Management of Coincident Pituitary Macroadenoma and Cavernous Carotid Aneurysm: A Systematic Literature Review

Abstract

Introduction Pituitary adenomas are a common intracranial pathology with an incidence of 15 to 20% in the population while cerebral aneurysms are less common with a prevalence of 1:50 patients. The incidence of aneurysms in patients with pituitary adenoma has been estimated at 2.3 to 5.4% of patients; however, this remains unclear. Equally, the management of concomitant lesions lacks significant understanding. Methods A case report is presented of a concomitant cerebral aneurysm and pituitary adenoma managed by minimally invasive endovascular and endoscopic methods, respectively. A systematic review of the literature for terms "pituitary adenoma" and "aneurysm" yielded 494 studies that were narrowed to 19 relevant articles. Results We report a case of a 67-year-old patient with an enlarging pituitary macroadenoma, cavernous carotid aneurysm, and unilateral carotid occlusion. After successful treatment of the aneurysm by a pipeline flow diverter, the pituitary adenoma was surgically resected by an endoscopic transsphenoidal approach. Conclusion The use of a pipeline flow diverter and endonasal approach was feasible in the treatment of our patient. This is the first report to our knowledge of the use of pipeline flow diversion in the management of a cavernous carotid aneurysm prior to pituitary adenoma treatment.

Keywords: cavernous carotid aneurysm; endoscopic; intracranial aneurysm; macroadenoma; pipeline; pituitary adenoma; transphenoidal.

Fig. 1

PRISMA flowchart describing the methods of literature review in this study. PRISMA, The Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Fig. 2

Preoperative MRI and angiogram views of concomitant pituitary adenoma and internal carotid artery aneurysm. Preoperative ( A ) coronal and ( B ) sagittal T1 contrast enhanced imaging demonstrates a pituitary macroadenoma with expansion of the sella (arrow). The left sided cavernous segment aneurysm can be noted as a flow void (arrowhead). ( C ) Anteroposterior and ( D ) lateral cerebral angiogram views demonstrate a medial projecting cavernous segment aneurysm.

Fig. 3

Diagnostic cerebral angiogram demonstrating complete occlusion of a medial internal carotid artery aneurysm. (A) Anteroposterior and ( B ) lateral cerebral angiogram views demonstrates a medially projection cavernous segment (arrow) along with the limits of a Pipeline flow diverter (arrowhead). 6-month follow-up ( C ) anteroposterior and ( D ) lateral cerebral angiogram views demonstrate resolution of the aneurysm (arrow).