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(a) lateral angiogram of left carotid artery showing an ICA aneurysm; (b) 3D reconstruction of the pseudoaneurysm with (c) flow diverter (Derivo ® -4,5/20) reconstruction.
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False aneurysm of internal carotid artery (ICA) is a rare but serious vascular complication observed after transsphenoidal pituitary surgery. Here, we present a 41-year-old woman with a pseudoaneurysm in the ophthalmic1 segment of the left ICA after exoscopic transsphenoidal pituitary surgery. The initially uneventful procedure was complicated by a...
Context in source publication
Context 1
... a prepontine and retroclival subarachnoid hemorrhage (Hunt & Hess Grade I), (Fig. 2). For further evaluation, a digital subtraction angiography (DSA) was conducted, and it showed a pseudoaneurysm of ophthalmic 1 /supraclinoid 2 /C2 3 part of the left ICA, which was directly treated by a flow diverter (Derivo ® -4,5/20), with remaining rest flow (Fig. 3). The patient was transferred to the ICU, transcranial doppler sonography was performed and revealed normal flow. In the following course, the patient suffered from Terson's syndrome and hyponatremia due to SIADH, but after clinical improvement, was transferred back to normal station after 10 days of post-operative monitoring. ...
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Citations
... The risk factors for developing ICAP after transsphenoidal surgery include a history of hypertension, previous radiation therapy, tumor invasion of the cavernous sinus, prior treatment with bromocriptine, acromegaly, and extensive surgical resection of the sellar region [2,5]. The clinical presentation of ICAP can vary from an asymptomatic finding on imaging to life-threatening complications such as subarachnoid hemorrhage, carotid-cavernous fistula, or even death [6]. Mortality rates from rupture of ICAP have been reported up to 50% [1,2]. ...
Here, we present a case report on internal carotid artery pseudoaneurysm (ICAP) which highlights a rare but potentially life-threatening complication of transsphenoidal pituitary surgery. A 32-year-old male underwent resection of a pituitary tumor and developed a large cerebrospinal fluid (CSF) leak during surgery, which was reconstructed with a fat graft and nasoseptal flap. Postoperatively, he was recovering well and discharged without complications; however, eight days after surgery he returned with massive epistaxis and hematemesis. This was initially managed with endoscopic exploration, nasal packing, and transfusion of blood products. Imaging revealed a pseudoaneurysm on the right internal carotid artery. The patient was started on aspirin and clopidogrel, and a flow diverter stent was placed without complications. Our case emphasizes the importance of prompt recognition and management of vascular injuries such as an internal carotid pseudoaneurysm after transsphenoidal pituitary surgery to prevent catastrophic outcomes.
We present a fatal complication of treatment in a patient with early-onset acromegaly, treated with two transsphenoidal operations, radiotherapy, radiosurgery and pegvisomant. He was diagnosed in his 30s, and controlled from his 40s, with stable residual tumour within the left cavernous sinus. In his 60s, 30 years after surgery/radiotherapy and 14 years after radiosurgery, he developed recurrent episodes of mild epistaxis. A week later, he presented at his local hospital’s emergency department with severe epistaxis and altered consciousness. He was diagnosed with a ruptured internal carotid artery (ICA) pseudoaneurysm, but unfortunately died before treatment could be attempted.
ICA pseudoaneurysms are rare complications of surgery or radiotherapy and can present with several years of delay, often with epistaxis. This case highlights the importance of life-long monitoring in patients with previous pituitary interventions and early recognition of epistaxis as a herald sign of a potentially catastrophic event, thus leading to timely treatment.
