PMC10310351_01
Clinical images after the onset of subarachnoid hemorrhage and epistaxis.
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(A) Coronal image of plain head computed tomography (CT). The hematoma was distributed around the pituitary tumor periphery and right Sylvian fissure. (B) Coronal image of contrast-enhanced CT. The white arrow indicates a small ruptured aneurysm embedded in the tumor. (C) CT bone image showed destruction of the surrounding skull base, including the sella base. (D) Coronal image of Gd-contrast T1-weighted image. A large pituitary tumor was enhanced. (E and F) Right internal carotid angiography and three-dimensional volume rendering image show a small irregularly shaped aneurysm of approximately 2 mm with a bleb at the same site as in Fig. 1B.
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Computed tomography (CT) revealed SAH and a tumor in the sphenoid sinus (Fig. 1A). T2-weighted magnetic resonance imaging (MRI) and coronal CTA revealed that the large pituitary tumor and aneurysm were adjacent to each other (Fig. 1B and D); the aneurysm was located at the boundary between the cisternal space and sphenoid sinus. Cerebral angiography, including balloon test occlusion (BTO), was performed under general anesthesia. These examinations demonstrated an aneurysm with an irregular shape and a diameter of 2.9 mm (Fig. 1E and F) and the presence of a collateral flow via the anterior communicating artery.
Digital subtraction angiography (DSA) images of endovascular treatment.
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(A) DSA image following the initial coil embolization. (B) DSA image at the time of recurrence 40 months after the initial treatment. (C) DSA image immediately after flow diverter stent treatment. (D) DSA image 6 months following flow diverter device placement, showing almost a complete occlusion of the aneurysm.
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Digital subtraction angiography (DSA) revealed a neck remnant (Fig. 2A). DSA revealed aneurysm regrowth with compaction of the coils inserted during the initial treatment (Fig. 2B). A few platinum coils were placed into the aneurysm, following which a Pipeline Flex embolization device (Medtronic, Minneapolis, MN, USA) was deployed in the parent artery (Fig. 2C). DSA performed 6 months after FDD treatment showed almost complete occlusion of the aneurysm (Fig. 2D).