Holdaway Matthew, Huda Shayan, D'Amico Randy S, Boockvar John A, Langer David J, McKeown Amy, Ben-Shalom Netanel
Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra New York, NY, United States; Albany Medical College, Albany, NY, United States.
Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra New York, NY, United States; CUNY School of Medicine, New York City, NY, United States.
J Clin Neurosci. 2023 Nov;117:46-53. doi: 10.1016/j.jocn.2023.09.012. Epub 2023 Sep 25.
Rarely, Pituitary adenomas (PA) can co-occur with intrasellar or intracavernous aneurysms. There is currently no clear guidance for the management of this dual pathology. We attempt to provide an algorithm to help guide clinical decision making for treatment of PAs co-occurring with adjacent cerebral aneurysms.
A comprehensive literature search was conducted following PRISMA guidelines using various databases. Search terms included "(Pituitary Adenoma OR Prolactinoma OR Macroadenoma OR Adenoma) AND (ICA OR Internal Carotid Artery OR paracliniod OR clinoid) Aneurysm AND (Intra-cavernous OR intracavernous OR intrasellar OR Cavernous)."
A total of 24 studies with 24 patients were included. Twelve (50%) patients experienced visual symptoms. Ten patients (42%) had an aneurysm embedded within the adenoma. Fourteen patients (58%) had an aneurysm adjacent to the adenoma. Embedded aneurysms were significantly associated with rupture events.
Vision loss is the most pressing determinant of treatment. In the absence of visual symptoms, the aneurysm should be treated first by coil embolization. If not amenable to coiling, place flow diverting stent followed by six months of anticoagulation and antiplatelet therapy. If visual loss is apparent, the adenoma-aneurysm spatial relationship becomes critical. In cases of an adjacent aneurysm, the adenoma should be removed transsphenoidally with extreme care and aneurysm rupture protocols in place. If the aneurysm is embedded within the adenoma, then a BTO is favored with permanent ICA occlusion followed by transsphenoidal resection if adequate collateral supply is demonstrated. If there is inadequate collateral supply, then an open-approach for amenable aneurysms with transcranial adenoma debulking should be performed.
垂体腺瘤（PA）极少会与鞍内或海绵窦内动脉瘤同时出现。目前对于这种双重病变的管理尚无明确指导。我们试图提供一种算法，以帮助指导对与相邻脑动脉瘤同时存在的垂体腺瘤的治疗决策。
按照PRISMA指南，使用各种数据库进行了全面的文献检索。检索词包括“（垂体腺瘤或催乳素瘤或大腺瘤或腺瘤）与（颈内动脉或颈内动脉或床突旁或床突）动脉瘤以及（海绵窦内或海绵窦内或鞍内或海绵窦）”。
共纳入24项研究中的24例患者。12例（50%）患者有视觉症状。10例（42%）患者的动脉瘤嵌入腺瘤内。14例（58%）患者的动脉瘤与腺瘤相邻。嵌入性动脉瘤与破裂事件显著相关。
视力丧失是治疗的最紧迫决定因素。在没有视觉症状的情况下，应首先通过弹簧圈栓塞治疗动脉瘤。如果不适合进行弹簧圈栓塞，则放置血流导向支架，随后进行六个月的抗凝和抗血小板治疗。如果出现明显的视力丧失，腺瘤 - 动脉瘤的空间关系就变得至关重要。对于相邻动脉瘤的情况，应极其小心地经蝶窦切除腺瘤，并制定动脉瘤破裂预案。如果动脉瘤嵌入腺瘤内，那么倾向于采用球囊闭塞试验（BTO）并永久性闭塞颈内动脉，若证明有足够的侧支供应，则随后进行经蝶窦切除术。如果侧支供应不足，则应对适合的动脉瘤采用开放入路并进行经颅腺瘤减瘤术。
