{"id":"99dc9090-ed18-4a92-8cb1-c41b298945e2","slug":"simultaneous-endoscopic-endonasal-treatment-of-a-gh-secreting-pitnet-and-paraclinoid-aneurysm-in-a-hybrid-operating-room-2d-operative-video","title":"Simultaneous endoscopic endonasal treatment of a GH-secreting PitNET and paraclinoid aneurysm in a hybrid operating room – 2D operative video","authors":["Juan Luis Gómez-Amador","Luis Alberto Rodriguez-Hernandez","Jorge Fernando Aragón-Arreola","Michel Gustavo Mondragón-Soto","Marco Antonio Munuzuri-Camacho","Jesús Tomás Moncada-Habib","Ariadna Domínguez-García","Gerardo Yoshiaki Guinto-Nishimura","Rodolfo Villalobos-Díaz"],"abstract":"Background: The coexistence of pituitary neuroendocrine tumor (PitNETs) and paraclinoid aneurysms is uncommon but clinically significant due to the risk of intraoperative rupture during transsphenoidal surgery. Hybrid operating rooms and advances in endoscopic endonasal techniques now permit the simultaneous treatment of both lesions in selected patients. Case Description: We present the case of a 61-year-old female who presented with progressive acral enlargement and intermittent headache. Neurological examination was unremarkable. Neuroendocrinological evaluation revealed elevated age-adjusted serum insulin-like growth factor 1 and growth hormone (GH) levels with preserved anterior pituitary function. Contrast-enhanced magnetic resonance imaging demonstrated a sellar mass consistent with a PitNET; within the lesion, a focal flow void suggested a vascular structure. Computed tomography angiography confirmed a left superior hypophyseal artery aneurysm projecting ventromedially into the sellar region. Given the risk of aneurysm rupture during tumor resection, we elected to perform simultaneous treatment of both lesions though an endoscopic endonasal approach in a hybrid operating room. The procedure included proximal balloon occlusion of the cavernous segment of the internal carotid artery, roadmapping-assisted clipping under direct endoscopic visualization, and intraoperative angiographic confirmation of aneurysm obliteration. Following aneurysm exclusion, gross total resection of the GH-secreting PitNET was achieved. The patient experienced an uneventful postoperative recovery. At 3-month follow-up, she demonstrated biochemical remission of acromegaly. Imaging confirmed complete aneurysm occlusion and total tumor resection. Conclusion: This case highlights the feasibility of simultaneous endoscopic endonasal aneurysm clipping and tumor resection in a hybrid operating room, avoiding staged procedures and minimizing morbidity. Close collaboration between surgical and endovascular teams is essential to optimize outcomes. Video Annotations: [ 1 - 6 ] 00:04 – Case presentation 00-40 – Neuroimaging findings 01:43- Rationale for the procedure 02:15 – Risks and benefits 02:51 – Alternative approaches 03:49 – Description of the setup 04:19 – Necessary equipment 04:49 – Key surgical steps 04:59 – Endonasal approach 05:46 – Proximal control 05:55 – Dural aperture 06:15 – Aneurysm clipping 06:27 – Tumoral resection 06:45 – Hemostasis and dural reconstruction 07:15 – Disease background 08:35 – Clinical outcome 08:57 – Imaging outcome Institutional review board approval is not required. The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. There are no conflicts of interest. The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI. http://dx.doi.org/10.25259/SNI_1251_2025 The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/placeholders/specialty/skull-base.png","publishDate":"2026-03-13T00:00:00.000Z","doi":"10.25259/SNI_1251_2025","categories":["Skull Base","Video Abstract"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/99dc9090-ed18-4a92-8cb1-c41b298945e2/pdf"}