title: [Treatment of a ruptured giant internal carotid artery pseudoaneurysm following transsphenoidal surgery: case report and literature review].
abstract: We report here a case of giant internal carotid artery (ICA) pseudoaneurysm as a complication of transsphenoidal surgery. This 50-year-old acromegalic male presented to our clinic with a status of hypovolemic shock due to serious epistaxis. Neuroradiological examinations at his admission revealed a giant aneurysm in the right cavernous portion projecting into the sphenoid sinus. Eight years before this presentation, he had undergone a transsphenoidal surgery for growth hormone producing pituitary tumor at the other clinic. Then intraoperative arterial bleeding was reported, probably as a result of carotid injury. His medical history and radiological findings suggested that his epistaxis resulted from a rupture of the iatrogenic pseudoaneurysm which had gradually grown after the ICA injury at the previous surgery over 8 years. Emergent coil embolization using Guglielmi detachable coils (GDCs) resulted in a successful homeostasis. Major part of the aneurysm dome was obliterated via the intervention, however small part of the aneurysm neck was unable to be obliterated due to a technical difficulty. His postoperative course was favorable, but he suffered from a recurrence of serious epitaxis 4 weeks after the embolization. Emergent angiography suggested a rupture of the un-obliterated aneurysm neck remnant. Thus, trapping of the aneurysm combined with high flow bypass was necessitated. Relevant literatures are reviewed, and possible therapeutic strategies for this rare lesion are discussed.
authors.affiliation: Department of Neurosurgery, National Hospital Organization Himeji Medical Center, Himeji City, Hyogo, Japan. hattorii@hmj.hosp.go.jp
authors.forename: Itaro
authors.initials: I
authors.lastname: Hattori
authors.forename: Koichi
authors.initials: K
authors.lastname: Iwasaki
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Horikawa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tanji
authors.forename: Masanori
authors.initials: M
authors.lastname: Gomi
mesh_terms: D017541:Aneurysm, False / Q000209:etiology* / Q000628:therapy; D017542:Aneurysm, Ruptured / Q000209:etiology* / Q000628:therapy; D002340:Carotid Artery Diseases / Q000209:etiology* / Q000628:therapy; D020212:Carotid Artery Injuries / Q000150:complications; D002343:Carotid Artery, Internal; D004621:Embolization, Therapeutic; D004844:Epistaxis / Q000209:etiology; D006801:Humans; D007016:Hypophysectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery; D011183:Postoperative Complications