J Cerebrovasc Endovasc Neurosurg.  2022 Dec;24(4):380-385. 10.7461/jcen.2022.E2021.10.004.

Surgical treatment of a ruptured internal carotid artery pseudoaneurysm following transsphenoidal surgery

• Adalid LAC
• Herrera VC
• Rubio DS
• Toro MA
• Estrada EE

• KMID: 2537323
• DOI: http://doi.org/10.7461/jcen.2022.E2021.10.004

Abstract

Development of Internal Carotid Artery pseudoaneurysms (ICAp) after transsphenoidal surgery is extremely rare, occurring only in 0.4% of cases. Surgical treatment of ICAp poses a real challenge to the neurosurgeon as treatment may require parent vessel sacrifice or artery reconstruction with bypass grafting. Furthermore, surgical resolution of these lesions is rarely reported in the literature. The internal carotid artery is prone to iatrogenic injury in transsphenoidal surgery due to its frequent involvement in pituitary adenomas. Intracranial pseudoaneurysms may be at high risk for rupture and increased morbidity and mortality. Here we present a case of a patient with an ICAp rupture two months after transsphenoidal surgery for a pituitary adenoma.

Keyword

Pseudoaneurysm; Carotid; Clipping; Artery; Pituitary; Ad

Figure

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  Fig. 1. (A) Preoperative cranial MRI in sagittal and coronal T1-weighted sections. (B) A giant sellar tumor consistent with pituitary adenoma with heterogeneous gadolinium enhancement. MRI, magnetic resonance imaging

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  Fig. 2. (A) Preoperative cranial CT scans in axial sections demonstrate Fisher IV subarachnoid hemorrhage and hydrocephalus. (B) Sagittal view demonstrates an extensive anterior cerebral artery stroke that prompted surgical resolution of the case. CT, computed tomography

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  Fig. 3. (A) Cerebral angiotomography with 3D reconstruction, demonstrating the right internal carotid artery pseudo aneurysm and the dome’s medial orientation (B) as well as its proximity to the sellar surgical region suggesting pseudoaneurysm.

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  Fig. 4. (A) Surgical view through a pterional approach depicting the right internal carotid artery and the inter opticcarotid space, which harbors the pseudoaneurysm in its depth. (B) Successful clipping was achieved using an angled fenestrated clip.

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  Fig. 5. (A) Postoperative cerebral angiotomography showing aneurysm exclusion (B) and adequate distal flow.

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