Giant cavernous carotid aneurysm causing pituitary dysfunction: Pituitary function recovery with high-flow bypass.

Area of Science:

• Neurosurgery
• Vascular Surgery
• Endocrinology

Background:

• Giant internal carotid artery (ICA) aneurysms extending to the sellar region are rare.
• These aneurysms can mimic pituitary tumors and cause pituitary dysfunction.
• Conventional treatments for these aneurysms often struggle to restore endocrine function.

Observation:

• A 56-year-old man presented with a giant ICA aneurysm causing pituitary impairment and consciousness disturbance due to hyponatremia.
• The patient underwent a high-flow bypass from the cervical external carotid artery to the middle cerebral artery with ICA ligation.
• Pituitary function recovered well one year post-operation, with sustained recovery for 8 years without hormone replacement.

Findings:

• High-flow bypass using a radial artery graft can effectively treat giant ICA aneurysms.
• This surgical approach can prevent aneurysm rupture.
• Restoration of pituitary function is achievable with this treatment.

Implications:

• Giant ICA aneurysms should be considered in the differential diagnosis of hypopituitarism.
• High-flow bypass offers a viable treatment option for preserving and restoring pituitary function in cases of giant ICA aneurysms.
• This approach highlights the potential for successful surgical management of complex cerebrovascular and endocrine conditions.