The Clinical Feature?Diagnosis And Treatment Strategy Of Pituitary Adenoma Associated With Intracranial Aneurysm

Purpose:To explore the clinical manifestations,the diagnosis and treatment strategy of pituitary adenoma associated with intracranial aneurysm.Methods:We retrospectively reviewed the patients with pituitary adenoma associated with intracranial aneurysm admitted to our institution from July 1,2014 to June 31,2018.Six cases of pituitary adenoma associated with intracranial aneurysm are included in present study.One case presented with aneurysms located at ophthalmic segment of bilateral ICA.This patient underwent endovascular treatment of intracranial aneurysms,followed by endoscopic trans-sphenoidal surgery for pituitary adenoma.Two of them coexisted with aneurysms at ophthalmic segment of right side ICA.Both of the aneurysm were treated endovascularly before endoscopic trans-sphenoidal surgery for pituitary adenomas.One aneurysm was detected at cavernous sinus segment of ICA by follow-up MRI image after pituitary adenoma and was managed conservatively.One patient refused surgical treatment,who had pituitary adenoma embedded with aneurysm at cavernous sinus segment of ICA.One patient with anterior communicating artery aneurysm underwent pituitary adenoma resection,followed by aneurysm clipping.Results:Six patients diagnosed with pituitary macroadenoma associated with intracranial aneurysms were enrolled in present study.Three of them underwent endovascular treatment of intracranial aneurysms,followed by endoscopic trans-sphenoidal surgery for pituitary adenomas.Post-operational MRI and DSA examination have not demonstrated reoccurrence of either pituitary adenoma or aneurysm.One patient who were detected with an aneurysm at cavernous sinus segment of ICA by follow-up MRI and was managed conservatively.Follow-up MRI and MRA image did not show recurrence of the pituitary adenoma or significant growth of the aneurysm.One patient who refused surgery was lost follow-up.One case initially considered as pituitary adenoma apoplexy,who was actually caused by the rupture of anterior communicating artery aneurysm embedded in the pituitary adenoma.This patient had unfavorable prognosis for lung infection although the surgery for aneurysm and pituitary adenoma were successfully performed.Conclusion:MRA examination is recommended for patients of pituitary tumor with high risk factors,and angiography diagnosis is also needed if necessary,in order to reduce the miss rates of the pituitary tumor with aneurysm.The flowing void on the weighted sequence of T1 and T2 of MRI is an important feature for patients who have pituitary adenoma associated with intracranial aneurysm.If the patient of pituitary adenoma manifested as pituitary adenoma apoplexy or SAH,aneurysm should be considered.For these patients,the treatment options should be based on the size,position and shape of pituitary tumor and aneurysm.If treated properly,patients with pituitary adenomas associated with aneurysm can have good prognosis.