title: Expanded endonasal endoscopic approach for resection of a growth hormone-secreting pituitary macroadenoma coexistent with a cavernous carotid artery aneurysm.
abstract: The co-existence of pituitary adenomas (PA) and carotid artery aneurysms has been described and may be particularly frequent in acromegaly. The co-occurrence of an intracranial aneurysm in the setting of a PA presents significant risk to the patient, particularly when the aneurysm is within or near the operative field. We describe a 48-year-old, right-handed female patient with a large skull base lesion who had a left cavernous carotid artery aneurysm detected on her preoperative imaging studies. This patient was managed using a staged approach. She first underwent endovascular stent-assisted coiling of the aneurysm followed, six months later, by resection of the tumor via an expanded endonasal endoscopic approach. Histopathological analysis revealed a pituitary macroadenoma with neuronal metaplasia. Angiographic embolization followed by an expanded endonasal endoscopic approach is a safe and effective treatment for such lesions. Vascular imaging studies and a low index for suspicion are required for preoperative identification of such complex situations.
authors: Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
authors: Xuewei
authors: X
authors: Xia
authors: Murugappan
authors: M
authors: Ramanathan
authors: Brent A
authors: BA
authors: Orr
authors: Vafi
authors: V
authors: Salmasi
authors: Roberto
authors: R
authors: Salvatori
authors: Douglas D
authors: DD
authors: Reh
authors: Gary L
authors: GL
authors: Gallia
mesh_terms: D000236:Adenoma / Q000150:complications / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000150:complications / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D013006:Growth Hormone / Q000378:metabolism*; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010902:Pituitary Gland / Q000473:pathology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery*
chemical_list: D013006:Growth Hormone