J Korean Neurosurg Soc.  2014 Mar;55(3):160-163. 10.3340/jkns.2014.55.3.160.

Large Intracranial Aneurysm after Transsphenoidal Surgery for Pituitary Macroadenoma

• Yoon KW
• Cho CS
• Lee SK

• KMID: 2191083
• DOI: http://doi.org/10.3340/jkns.2014.55.3.160

Abstract

Uncontrolled cerebrospinal fluid (CSF) leakage after transsphenoidal surgery (TSS) for pituitary adenoma can lead to meningitis. Intracranial mycotic pseudoaneurysm is a rare complication in central nervous system infection. Large single pseudoaneurysm is more uncommon. Most mycotic aneurysms occur due to endocarditis. The present patient had no heart problem and was infected by CSF leakage after transsphenoidal surgery. We present a case of large ruptured mycotic pseudoaneurysm as a complication of cerebral infection after TSS for pituitary macroadenoma.

Keyword

Intracranial aneurysm; Transsphenoidal surgery; Pituitary macroadenoma

MeSH Terms

Aneurysm, False
Aneurysm, Infected
Central Nervous System Infections
Cerebrospinal Fluid
Endocarditis
Heart
Humans
Intracranial Aneurysm*
Meningitis
Pituitary Neoplasms

Figure

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  Fig. 1 A : Preoperative sellar MRI (sagittal view) shows suprasella mass (1.4×1.0×1.6 cm) with heterogenous enhancement and fluid-fluid level, implying focal hemorrhage. B : Preoperative enhanced MRI (axial view) shows no evidence of right posterior cerebral artery aneurysm (arrow).

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  Fig. 2 Brain CT (axial view) presents an acute subarachnoid hemorrhage and intraventricular hemorrhage.

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  Fig. 3 Conventional cerebral angiography (anteroposterior and lateral view) shows a large pseudoaneurysm at right posterior cerebral artery.

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  Fig. 4 Postoperative cerebral angiography (anteroposterior and lateral view) shows total occlusion of pseudoaneurysm at right posterior cerebral artery.

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