Posterior communicating artery pseudoaneurysm [Neurosurgery Wiki]

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====== Posterior communicating artery pseudoaneurysm ======

[[Intracranial]] [[pseudoaneurysm]] is a rare [[complication]] of [[endoscopic endonasal surgery]]. Herein, Morinaga et al., from [[Fukuoka University Chikushi Hospital]] describe two-staged [[stent assisted coil embolization]] for [[posterior communicating artery pseudoaneurysm]] after [[endoscopic endonasal surgery]] for [[pituitary neuroendocrine tumor]].

A 68-year-old man had a history of severe adult [[growth hormone]] secretion deficiency, requiring growth [[hormone replacement therapy]]; secondary [[adrenal hypofunction]]; [[hyperthyroidism]]; [[hypertension]]; [[constipation]]; [[glaucoma]]; and [[hyperuricemia]]. Five years ago, after initial endoscopic [[transsphenoidal surgery]] for [[pituitary neuroendocrine tumor]], he was hospitalized for [[reoperation]]. [[Posterior communicating artery]] injury was observed during second endoscopic trans-sphenoidal surgery and pressure hemostasis was performed using a hemostatic preparation. Immediately post-surgery, a localized [[subarachnoid hemorrhage]] was observed. Sudden-onset impaired [[consciousness]] and respiratory disturbances ensued on postoperative day 7, and computed tomography of the head was performed. Recurrent subarachnoid hemorrhage was confirmed, and [[acute hydrocephalus]] secondary to third ventricular blockage was identified. [[Cerebral angiography]] was performed after urgent bilateral cerebral [[ventricular drainage]] under [[general anesthesia]]. A [[pseudoaneurysm]] was identified in the left posterior communicating artery, and [[coil embolization]] was performed. Six weeks post-surgery, [[LVIS]]® Jr. [[stent]] was placed in the posterior communicating artery. Recurrence of the aneurysm was not detected 6 months post-surgery. He underwent [[lumboperitoneal shunt]]ing for secondary [[normal pressure hydrocephalus]] after [[dual antiplatelet therapy]] discontinuation and is being followed-up as an outpatient with a [[modified Rankin Scale]] of 2 10 months post-surgery.

Two-staged stent-assisted coil embolization using LVIS® stent was effective for a posterior communicating artery pseudoaneurysm occurring after [[posterior communicating artery injury]] following endoscopic trans-sphenoidal surgery for [[Follicle stimulating hormone secreting pituitary neuroendocrine tumor]]
((Morinaga Y, Nii K, Sakamoto K, Inoue R, Mitsutake T, Hanada H. Stent-assisted 
Coil Embolization for a Ruptured Posterior Communicating Artery Pseudoaneurysm
after Endoscopic Trans-sphenoidal Surgery for pituitary neuroendocrine tumor. World Neurosurg.
2018 Dec 21. pii: S1878-8750(18)32870-5. doi: 10.1016/j.wneu.2018.12.047. [Epub
ahead of print] PubMed PMID: 30583130.
)).