PMC7265385_01
Preoperative magnetic resonance image. (a) T1-weighted coronal image was obtained. (b) T2-weighted coronal image was obtained. Large pituitary macroadenoma with hemorrhagic component inside the tumor.
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F1
Brain magnetic resonance imaging (MRI) on admission showed about 38 mm x 28 mm sized large pituitary macroadenoma with hemorrhagic component inside the tumor [Figure 1].
Preoperative computed tomographic angiography and diffusion-perfusion images. (a) Disappeared right internal carotid artery flow near clinoid segment. (b) No definite acute infarction in the diffusion weighted magnetic resonance study. (c) Severe perfusion delays were identified on whole right internal carotid artery territory.
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F2
Brain CT angiography showed right ICA total occlusion [Figure 2].
Preoperative conventional angiography. (a) AP view. Tapered thin steno-occlusive lesion due to the large parasellar mass. (b) Lateral view.
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F3
Left ICA angiogram also showed narrowed left ICA at the same segment [Figure 3].
Postoperative conventional angiography. (a) AP view. (b) Lateral view. Complete restoration of whole right internal carotid artery flow.
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F4
Follow-up conventional angiography was performed before discharge, and bilateral ICA maintained patency without stenosis [Figure 4].