STA-MCA Bypass as a "Bridge" to Pituitary Surgery in a Patient with an Adenoma Occluding the Internal Carotid Artery: Case Report and Review of the Literature.

Luigi A Lanterna,Emanuele Costi,Carlo Brembilla,Paolo Gritti,Antonio Signorelli,Claudio Bernucci,Gianluigi Dorelli

doi:10.1155/2015/359586

Abstract

Occlusion of the intracranial internal carotid artery (ICA) by a pituitary adenoma with resulting cerebral ischemia is a very rare but devastating occurrence. The authors present a case in which a condition of symptomatic ICA occlusion due to a giant pituitary adenoma was successfully treated using a preliminary extraintracranial bypass as a “bridge” to the tumor removal. A 52-year-old patient presented with a minor stroke followed by pressure-dependent transient ischemic attacks consistent with a condition of hypoperfusion. MR imaging and a digital subtraction angiography revealed a pituitary adenoma occluding the ICA on the right side. He underwent a superficial temporal artery to middle cerebral artery (STA-MCA) bypass with the aim of revascularizing the ischemic hemisphere and reducing the risk of perioperative stroke or stroke evolution. The patient was subsequently operated on to remove the adenoma through a transsphenoidal approach. The postoperative course was uneventful and the patient has suffered no further ischemic events. When there are no emergency indications to decompress the optical pathways but the patient is at risk of impending stroke because of ICA occlusion, a two-step strategy consisting of a bypass and subsequent removal of the pituitary adenoma may be a valuable option.

Highlights

The association of internal carotid artery (ICA) occlusion and pituitary tumors is a very rare occurrence that has been described in only a handful of case reports [1, 2]
We report the case of a patient with a pituitary adenoma causing symptomatic ICA
Mechanical obstruction of the ICA by the expansion of a pituitary adenoma is a very unusual but potentially devastating event where eye-saving and oncological priorities intermingle with a high risk of ischemic stroke and fatality

Summary

Introduction

The association of internal carotid artery (ICA) occlusion and pituitary tumors is a very rare occurrence that has been described in only a handful of case reports [1, 2]. The ICA occlusion has been attributed to the extrinsic compression exerted by the tumor on the artery that lies in the confined parasellar space. The management strategy has ranged from a conservative approach to attacking the tumor directly. In no case has the option of treating the ischemic risk first and tackling the tumor in a safer setting been considered. We report the case of a patient with a pituitary adenoma causing symptomatic ICA occlusion in whom we decided to perform a cerebral bypass as a “bridge” to the removal of the adenoma, and we review the literature

Case Report

Discussion

Findings

Conflict of Interests