gms | German Medical Science

Objective: The occurrence of a false aneurysm of the extradural internal carotid artery (ICA) following transsphenoidal pituitary surgery is a rare, but often life-threatening complication. In cases of massive epistaxis, endovascular occlusion of the ICA often is the only therapeutic option. However, as ICA occlusion carries a significant risk of hemispheric infarction, alternative endovascular procedures leaving the parent vessel open had been attempted. We report a rare complication of stenting and coiling of a false ICA aneurysm and our neurosurgical management strategy.

Methods: A 39-year-old male patient underwent a transsphenoidal pituitary operation. After uneventful surgery, a massive epistaxis occurred on day 1 after operation. Emergent angiography revealed a false 1.5 cm ICA aneurysm protruding into the sphenoid sinus, which was successfully treated by ICA stenting and coiling. The patient came to re-admission with a transnasal dislocation of the coils. Angiography excluded the re-occurrence of the false aneurysm despite coil dislocation.

Results: Simple cutting of the protruding coils was considered not to be effective to prevent further loosening of the coil basket. As no residual aneurysm was seen on angiography, the transsphenoidal route was taken again, and the coils were sharply cut down to the level of the former aneurysm neck. Extraction of the coils as well as removal of coil stumps at the neck were avoided to prevent weakening of the damaged ICA wall. Transoronasal coil dislocation did not occur again, and repeated angiography ruled out aneurysm re-growth.

Conclusions: Stenting and coiling allows to control false ICA aneurysms after during pituitary surgery without sacrifice of the parent vessel. However, false aneurysms do not have a true dome, and apical coil dislocation is a potential complication. We describe how such a complication could be managed successfully.