- Department of Neurosurgery, St. Marianna University School of Medicine, Yokohama, Kanagawa, Japan
- Department of Neurosurgery, Kawasaki Municipal Tama Hospital, Yokohama, Kanagawa, Japan
- Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
Department of Neurosurgery, St. Marianna University School of Medicine, Yokohama, Kanagawa, Japan
DOI:10.4103/2152-7806.157795Copyright: © 2015 Ito H. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Ito H, Onodera H, Sase T, Uchida M, Morishima H, Oshio K, Shuto T, Tanaka Y. Percutaneous transluminal angioplasty in a patient with internal carotid artery stenosis following gamma knife radiosurgery for recurrent pituitary adenoma. Surg Neurol Int 28-May-2015;6:
How to cite this URL: Ito H, Onodera H, Sase T, Uchida M, Morishima H, Oshio K, Shuto T, Tanaka Y. Percutaneous transluminal angioplasty in a patient with internal carotid artery stenosis following gamma knife radiosurgery for recurrent pituitary adenoma. Surg Neurol Int 28-May-2015;6:. Available from: http://surgicalneurologyint.com/surgicalint_articles/percutaneous-transluminal-angioplasty-patient-internal/
Background:Intracranial vascular complications following radiosurgery are extremely rare.
Case Description:We report a case of stenosis in the internal carotid artery 5 years after gamma knife radiosurgery for a recurrent pituitary adenoma. Percutaneous transluminal angioplasty was performed successfully with anatomical and functional improvement.
Conclusion:These results suggested the importance of monitoring for arterial stenosis in the long-term follow-up. Moreover, this is the first case of endovascular treatment as an effective therapy for intracranial arterial stenosis due to radiotherapy.
Keywords: Angioplasty, endovascular treatment, gamma knife radiosurgery, internal carotid artery stenosis, pituitary adenoma
Gamma knife radiosurgery (GKS) has been considered as an effective and safe management strategy for recurrent pituitary adenoma.[
A 54-year-old male patient was admitted following a 3-month history of visual disturbance. He had no history of heart disease or metabolic disorder that could predispose to cerebrovascular complications. Neurological examination revealed a right homonymous hemianopia and decreased visual acuity. Magnetic resonance imaging (MRI) demonstrated a 5.0 × 5.3 cm pituitary tumor projecting toward the suprasellar region with encasement of both ICAs [
(a) Dosimetry of the GKS procedure. The marginal dose to the tumor margin was 15 Gy at the 50% isodose curve. (b) Isodose lines on the dosimetry planning showing the dose received by the intracavernous segment of the ICA, retrospectively (red line = 20-22 Gy isodose line, yellow line = 15 Gy isodose line)
Five years after the GKS, the MRA demonstrated severe stenosis of the cavernous segment of the right ICA with a remarkable reduction of the residual pituitary adenoma [
Pretreatment and posttreatment right ICA angiograms. The pretreatment angiogram indicating severe stenosis in the cavernous segment of the ICA (a, arrowhead). A microguidewire was advanced through the stenotic lesion and into the supraclinoid segment of the ICA. Inflation of a contrast-filled gateway PTA balloon (b, arrowhead) within the stenotic cavernous segment of the ICA dilated the vessel lumen, improving flow (c, arrowhead)
Several therapeutic options are recommended for the management of pituitary adenomas, for example, medical treatment, surgery, or radiotherapy.[
Accelerated atherosclerosis in the extracranial ICA is a well-recognized complication of irradiation for head and neck diseases.[
Intracranial vascular complications following radiosurgery seem to be extremely rare. The first case report of ICA stenosis after GKS was published by Ikeyama et al.[
Extracranial carotid artery angioplasty and stenting have clear advantages in treating patients with radiation-induced extracranial carotid artery stenosis.[
The resteonsis rate of a stenting for symptomatic intracranial stenosis has been reported to be from 7.5% to 30%,[
We reported a rare case of ICA stenosis 5 years after GKS for a recurrent pituitary adenoma. The irradiated vessels could be affected with stenosis in a delayed fashion; therefore, surveillance imaging should be performed even if the patient is asymptomaic up until that time. Endovascular angioplasty may most likely be the treatment of choice for steno-occlusive arteries following GKS.
The authors thank Robert E. Brandt, Founder, CEO, and CME, of MedEd Japan, for editing the manuscript.
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