Carotid Artery Aneurysm

Abstract

Pituitary tumor apoplexy refers to a clinical syndrome consisting of a constellation of signs and symptoms that occur as a result of hemorrhage or infarction of a preexisting adenoma. These clinical manifestations can closely resemble those patients presenting with subarachnoidal hemorrhage secondary to aneurysmal rupture (sudden and severe headache, diplopia, impaired consciousness, and meningismus). Special attention has to be paid in all the preoperative laboratory and radiological findings to do the correct diagnosis and treatment. Furthermore, the association between pituitary adenoma and adjacent aneurysms is not uncommon (co-occurrence rate of 7.4 %). This relation between cerebral aneurysms and pituitary adenomas will be discussed. Particularly, intracavernous internal carotid artery (ICA) aneurysms can extend into the sella turcica, and their radiological appearance can simulate pituitary macroadenomas. These intrasellar aneurysms are usually asymptomatic, although they can sometimes present with hypopituitarism. However, ICA aneurysm rupture or pituitary apoplexy is extremely rare. A review of the literature will be presented. Angio-CT, MRI, or angiogram is extremely helpful before the surgical treatment is performed to rule out a vascular lesion. Differential radiological appearance will be extensively discussed. When treating intrasellar masses with the slightest suspicion of a nonpituitary origin, further workup should be considered. The possibility of a vascular lesion simulating a pituitary adenoma should always be considered by neurosurgeons and ear, nose, and throat surgeons operating in the sellar region