title: Endoscopic extracapsular removal of pituitary adenoma: the importance of pretreatment of an adjacent unruptured internal carotid artery aneurysm.
abstract: The presence of an intracranial aneurysm together with a pituitary adenoma presents tremendous risk of subarachnoid hemorrhage, during transsphenoidal surgery, particularly when the aneurysm lies near the operative field. A left supraclinoid internal carotid artery aneurysm and a clinically nonfunctioning pituitary adenoma coexisted in a 57-year-old woman. Initially, the aneurysm was treated by endovascular coil placement, and then the patient underwent pseudocapsule-based extracapsular resection of the pituitary tumor via a transnasal transsphenoidal endoscopic approach. Pseudocapsule-based extracapsular total resection was safely performed, because of the extirpated risk of rupture of the coil-treated aneurysm. Recently, transsphenoidal pseudocapsule-based extracapsular resection approach for pituitary adenomas provides a more effective and safe alternative compared to the traditional intracapsular one because of its higher tumor removal and remission rates and lower recurrence rate. Compared with conventional subcapsular removal, pseudocapsule-based extracapsular resection has more risks of aneurysmal rupture that is located adjacent to pituitary adenoma. Thus, in a patient having a cerebral aneurysm with the proximity to the operative field, the cerebral aneurysm should be first treated with endovascular coil placement or direct surgical procedure; subsequently, pseudocapsule-based extracapsular resection of the pituitary tumor via a transnasal transsphenoidal endoscopic approach should be performed.
authors.affiliation: Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba 299-0111, Japan.
authors.forename: So
authors.initials: S
authors.lastname: Yamada
authors.forename: Shoko M
authors.initials: SM
authors.lastname: Yamada
authors.forename: Toshio
authors.initials: T
authors.lastname: Hirohata
authors.forename: Yudo
authors.initials: Y
authors.lastname: Ishii
authors.forename: Katsumi
authors.initials: K
authors.lastname: Hoya
authors.forename: Mineko
authors.initials: M
authors.lastname: Murakami
authors.forename: Akira
authors.initials: A
authors.lastname: Matsuno