PMC5838828_01
Contrast-enhanced MRI of the pituitary region showing a subtle area of flow void (arrow) in the right anterior aspect of pituitary adenoma
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F1
During the preoperative review of MRI films, a subtle area of flow void was noticed within the right anterior aspect of the tumor [Figure 1].
Contrast-enhanced MRI of the pituitary region demonstrating gradual decrease in tumor size over 18 months follow-up and returning of pituitary stalk to its physiologic position (white arrows), (a-c) as well as corresponding MRA follow-up demonstrating enlargement of ICA aneurysm (d-f)
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F2
The efficacy of medical therapy was also confirmed by a steady decline in tumor size from 17.5 mm x 15.7 mm x 17.4 mm to 10.9 mm x 4.9 mm x 8.9 mm [Figure 2a-c]. Simultaneously, there was a gradual increase in the aneurysm size from 2.7 mm to 4 mm [Figure 2d-f].
CTA of the circle of Willis demonstrating a 4.5 mm x 4 mm aneurysm of the right cavernous ICA (arrow)
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F3
Stent-assisted coil embolization of cavernous ICA aneurysm: (a) Preoperative angiogram. (b) Angiogram following the placement of the stent. (c and d) Postoperative angiograms with and without subtraction
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F4
Given the steady increase in the size of the aneurysm and considering the absence of reliable data about the natural history of intratumoral aneurysms, the patient was again offered endovascular treatment and subsequently underwent a successful stent-assisted coil embolization of the aneurysm without complications [Figure 4].
One-year follow-up diagnostic angiography demonstrating complete occlusion of the aneurysm with digital subtraction (left) and without digital subtraction (right)
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F5
One-year follow-up angiogram revealed complete occlusion of the aneurysm along with continuous decrease of IGF-1 levels [Figure 5].