Simultaneous resection of pituitary adenoma and clipping of aneurysm through endoscopic endonasal approach: a case report

Abstract

Pituitary adenomas and intracranial aneurysms are prevalent neurosurgical conditions, but their simultaneous presence is uncommon, affecting only 0.5%-7.4% of those with pituitary adenomas. The strategy of treating aneurysms endovascularly before removing pituitary adenomas is widely adopted, yet reports on addressing both conditions at once through an endoscopic endonasal approach (EEA) are scarce. We present a case involving a pituitary adenoma coupled with an anterior communicating artery aneurysm. Utilizing the EEA, we excised the adenoma and clipped the aneurysm concurrently. The patient recovered well post-surgery, with follow-up assessments confirming the successful resolution of both the adenoma and aneurysm. We proved the feasibility of the EEA in the treatment of pituitary adenomas with anterior communicating artery aneurysms under specific anatomical relationships and close intraoperative monitoring.

Keywords: clipping; endoscopic endonasal approach; intracranial aneurysm; pituitary adenoma; surgical technique.

Figure 1

Preoperative imaging examination of the reported patient. Left and Middle: Sagittal and coronal T1 MR imaging after injection of gadolinium. Both pictures showed massive masses in the sellar fossa and suprasellar cistern. Right: Computed Tomography Angiography (CTA) showed an aneurysm at the anterior edge of the anterior communicating artery, with a diameter of about 0.5cm.

Figure 2

Intraoperative nasal endoscopic images of the reported patient. Left: After resection of sellar region masses and opening of dura mater, it can be seen that the aneurysm was located in the anterior communicating artery. Right: The aneurysm neck was clamped with 3 aneurysm clips and the bilateral A2 filled well.

Figure 3

Imaging examination of the reported patient after operation. Left and Middle: Pituitary enhanced MRI showed complete removal of sellar region lesion 3 days after operation. Right: Catheter-based cerebral angiography indicated no obvious abnormality after clipping of anterior communicating artery aneurysm.

Figure 4

The detailed images reexamined 6 months after operation. Left and Middle: Pituitary enhanced MRI showed no recurrence of the pituitary adenoma 6 months after operation. Right: Computed Tomography Angiography (CTA) 6 months after operation showed the aneurysm was well clipped.