title: Pituitary macroadenoma causing symptomatic internal carotid artery compression: surgical treatment through transsphenoidal tumor resection.
abstract: Pituitary macroadenomas can invade the cavernous sinus and rarely cause occlusion of the internal carotid artery (ICA). Most patients with symptomatic obstruction of the ICA by a pituitary tumor have been reported as a result of apoplexy. The authors review the literature about this condition and report a 48-year-old man who presented with transient ischemic attacks leading to a stroke. Imaging studies demonstrated complete occlusion of the left ICA and critical narrowing of the right ICA at the level of the clinoid processes, most likely due to macroadenoma mass effect. There was no radiologic evidence of apoplexy. Surgical resection of the tumor and ICA decompression via the transsphenoidal route resulted in prevention of further symptoms. Histopathologic analysis confirmed a nonfunctioning pituitary adenoma without evidence of hemorrhage or intratumoral infarction. This patient, to the authors' knowledge, is the first documented patient with symptomatic carotid compression by a pituitary adenoma without evidence of apoplexy.
authors.affiliation: Department of Neurosurgery, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rey-Dios
authors.affiliation: Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, 355 West 16th Street, Suite 5100, Indianapolis, IN 46202, USA.
authors.forename: Troy D
authors.initials: TD
authors.lastname: Payner
authors.affiliation: Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, 355 West 16th Street, Suite 5100, Indianapolis, IN 46202, USA. Electronic address: acohenmd@gmail.com.
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Cohen-Gadol
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D001921:Brain / Q000473:pathology; D002343:Carotid Artery, Internal / Q000473:pathology; D016893:Carotid Stenosis / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D020521:Stroke / Q000209:etiology / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Brain ischemia; Carotid stenosis; Pituitary adenoma; Transsphenoidal resection