatment for intracranial mycotic aneurysms prior to cardiac surgery. Eur J Cardiothorac Surg. 2002; 21:948–950. PMID: 12062301.
Article
2. Berker M, Hazer DB, Yücel T, Gürlek A, Cila A, Aldur M, et al. Complications of endoscopic surgery of the pituitary adenomas : analysis of 570 patients and review of the literature. Pituitary. 2012; 15:288–300. PMID: 22161543.
Article
3. Brust JC, Dickinson PC, Hughes JE, Holtzman RN. The diagnosis and treatment of cerebral mycotic aneurysms. Ann Neurol. 1990; 27:238–246. PMID: 2327735.
Article
4. Cappabianca P, Cavallo LM, Colao A, de Divitiis E. Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg. 2002; 97:293–298. PMID: 12186456.
Article
5. Chapot R, Houdart E, Saint-Maurice JP, Aymard A, Mounayer C, Lot G, et al. Endovascular treatment of cerebral mycotic aneurysms. Radiology. 2002; 222:389–396. PMID: 11818604.
Article
6. Chun JY, Smith W, Halbach VV, Higashida RT, Wilson CB, Lawton MT. Current multimodality management of infectious intracranial aneurysms. Neurosurgery. 2001; 48:1203–1213. discussion 1213-1214. PMID: 11383721.
Article
7. Corr P, Wright M, Handler LC. Endocarditis-related cerebral aneurysms : radiologic changes with treatment. AJNR Am J Neuroradiol. 1995; 16:745–748. PMID: 7611032.
8. Frazee JG, Cahan LD, Winter J. Bacterial intracranial aneurysms. J Neurosurg. 1980; 53:633–641. PMID: 6893602.
Article
9. Hara Y, Hosoda K, Wada T, Kimura H, Kohmura E. Endovascular treatment for a unusually large mycotic aneurysm manifesting as intracerebral hemorrhage - case report. Neurol Med Chir (Tokyo). 2006; 46:544–547. PMID: 17124370.
Article
10. Jagetia A, Rajan S, Sinha S, Singh D. Fatal epistaxis from the fetal posterior communicating artery--a delayed complication of trans-sphenoidal surgery. J Clin Neurosci. 2010; 17:656–658. PMID: 20189396.
Article
11. Kadyrov NA, Friedman JA, Nichols DA, Cohen-Gadol AA, Link MJ, Piepgras DG. Endovascular treatment of an internal carotid artery pseudoaneurysm following transsphenoidal surgery. Case report. J Neurosurg. 2002; 96:624–627. PMID: 11883853.
Article
12. Masuda J, Yutani C, Waki R, Ogata J, Kuriyama Y, Yamaguchi T. Histopathological analysis of the mechanisms of intracranial hemorrhage complicating infective endocarditis. Stroke. 1992; 23:843–850. PMID: 1595103.
Article
13. Monsuez JJ, Vittecoq D, Rosenbaum A, Goujon C, Wolff M, Witchitz S, et al. Prognosis of ruptured intracranial mycotic aneurysms : a review of 12 cases. Eur Heart J. 1989; 10:821–825. PMID: 2806280.
Article
14. Nakahara I, Taha MM, Higashi T, Iwamuro Y, Iwaasa M, Watanabe Y, et al. Different modalities of treatment of intracranial mycotic aneurysms : Report of 4 cases. Surg Neurol. 2006; 66:405–409. discussion 409-410. PMID: 17015123.
Article
15. Nakata Y, Shionoya S, Kamiya K. Pathogenesis of mycotic aneurysm. Angiology. 1968; 19:593–601. PMID: 5695978.
Article
16. Pruitt AA, Rubin RH, Karchmer AW, Duncan GW. Neurologic complications of bacterial endocarditis. Medicine (Baltimore). 1978; 57:329–343. PMID: 580794.
Article
17. 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; 18:655–665. PMID: 9127026.
18. Scotti G, Li MH, Righi C, Simionato F, Rocca A. Endovascular treatment of bacterial intracranial aneurysms. Neuroradiology. 1996; 38:186–189. PMID: 8692438.
Article
19. Watanabe A, Hirano K, Ishii R. Cerebral mycotic aneurysm treated with endovascular occlusion--case report. Neurol Med Chir (Tokyo). 1998; 38:657–660. PMID: 9861850.
Article
Full Text Links
  • JKNS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr