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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
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Ruptured aneurysm-induced pituitary apoplexy: illustrative case
Michiharu Yoshida1, Takeshi Hiu1, Shiro Baba1
1Departments of Neurosurgery.
Journal of Neurosurgery. Case Lessons
|July 20, 2022
Summary
Pituitary apoplexy from a ruptured brain aneurysm is rare. Prompt diagnosis and treatment of the aneurysm before pituitary apoplexy management are crucial for improved outcomes.
Area of Science:
- Neuroendocrinology
- Neuroradiology
- Neurosurgery
Background:
- Pituitary apoplexy is a rare endocrine emergency.
- Ruptured aneurysms within pituitary adenomas are exceptionally uncommon.
- Misdiagnosis as primary pituitary adenoma apoplexy can occur.
Observation:
- A 78-year-old male presented with sudden headache and vision loss.
- MRI revealed a giant pituitary tumor with abnormal signals and an associated right A1 segment aneurysm.
- Urgent transsphenoidal surgery for pituitary apoplexy was performed, followed by successful aneurysm embolization.
Findings:
- Preoperative MRI demonstrated contrast extravasation from the aneurysm into the pituitary adenoma.
- Histopathology confirmed a gonadotroph adenoma with hemorrhagic necrosis.
- Postoperative improvement in the patient's visual function was noted.
Implications:
- This case highlights the importance of considering aneurysmal rupture in pituitary apoplexy differentials.
- MRI is crucial for identifying pituitary apoplexy secondary to aneurysmal rupture.
- Prioritizing aneurysm treatment over pituitary apoplexy management is recommended.
Keywords:
CT = computed tomographyGH = growth hormoneMRI = magnetic resonance imagingPRL = prolactinSAH = subarachnoid hemorrhageanterior cerebral artery aneurysmnonfunctioning pituitary adenomapituitary apoplexyruptured aneurysmMore Related Videos
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