PMC5569439_01
(a) Computed tomography scan showing a mass suggestive of tumor near the sellar region. (b) Magnetic resonance angiogram showing a large aneurysm of the left internal carotid artery (ICA). (c) T2-weighted magnetic resonance image revealing the aneurysm extending to the suprasellar region. (d) Cerebral digital subtraction angiogram of the left ICA revealing a giant aneurysm at the cavernous portion extending in the medial direction
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F1
Head computed tomography (CT) disclosed a mass suggestive of tumor near the sellar region and he was referred to our hospital [Figure 1a]. Magnetic resonance (MR) angiography demonstrated a large aneurysm of the left ICA, and T2-weighted MR imaging revealed the aneurysm extending to the suprasellar region [Figure 1b and c]. Cerebral digital subtraction angiography of the left ICA revealed a giant aneurysm at the cavernous portion extending in the medial direction [Figure 1d].
Time-series graphs of hormone load tests. Luteinizing hormone (LH)-releasing hormone load test: after intravenous injection of LH-releasing hormone (0.1 mg), LH and follicle-stimulating hormone (FSH) levels were examined. Thyrotropin-releasing hormone load test: after intravenous injection of thyrotropin-releasing hormone (0.5 mg), thyroid-stimulating hormone (TSH) and prolactin (PRL) levels were examined. Corticotropin-releasing hormone load test: after intravenous injection of corticotropin-releasing hormone (0.1 mg), adrenocorticotrophic hormone (ACTH) and cortisol levels were examined. Growth hormone (GH)-releasing factor load test: after intravenous injection of GH-releasing factor (0.1 mg), GH level was examined. Solid, dotted, and dashed lines indicate the data for preoperation, postoperation (3 weeks after operation), and 1 year after operation
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F2
Several hormone load tests were conducted [Figure 2]. Hormone load tests conducted 3 weeks after the operation during administration of hydrocortisone 10 mg daily showed recovery of the rapid reactions of ACTH and GH [Figure 2]. Follow-up examination at 1 year showed normal pituitary hormone levels, which were elevated by the hormone load test without hormonal replacement therapy [Figure 2].
(a) Computed tomography scan on the day after the operation showing thrombosis of the aneurysm. (b) Cerebral angiogram performed at 8 days after the operation demonstrating good patency of the bypasses and disappearance of flow to the aneurysm. (c, d) Magnetic resonance angiogram (c) and image (d) obtained at 8 years after the operation showing good patency of the radial artery graft and shrinkage of the aneurysm
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F3
CT obtained on the day after the operation disclosed thrombosis of the aneurysm and cerebral angiography performed at 8 days after the operation demonstrated good patency of the bypasses and disappearance of flow to the aneurysm [Figure 3a and b]. He has been followed up as an outpatient without hormonal replacement therapy, and the latest MR angiography and MR imaging findings at 8 years after the operation disclosed good patency of the RAG and shrinkage of the aneurysm [Figure 3c and d].