title: Subarachnoid Hemorrhage Due to Rupture of an Intracavernous Carotid Artery Aneurysm Coexisting with a Prolactinoma under Cabergoline Treatment.
abstract: We report an unusual case of subarachnoid hemorrhage caused by intraoperative rupture of an intracavernous carotid artery aneurysm coexisting with a prolactinoma. A 58-year-old man presenting with diplopia was found to have a left intracavernous carotid artery aneurysm encased by a suprasellar tumor on magnetic resonance imaging. His serum prolactin level was 5036 ng/mL. Proximal ligation of the left internal carotid artery with a superficial temporal artery to middle cerebral artery anastomosis was scheduled. Because the patient's diplopia had deteriorated, we started him on cabergoline at a dose of 0.25 mg once a week. One month after administration of cabergoline, the diplopia was improved to some extent and serum prolactin was decreased to 290 ng/ml. Six weeks after starting the cabergoline, the patient underwent a left frontotemporal craniotomy to treat the aneurysm. When the dura mater was opened, abnormal brain swelling and obvious subarachnoid hemorrhage were observed. Postoperative computed tomography demonstrated a thick subarachnoid hemorrhage. This case suggests that medical therapy for a pituitary adenoma should be started after treatment for a coexisting intracavernous aneurysm is completed.
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Akutsu
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
authors.forename: Kohkichi
authors.initials: K
authors.lastname: Hosoda
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Ohta
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
authors.forename: Hirotomo
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Taniguchi
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kohmura
keywords: cabergoline; intracavernous aneurysm; prolactinoma; subarachnoid hemorrhage
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