Traumatic aneurysm and carotid-cavernous fistula following transsphenoidal approach to a pituitary adenoma: treatment by transcranial operation.

A 39-year old woman presented with galactorrhoea. Magnetic resonance imaging revealed an intrasellar tumour. During transsphenoidal surgery to remove the tumour, arterial bleeding occurred from the right internal carotid artery (ICA). The bleeding was stopped by packing with Surgicel. The operation was discontinued at this point and the intrasellar tumour was not removed. Four-vessel angiography was performed on the third day after the operation, revealing a traumatic (false) ICA aneurysm and a low-flow carotid-cavernous fistula (CCF) on the right side. The patient did not have any neurological deficit, and was re-operated on transcranially. Both the traumatic ICA aneurysm and the CCF were excluded from the circulation by a Sundt-Kees cuff clip. The patency of the ICA was preserved.

Anterior communicating artery aneurysm associated with tuberculum sellae meningioma--case report.

A 50-year-old male presented with a very unusual case of a calcified anterior communicating artery (AComA) aneurysm associated with a tuberculum sellae meningioma. Until 10 years previously, the patient had been a professional soccer player for 15 years. He noticed a slight decrease in visual acuity in the right eye 7 years before. The patient was in the care of an oculist throughout this period. Two months before admission, a significant and rapid decrease of vision in the right eye occurred. Computed tomography and magnetic resonance imaging showed a round-shaped, partially calcified tumorous lesion. Four-vessel angiography revealed a large AComA aneurysm. During surgery, a tuberculum sellae. meningioma was found in combination with an AComA aneurysm with a completely calcified wall. The meningioma was resected totally. The AComA aneurysm with a calcified wall could not be clipped or resected and was left alone. His visual deficit improved postoperatively.