Expanded endonasal endoscopic approach for resection of a growth hormone-secreting pituitary macroadenoma coexistent with a cavernous carotid artery aneurysm

Xuewei Xia, Murugappan Ramanathan, Brent A. Orr, Vafi Salmasi, Roberto Salvatori, Douglas D. Reh, Gary L Gallia

Research output: Contribution to journalArticle


The co-existence of pituitary adenomas (PA) and carotid artery aneurysms has been described and may be particularly frequent in acromegaly. The co-occurrence of an intracranial aneurysm in the setting of a PA presents significant risk to the patient, particularly when the aneurysm is within or near the operative field. We describe a 48-year-old, right-handed female patient with a large skull base lesion who had a left cavernous carotid artery aneurysm detected on her preoperative imaging studies. This patient was managed using a staged approach. She first underwent endovascular stent-assisted coiling of the aneurysm followed, six months later, by resection of the tumor via an expanded endonasal endoscopic approach. Histopathological analysis revealed a pituitary macroadenoma with neuronal metaplasia. Angiographic embolization followed by an expanded endonasal endoscopic approach is a safe and effective treatment for such lesions. Vascular imaging studies and a low index for suspicion are required for preoperative identification of such complex situations.

Original languageEnglish (US)
Pages (from-to)1437-1441
Number of pages5
JournalJournal of Clinical Neuroscience
Issue number10
StatePublished - Oct 2012



  • Cavernous carotid artery aneurysm
  • Coiling
  • Endoscopy
  • Expanded endonasal endoscopic approach
  • Neuronal metaplasia
  • Pituitary macroadenoma

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Physiology (medical)

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