Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Large Intracranial Aneurysm after Transsphenoidal Surgery for Pituitary Macroadenoma

  • Yoon, Kyeong-Wook (Department of Neurosurgery, Dankook University College of Medicine) ;
  • Cho, Chun-Sung (Department of Neurosurgery, Dankook University College of Medicine) ;
  • Lee, Sang-Koo (Department of Neurosurgery, Dankook University College of Medicine)
  • Received : 2014.01.09
  • Accepted : 2014.03.09
  • Published : 2014.03.28
Download PDF
⟨ Previous Next ⟩

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.

Keywords

References

  1. Asai T, Usui A, Miyachi S, Ueda Y : Endovascular treatment for intracranial mycotic aneurysms prior to cardiac surgery. Eur J Cardiothorac Surg 21 : 948-950, 2002 https://doi.org/10.1016/S1010-7940(02)00092-1
  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 15 : 288-300, 2012 https://doi.org/10.1007/s11102-011-0368-2
  3. Brust JC, Dickinson PC, Hughes JE, Holtzman RN : The diagnosis and treatment of cerebral mycotic aneurysms. Ann Neurol 27 : 238-246, 1990 https://doi.org/10.1002/ana.410270305
  4. Cappabianca P, Cavallo LM, Colao A, de Divitiis E : Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 97 : 293-298, 2002 https://doi.org/10.3171/jns.2002.97.2.0293
  5. Chapot R, Houdart E, Saint-Maurice JP, Aymard A, Mounayer C, Lot G, et al. : Endovascular treatment of cerebral mycotic aneurysms. Radiology 222 : 389-396, 2002 https://doi.org/10.1148/radiol.2222010432
  6. Chun JY, Smith W, Halbach VV, Higashida RT, Wilson CB, Lawton MT : Current multimodality management of infectious intracranial aneurysms. Neurosurgery 48 : 1203-1213; discussion 1213-1214, 2001
  7. Corr P, Wright M, Handler LC : Endocarditis-related cerebral aneurysms : radiologic changes with treatment. AJNR Am J Neuroradiol 16 : 745-748, 1995
  8. Frazee JG, Cahan LD, Winter J : Bacterial intracranial aneurysms. J Neurosurg 53 : 633-641,1980 https://doi.org/10.3171/jns.1980.53.5.0633
  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) 46 : 544-547, 2006 https://doi.org/10.2176/nmc.46.544
  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 17 : 656-658, 2010 https://doi.org/10.1016/j.jocn.2009.09.010
  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 96 : 624-627, 2002 https://doi.org/10.3171/jns.2002.96.3.0624
  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 23 : 843-850, 1992 https://doi.org/10.1161/01.STR.23.6.843
  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 10 : 821-825, 1989 https://doi.org/10.1093/oxfordjournals.eurheartj.a059576
  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 66 : 405-409; discussion 409-410, 2006 https://doi.org/10.1016/j.surneu.2006.01.021
  15. Nakata Y, Shionoya S, Kamiya K : Pathogenesis of mycotic aneurysm. Angiology 19 : 593-601, 1968 https://doi.org/10.1177/000331976801901003
  16. Pruitt AA, Rubin RH, Karchmer AW, Duncan GW : Neurologic complications of bacterial endocarditis. Medicine (Baltimore) 57 : 329-343, 1978 https://doi.org/10.1097/00005792-197807000-00004
  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 18 : 655-665, 1997
  18. Scotti G, Li MH, Righi C, Simionato F, Rocca A : Endovascular treatment of bacterial intracranial aneurysms. Neuroradiology 38 : 186-189, 1996 https://doi.org/10.1007/BF00604818
  19. Watanabe A, Hirano K, Ishii R : Cerebral mycotic aneurysm treated with endovascular occlusion--case report. Neurol Med Chir (Tokyo) 38 : 657-660, 1998 https://doi.org/10.2176/nmc.38.657

Cited by

  1. Enlargement of an incidental internal carotid artery aneurysm embedded in pituitary adenoma associated with medical shrinkage of the tumor: Case report vol.9, pp.1, 2014, https://doi.org/10.4103/sni.sni_317_17