Incidental Superior Hypophygeal Artery Aneurysm Embedded within Pituitary Adenoma
A 70-year-old woman presented with visual disturbance for one year. The results of the neuro-ophalmologiclal examination revealed bitemporal hemianopsia. Magnetic resonance (MR) imaging showed persistence of a homogeneously enhancing suprasellar lesion, compressing the visual pathways. Endocrine tests confirmed normal pituitary function. However, the axial or coronal MR images presented a flow void in the medial portion of the right internal carotid artery (ICA) (). These MR images raised the suspicion of a coexisting intrasellar aneurysm before the planned transsphenoidal procedure. Consequently, 3-dementional computed tomography (CT) angiogram demonstrated the opthalmic segment of the right distal ICA (). Four vessels angiogram confirmed a right superior hypophygeal artery aneurysm and the saccular aneurysmal sac that had a 4.13 mm neck, 6.27 mm width, and 3.99 mm height ().\nFirst, we treated the aneurysm by coil embolization with the goal of maintaining the patency of the ICA (). Two months later, she underwent surgery via the transsphenoidal microsurgical approach for the removal of the tumor. We carefully dissected the tumoral portion surrounding the coil-treated aneurysm and a total resection of the tumor was successfully achieved. The patient's postoperative course was uneventful. Immunohistological microscopic findings confirmed the diagnosis of a non-functional PA. Postoperative endocrine tests confirmed normal pituitary function. MR at 8 month follow-up after surgery demonstrated complete obliteration of the aneurysm and no sign of regrowth of the adenoma ().