Intra-Operative Rupture of Remote Aneurysm during Transphenoidal Resection of Pituitary Macroadenoma
ABSTRACT
Rupture of intracranial aneurysm resulting in subarachnoid hemorrhage is well known to carry significant risk of poor outcome. Intra-operative rupture of an unknown intracranial aneurysm during a neurosurgical procedure is a rare occurrence that can lead to devastating consequences if not recognized and managed appropriately. Here we describe to our knowledge, the first reported case of previously unknown, remote from the surgical site, intra-operative posterior cerebral artery aneurysm rupture during transnasal endoscopic transphenoidal resection of a pituitary macroadenoma, review relevant literature, and discuss strategies to reduce surgical risk and improve patient outcomes.
Rupture of intracranial aneurysm resulting in subarachnoid hemorrhage is well known to carry significant risk of poor outcome. Intra-operative rupture of an unknown intracranial aneurysm during a neurosurgical procedure is a rare occurrence that can lead to devastating consequences if not recognized and managed appropriately. Here we describe to our knowledge, the first reported case of previously unknown, remote from the surgical site, intra-operative posterior cerebral artery aneurysm rupture during transnasal endoscopic transphenoidal resection of a pituitary macroadenoma, review relevant literature, and discuss strategies to reduce surgical risk and improve patient outcomes.
Cite this paper
Rajah, G. and Hornyak, M. (2014) Intra-Operative Rupture of Remote Aneurysm during Transphenoidal Resection of Pituitary Macroadenoma. Open Journal of Modern Neurosurgery, 4, 64-68. doi: 10.4236/ojmn.2014.42014.
Rajah, G. and Hornyak, M. (2014) Intra-Operative Rupture of Remote Aneurysm during Transphenoidal Resection of Pituitary Macroadenoma. Open Journal of Modern Neurosurgery, 4, 64-68. doi: 10.4236/ojmn.2014.42014.
References
[1] Wakai, S., Fukushima, T., Furihata, T. and Sano, K. (1979) Association of Cerebral Aneurysm with Pituitary Adenoma. Surgical Neurology, 12, 503-507. [2] Jakubowski, J. and Kendall, B. (1978) Coincidental Aneurysms with Tumours of Pituitary Origin. Journal of Neurology. Neurosurgery & Psychiatry, 41, 972-979. http://dx.doi.org/10.1136/jnnp.41.11.972 [3] Pant, B., Arita, K., Kurisu, K., Tominaga, A., Eguchi, K. and Uozumi, T. (1997) Incidence of Intracranial Aneurysm Associated with Pituitary Adenoma. Neurosurgical Review, 20, 13-17.
http://dx.doi.org/10.1007/BF01390519 [4] Wang, C.-S., Yeh, T.-C., Wu, T.-C. and Yeh, C.-H. (2009) Pituitary Macroadenoma Co-Existent with Supraclinoid Internal Carotid artery Cerebral Aneurysm: A Case Report and Review of the Literature. Cases Journal, 2, 6459. http://dx.doi.org/10.4076/1757-1626-2-6459 [5] Ezzat, S., Asa, S.L., Couldwell, W.T., Barr, C.E., Dodge, W.E., Vance, M.L. and McCutcheon, I.E. (2004) The Prevalence of Pituitary Adenomas: A Systematic Review. Cancer, 101, 613-619.
http://dx.doi.org/10.1002/cncr.20412 [6] Locatelli, M., Spagnoli, D., Caroli, M., Isalberti, M., Branca, V., Gaini, S.M. and Lania, A. (2008) A Potential Catastrophic Trap: An Unusually Presenting Sellar Lesion. European Journal of Neurology, 15, 98-101. [7] Oh, M.C., Kim, E.H. and Kim, S.H. (2012) Coexistence of Intracranial Aneurysm in 800 Patients with Surgically Confirmed Pituitary Adenoma. Journal of Neurosurgery, 116, 942-947.
http://dx.doi.org/10.3171/2011.12.JNS11875 [8] du Boulay, G.H. (1965) Some Observations on the Natural History of Intracranial Aneurysms. British Journal of Radiology, 38, 721-757. http://dx.doi.org/10.1259/0007-1285-38-454-721 [9] van Lindert, E.J., Bocher-Schwarz, H.G. and Perneczky, A. (2001) The Influence of Surgical Experience on the Rate of Intraoperative Aneurysm Rupture and Its Impact on Aneurysm Treatment Outcome. Surgical Neurology, 56, 151-156. http://dx.doi.org/10.1016/S0090-3019(01)00547-X [10] Stoodley, M.A., Macdonald, R.L. and Weir, B.K. (1998) Pregnancy and Intracranial Aneurysms. Neurosurgery Clinics of North America, 9, 549-556. [11] Horsley, M., Taylor, T.K. and Sorby, W.A. (1997) Traction-Induced Rupture of an Extracranial Vertebral Artery Aneurysm Associated With Neurofibromatosis: A Case Report. Spine, 22, 225-227.
http://dx.doi.org/10.1097/00007632-199701150-00019 [12] Sahjpaul, R.L., Abdulhak, M.M., Drake, C.G. and Hammond, R.R. (1998) Fatal Traumatic Vertebral Artery Aneurysm Rupture. Journal of Neurosurgery, 89, 822-824.
http://dx.doi.org/10.3171/jns.1998.89.5.0822 [13] Tsuchida, T., Tanaka, R., Yokoyama, M. and Sato, H. (1983) Rupture of Anterior Communicating Artery Aneurysm during Transsphenoidal Surgery for Pituitary Adenoma. Surgical Neurology, 20, 67-70. http://dx.doi.org/10.1016/0090-3019(83)90110-6 [14] Suzuki, H., Muramatsu, M., Murao, K., Kawaguchi, K. and Shimizu, T. (2001) Pituitary Apoplexy Caused by Ruptured Internal Carotid Artery Aneurysm. Stroke, 32, 567-569.
http://dx.doi.org/10.1161/01.STR.32.2.567 [15] Berker, M. (2010) Overview of Vascular Complications of Pituitary Surgery with Special Emphasis on Unexpected Abnormality. Pituitary, 13, 160-167. http://dx.doi.org/10.1007/s11102-009-0198-7 [16] Paré, L., Delfino, R. and Leblanc, R. (1992) The Relationship of Ventricular Drainage to Aneurysmal Rebleeding. Journal of Neurosurgery, 76, 422-427. [17] Houkin, K. (1999) Intra-Operative Premature Rupture of the Cerebral Aneurysms. Analysis of the Causes and Management. Acta Neurochirurgica, 141, 1255-1263.
http://dx.doi.org/10.1007/s007010050428 [18] Liu, J.K., Das, K., Weiss, M.H., Laws, E.R. and Couldwell, W.T. (2001) The History and Evolution of Transsphenoidal Surgery. Journal of Neurosurgery, 95, 1083-1096.
http://dx.doi.org/10.3171/jns.2001.95.6.1083 [19] Karamessini, M.T., Kagadis, G.C., Petsas, T., Karnabatidis, D., Konstantinou, D., Sakellaropoulos, G.C., Nikiforidis, G.C. and Siablis, D. (2004) CT Angiography with Three-Dimensional Techniques for the Early Diagnosis of Intracranial Aneurysms. Comparison with Intra-Arterial DSA and the Surgical Findings. European Journal of Radiology, 49, 212-223. http://dx.doi.org/10.1016/S0720-048X(03)00173-6 [20] Kappelle, L.J. (2000) Small, Unruptured Intracranial Aneurysms and Management of Symptomatic Carotid Artery Stenosis. Neurology, 55, 307-309. http://dx.doi.org/10.1212/WNL.55.2.307
[1] Wakai, S., Fukushima, T., Furihata, T. and Sano, K. (1979) Association of Cerebral Aneurysm with Pituitary Adenoma. Surgical Neurology, 12, 503-507. [2] Jakubowski, J. and Kendall, B. (1978) Coincidental Aneurysms with Tumours of Pituitary Origin. Journal of Neurology. Neurosurgery & Psychiatry, 41, 972-979. http://dx.doi.org/10.1136/jnnp.41.11.972 [3] Pant, B., Arita, K., Kurisu, K., Tominaga, A., Eguchi, K. and Uozumi, T. (1997) Incidence of Intracranial Aneurysm Associated with Pituitary Adenoma. Neurosurgical Review, 20, 13-17.
http://dx.doi.org/10.1007/BF01390519 [4] Wang, C.-S., Yeh, T.-C., Wu, T.-C. and Yeh, C.-H. (2009) Pituitary Macroadenoma Co-Existent with Supraclinoid Internal Carotid artery Cerebral Aneurysm: A Case Report and Review of the Literature. Cases Journal, 2, 6459. http://dx.doi.org/10.4076/1757-1626-2-6459 [5] Ezzat, S., Asa, S.L., Couldwell, W.T., Barr, C.E., Dodge, W.E., Vance, M.L. and McCutcheon, I.E. (2004) The Prevalence of Pituitary Adenomas: A Systematic Review. Cancer, 101, 613-619.
http://dx.doi.org/10.1002/cncr.20412 [6] Locatelli, M., Spagnoli, D., Caroli, M., Isalberti, M., Branca, V., Gaini, S.M. and Lania, A. (2008) A Potential Catastrophic Trap: An Unusually Presenting Sellar Lesion. European Journal of Neurology, 15, 98-101. [7] Oh, M.C., Kim, E.H. and Kim, S.H. (2012) Coexistence of Intracranial Aneurysm in 800 Patients with Surgically Confirmed Pituitary Adenoma. Journal of Neurosurgery, 116, 942-947.
http://dx.doi.org/10.3171/2011.12.JNS11875 [8] du Boulay, G.H. (1965) Some Observations on the Natural History of Intracranial Aneurysms. British Journal of Radiology, 38, 721-757. http://dx.doi.org/10.1259/0007-1285-38-454-721 [9] van Lindert, E.J., Bocher-Schwarz, H.G. and Perneczky, A. (2001) The Influence of Surgical Experience on the Rate of Intraoperative Aneurysm Rupture and Its Impact on Aneurysm Treatment Outcome. Surgical Neurology, 56, 151-156. http://dx.doi.org/10.1016/S0090-3019(01)00547-X [10] Stoodley, M.A., Macdonald, R.L. and Weir, B.K. (1998) Pregnancy and Intracranial Aneurysms. Neurosurgery Clinics of North America, 9, 549-556. [11] Horsley, M., Taylor, T.K. and Sorby, W.A. (1997) Traction-Induced Rupture of an Extracranial Vertebral Artery Aneurysm Associated With Neurofibromatosis: A Case Report. Spine, 22, 225-227.
http://dx.doi.org/10.1097/00007632-199701150-00019 [12] Sahjpaul, R.L., Abdulhak, M.M., Drake, C.G. and Hammond, R.R. (1998) Fatal Traumatic Vertebral Artery Aneurysm Rupture. Journal of Neurosurgery, 89, 822-824.
http://dx.doi.org/10.3171/jns.1998.89.5.0822 [13] Tsuchida, T., Tanaka, R., Yokoyama, M. and Sato, H. (1983) Rupture of Anterior Communicating Artery Aneurysm during Transsphenoidal Surgery for Pituitary Adenoma. Surgical Neurology, 20, 67-70. http://dx.doi.org/10.1016/0090-3019(83)90110-6 [14] Suzuki, H., Muramatsu, M., Murao, K., Kawaguchi, K. and Shimizu, T. (2001) Pituitary Apoplexy Caused by Ruptured Internal Carotid Artery Aneurysm. Stroke, 32, 567-569.
http://dx.doi.org/10.1161/01.STR.32.2.567 [15] Berker, M. (2010) Overview of Vascular Complications of Pituitary Surgery with Special Emphasis on Unexpected Abnormality. Pituitary, 13, 160-167. http://dx.doi.org/10.1007/s11102-009-0198-7 [16] Paré, L., Delfino, R. and Leblanc, R. (1992) The Relationship of Ventricular Drainage to Aneurysmal Rebleeding. Journal of Neurosurgery, 76, 422-427. [17] Houkin, K. (1999) Intra-Operative Premature Rupture of the Cerebral Aneurysms. Analysis of the Causes and Management. Acta Neurochirurgica, 141, 1255-1263.
http://dx.doi.org/10.1007/s007010050428 [18] Liu, J.K., Das, K., Weiss, M.H., Laws, E.R. and Couldwell, W.T. (2001) The History and Evolution of Transsphenoidal Surgery. Journal of Neurosurgery, 95, 1083-1096.
http://dx.doi.org/10.3171/jns.2001.95.6.1083 [19] Karamessini, M.T., Kagadis, G.C., Petsas, T., Karnabatidis, D., Konstantinou, D., Sakellaropoulos, G.C., Nikiforidis, G.C. and Siablis, D. (2004) CT Angiography with Three-Dimensional Techniques for the Early Diagnosis of Intracranial Aneurysms. Comparison with Intra-Arterial DSA and the Surgical Findings. European Journal of Radiology, 49, 212-223. http://dx.doi.org/10.1016/S0720-048X(03)00173-6 [20] Kappelle, L.J. (2000) Small, Unruptured Intracranial Aneurysms and Management of Symptomatic Carotid Artery Stenosis. Neurology, 55, 307-309. http://dx.doi.org/10.1212/WNL.55.2.307