上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 病例报告 • 上一篇    

以蛛网膜下腔出血为首发症状的颅内动脉瘤合并垂体瘤1例报告

陈奎，姜秀峰，杨西涛，冯东福   

  1. 上海交通大学 医学院附属第三人民医院神经外科， 上海 201999
  • 出版日期:2015-11-28 发布日期:2016-01-13
  • 通讯作者: 冯东福, 电子信箱: feng_df@yahoo.com。
  • 作者简介:陈奎（1988—）， 男， 博士生; 电子信箱: 1987877544@qq.com。

Report of a case of intracranial aneurysm combined with pituitary adenoma with the initial symptom of subarachnoid hemorrhage

CHEN Kui, JIANG Xiu-feng, YANG Xi-tao, FENG Dong-fu   

  1. Department of Neurosurgery, Shanghai Third People's Hospital, Shanghai Jiao Tong University School of Medicine， Shanghai 201999, China
  • Online:2015-11-28 Published:2016-01-13

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摘要：

目的  探讨以蛛网膜下腔出血为首发症状的颅内动脉瘤合并垂体瘤的诊断及治疗。方法  分析1例颅内动脉瘤合并垂体瘤患者的临床表现及体格检查和辅助检查结果，并复习相关文献。结果  患者,男性,53岁,因突发头痛伴颈部僵硬4 h就诊。查体：血压203/123 mmHg，神志清楚，急性面容，视力及视野粗测未见异常，Kerning征（+）。术前CT平扫示蛛网膜下腔出血，鞍上池高密度影；颅脑CTA示前交通动脉处瘤样突起；入院当日行全脑数字减影血管造影检查示前交通动脉处瘤样突起。发病24 h后行前交通动脉瘤夹闭术，术中发现视交叉前池一类圆形肿物，有包膜，质地较韧，色泽灰红，直径约3 cm。结合术前影像考虑为垂体瘤，行次全切除后沿左侧颈内动脉向远侧探查，可见一前交通动脉瘤，瘤体直径约3 mm，使用Yasargil动脉瘤夹1枚夹闭瘤颈。术后1周复查颅脑CTA示前交通动脉处瘤样突起消失。结论  对于以蛛网膜下腔出血合并鞍上池高密度影的患者，除了警惕为颅内动脉瘤破裂之外，还应考虑颅内动脉瘤合并垂体瘤的可能。

关键词: 蛛网膜下腔出血, 颅内动脉瘤, 垂体瘤

Abstract:

Objective  To explore the diagnosis and treatment of intracranial aneurysm combined with pituitary adenoma with the initial symptom of subarachnoid hemorrhage. Methods  The clinical data and results of physical and assistant examinations of one case of intracranial aneurysm combined with pituitary adenoma were analyzed and relevant literature was reviewed. Results  A 53-year old male patient visited hospital due to a sudden headache with stiff neck for 4h. Physical examination showed that the blood pressure was 203/123 mmHg and the patient was sane with a face of acute illness, normal visual acuity and visual field, and Kerning sign (+). The preoperative cranial computed tomographic (CT) scan showed intracranial subarachnoid hemorrhage and high density shadow in the suprasellar cistern. The computed tomographic arteriography (CTA) showed a tumor like lump at the anterior communicating artery, which was confirmed by the whole brain DSA examination on the admission day. The patient underwent an anterior communicating aneurysm clipping 24h after the onset. A round mass in the prechiasmatic cistern was observed during surgery. The mass was enveloped with a clear boundary with tough texture. The color of the mass was grey red and the diameter was about 3 cm. According to preoperative imaging, the mass was considered to be a pituitary adenoma and partial excision was performed. The exploration of the far side along the left internal carotid artery showed an anterior communicating artery aneurysm with the diameter of 3 mm. A Yasargil aneurysm clip was used to clip the aneurysm. One week after the surgery, the head CTA showed that the tumor like lump at the anterior communicating artery disappeared. Conclusion  For the patients with subarachnoid hemorrhage and high density shadow in the suprasellar cistern, the possibility of intracranial aneurysm combined with pituitary tumor should be considered besides the ruptured intracranial aneurysms.

Key words: subarachnoid hemorrhage, intracranial aneurysm, pituitary adenoma