Pituitary macroadenoma causing symptomatic internal carotid artery compression: Surgical treatment through transsphenoidal tumor resection |
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| Institution: | 1. Department of Neurosurgery, University of Mississippi Medical Center, Jackson, MS, USA;2. Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, 355 West 16th Street, Suite 5100, Indianapolis, IN 46202, USA;1. Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Ohio State University Medical Center, N1025 Doan Hall, 410 W. 10th Street, Columbus, OH 43210, USA;2. Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA;1. Clinic of Neurology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland;2. Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, Szczecin, Poland;3. Clinic of Gynaecology and Urogynaecology, Pomeranian Medical University, Police, Poland;1. Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC;2. Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC;3. Department of Internal Medicine, Division of Hematology & Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC;1. Department of Radiology, Ilsan Paik Hospital, Inje University School of Medicine, 2240, Daehwa-dong, Ilsanseo-gu, Goyang-si, Gyeonggi-do 411-706, Republic of Korea;2. Department of Neurology, Ilsan Paik Hospital, Inje University School of Medicine, Goyang-si, Gyeonggi-do, Republic of Korea;1. Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Ein Kerem, P.O. Box 12000, Jerusalem 91120, Israel;2. Department of Endovascular Neurosurgery and Interventional Neuroradiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel;3. Department of Neurosurgery, Soroka Medical Center, Beer Sheva, Israel |
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| Abstract: | Pituitary macroadenomas can invade the cavernous sinus and rarely cause occlusion of the internal carotid artery (ICA). Most patients with symptomatic obstruction of the ICA by a pituitary tumor have been reported as a result of apoplexy. The authors review the literature about this condition and report a 48-year-old man who presented with transient ischemic attacks leading to a stroke. Imaging studies demonstrated complete occlusion of the left ICA and critical narrowing of the right ICA at the level of the clinoid processes, most likely due to macroadenoma mass effect. There was no radiologic evidence of apoplexy. Surgical resection of the tumor and ICA decompression via the transsphenoidal route resulted in prevention of further symptoms. Histopathologic analysis confirmed a nonfunctioning pituitary adenoma without evidence of hemorrhage or intratumoral infarction. This patient, to the authors’ knowledge, is the first documented patient with symptomatic carotid compression by a pituitary adenoma without evidence of apoplexy. |
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| Keywords: | Brain ischemia Carotid stenosis Pituitary adenoma Transsphenoidal resection |
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