A giant intracavernous carotid artery aneurysm embedded in pituitary macroadenoma presenting with pituitary apoplexy.

Case Report A 60-year-old man presented with slow decreasing visual acuity for 3 months. Sudden deterioration in the right side vision, accompanied by severe headache and vomiting, was noted 1 day prior to admission. Physical examination revealed mild fever, neck stiffness and blunting of consciousness. Emergent brain CT showed a bright mass within the sella which was thought compatible with pituitary apoplexy. The mass extended into the right cavernous sinus with bony destruction. A brain MRI was arranged before emergent optic nerve decompression via the transsphenoidal route. The MRI of the brain revealed an intracavernous carotid aneurysm with a signal void embedded in pituitary macroadenoma. The tumor was located in the sellar region with marked suprasellar extension ( fi g. 1 ). High-dose glucocorticoids were administered after diagnosis, and cerebral angiography for embolization of the aneurysm was performed. Due to diffi culties in identifying the neck of the aneurysm, we checked the collateral circulation by the balloon occlusion test. An angiogram showed good collateral blood supply through both the anterior and posterior communicating arteries. The patient tolerated the occlusion test well. Trapping was not done, but proximal occlusion of the right ICA was performed with detachable Cerebrovasc Dis 2006;21:142–144 DOI: 10.1159/000090450