[Stenosis of the intracranial internal carotid artery by a craniopharyngioma: report of a case]

Abstract

Stenosis of the intracranial internal carotid artery by other tumors than meningiomas and pituitary adenomas is a rare occurrence. We present here a case with craniopharyngioma, which developed severe stenosis of the intracranial internal carotid artery 7 years following partial removal and irradiation. This severe stenosis of the intracranial internal carotid artery would result from combination of compression of the arterial walls against the surrounding bony structures and radiation effect on the arterial walls. A 29-year-old male was found to have a craniopharyngioma, which was treated by partial removal in 1971. He had suffered bilateral optic atrophy, right homonymous hemianopsia and panhypopituitarism. Angiography revealed elevation of the A-1 and opening of the carotid siphon on both sides. He had a course of 5,000 rads of Lineac irradiation in 1972. He showed no clinical improvement. He became totally blind in 1976. He was admitted again in 1979, because of left sided weakness and Korsakoff syndrome. Examination disclosed that there were bilateral optic atrophy, left hemiplegia with hyperreflexia and pathological reflexes, hypesthesia in the left side of the face and Korsakoff syndrome, chiefly consisting of confabulation. Angiography showed that the right internal carotid artery was markedly elevated and stenosed. The left internal carotid artery was elevated and the left A-1 was stenotic. The territory of the left distal anterior cerebral artery was filled from the anterior falx artery of the ophthalmic artery. The right A-1, M-1 and M-2 were filled through the left A-1. The territory of the right anterior cerebral artery was filled through the right posterior pericallosal artery and that of the right middle cerebral artery was partly filled through the posterior temporal and occipito-parietal arteries of the posterior cerebral artery. A right superficial temporal-middle cerebral artery bypass surgery was performed with some clinical improvement.