Treatment of an anterior cerebral artery pseudoaneurysm secondary to a transsphenoidal surgery using stent-assisted coiling
- Department of Neurosurgery, Moriyama Memorial Hospital, Edogawa, Tokyo, Japan.
DOI:10.25259/SNI_860_2020Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Atsushi Ishida, Keizoh Asakuno, Masataka Kato, Hideki Shiramizu, Haruko Yoshimoto, Hikari Sato, Ko Nakase, Masahiro Hirayama, Seigo Matsuo, Shozo Yamada. Treatment of an anterior cerebral artery pseudoaneurysm secondary to a transsphenoidal surgery using stent-assisted coiling. 13-Jan-2021;12:20
How to cite this URL: Atsushi Ishida, Keizoh Asakuno, Masataka Kato, Hideki Shiramizu, Haruko Yoshimoto, Hikari Sato, Ko Nakase, Masahiro Hirayama, Seigo Matsuo, Shozo Yamada. Treatment of an anterior cerebral artery pseudoaneurysm secondary to a transsphenoidal surgery using stent-assisted coiling. 13-Jan-2021;12:20. Available from: https://surgicalneurologyint.com/surgicalint-articles/10519/
Background: Injury of the internal carotid artery (ICA) during transsphenoidal surgery (TSS) is a rare but critical complication. There are several reports on endovascular treatment of ICA injury during TSS. With the recent flourishing of extended TSS, injuries to the distal arteries such as the anterior cerebral artery (ACA) are more likely to occur.
Case Description: In the present case, we report a pseudoaneurysm of the right ACA due to injury during extended TSS for aggressive prolactinoma. Due to the absence of collateral vessels, the pseudoaneurysm had to be obliterated while preserving the parent artery. Hence, we decided to treat the pseudoaneurysm using stent-assisted coiling (SAC). The pseudoaneurysm was completely obliterated and he was discharged without any complications.
Conclusion: To the best of our knowledge, this is the first case in which an ACA pseudoaneurysm caused by injury during the TSS was treated with SAC and the parent artery was preserved.
Keywords: Anterior cerebral artery, Parent artery preservation, Pseudoaneurysm, Stent-assisted coiling, Transsphenoidal surgery
Injuries of the cerebral arteries are the most severe and critical complications of the transsphenoidal surgery (TSS).[
A 53-year-old man with aggressive dopamine-resistant prolactinoma had undergone TSS in another hospital a year ago. Most of the tumor was left untouched due to the close proximity of the ICAs and an insufficient operative field [
(a) Preoperative magnetic resonance (MR) imaging shows a large sellar tumor with upward and bilateral extensions. (b) Endoscopic view shows arterial bleeding from the injured vessel (arrow). (c) Postoperative computed tomography angiography shows flow impairment around the lesion. (d) Diffusion- weighted imaging shows infarction of its perfusion area. MR angiography on day 1 (e), day 3 (f), day 7 (g), and 1 month later (h) shows dramatic changes in the lesion. Arrow indicates pseudoaneurysm.
Due to the extent of the tumor, the patient underwent an extended TSS. Tumors of the suprasellar area were firmly adhered to the surroundings, and an unexpected arterial bleeding occurred during debulking of the area [
A treatment intervention was necessary in this case as pseudoaneurysms are associated with a high rupture rate and significant mortality.[
Hence, we decided to treat the pseudoaneurysm using stent-assisted coiling (SAC). Preoperatively, the patient was administered 300 mg clopidogrel and 300 mg aspirin orally. Under local anesthesia, an 8-French sheath was placed in the left femoral artery. An initial bolus dose of 50 IU/kg heparin was administered intravenously. Three-dimensional rotational angiography from an 8-French balloon-guiding catheter (Optimo, Tokai Medical Products, Aichi, Japan) confirmed a small pseudoaneurysm [
Perforation and laceration of the ICA are the most common types of injuries during a TSS that results in a pseudoaneurysm formation.[
This is the first case in which an ACA pseudoaneurysm caused by injury during the TSS was treated with SAC and the parent artery was preserved. SAC could be the best treatment option for this kind of fatal complication in TSS until FD is available for ACA.
The authors certify that they have obtained all appropriate patient consent.
There are no conflicts of interest.
We would like to thank Ms. Aki Naoi for the helpful discussion regarding our case. We also would like to thank Editage (www.editage.com) for English language editing.
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