Stent-Assisted Coil Embolization for a Ruptured Posterior Communicating Artery Pseudoaneurysm After Endoscopic Transsphenoidal Surgery for Pituitary Adenoma

Abstract

Intracranial pseudoaneurysm is a rare complication of endoscopic endonasal surgery. Herein, we describe 2-staged stent-assisted coil embolization for posterior communicating artery pseudoaneurysm after endoscopic endonasal surgery for pituitary adenoma. A 68-year-old man had a history of severe adult growth hormone secretion deficiency, requiring growth hormone replacement therapy; secondary adrenocortical hypofunction; hyperthyroidism; hypertension; constipation; glaucoma; and hyperuricemia. Five years ago, after initial endoscopic transsphenoidal surgery for pituitary adenoma, he was hospitalized for reoperation. Posterior communicating artery injury was observed during second endoscopic transsphenoidal surgery, and pressure hemostasis was performed using a hemostatic preparation. Immediately post surgery, a localized subarachnoid hemorrhage was observed. Sudden-onset impaired consciousness and respiratory disturbances ensued on postoperative day 7, and computed tomography of the head was performed. Recurrent subarachnoid hemorrhage was confirmed, and acute hydrocephalus secondary to third ventricular blockage was identified. Cerebral angiography was performed after urgent bilateral cerebral ventricular drainage under general anesthesia. A pseudoaneurysm was identified in the left posterior communicating artery, and coil embolization was performed. Six weeks post surgery, a low-profile visualized intraluminal stent called an LVIS Jr. stent was placed in the posterior communicating artery. Recurrence of the aneurysm was not detected 6 months post surgery. He underwent lumboperitoneal shunting for secondary normal pressure hydrocephalus after dual antiplatelet therapy discontinuation and is being followed up as an outpatient with a modified Rankin scale score of 2 ten months post surgery. Two-staged stent-assisted coil embolization using a low-profile visualized intraluminal stent was effective for a posterior communicating artery pseudoaneurysm occurring after posterior communicating artery injury following endoscopic transsphenoidal surgery for follicle-stimulating hormone-producing pituitary adenoma.