Tan Lee A, Sandler Victoria, Todorova-Koteva Kristina, Levine Laurence, Lopes Demetrius K, Moftakhar Roham
Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
BMJ Case Rep. 2014 May 5;2014:bcr2014011233. doi: 10.1136/bcr-2014-011233.
Giant aneurysms arising from the cavernous internal carotid artery (ICA) can mimic pituitary adenomas and may cause pituitary dysfunction due to their mass effect on the pituitary gland. We report a case of a 56-year-old man presenting with impotence, fatigue and panhypopituitarism who was found to have a giant unruptured aneurysm arising from the right cavernous ICA with severe mass effect on the pituitary gland. The patient underwent endovascular treatment of the giant aneurysm using two telescoping Surpass flow-diverting stents. At 6-month follow-up, repeat cerebral angiography showed Raymond grade II occlusion of the aneurysm with a small neck remnant. At the 10-month follow-up the patient showed full recovery of his pituitary function and clinical resolution of impotence and fatigue. This is the first report of occlusion of a giant cavernous carotid aneurysm using next generation Surpass flow-diverting stents leading to complete recovery of pituitary function.
起源于海绵窦段颈内动脉(ICA)的巨大动脉瘤可酷似垂体腺瘤,并可能因其对垂体的占位效应而导致垂体功能障碍。我们报告一例56岁男性患者,表现为阳痿、乏力和全垂体功能减退,经检查发现其右侧海绵窦段颈内动脉有一个巨大未破裂动脉瘤,对垂体有严重占位效应。该患者使用两枚重叠的Surpass血流导向支架对巨大动脉瘤进行了血管内治疗。在6个月的随访中,重复脑血管造影显示动脉瘤呈Raymond II级闭塞,有一小段残颈。在10个月的随访中,患者垂体功能完全恢复,阳痿和乏力的临床症状消失。这是首例使用新一代Surpass血流导向支架闭塞巨大海绵窦段颈动脉动脉瘤并使垂体功能完全恢复的报告。