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