Giant Prolactinoma Embedded by Pseudoaneurysm of the Cavernous Carotid Artery Treated with a Tailored Therapeutic Scheme.
Giant Prolactinoma Embedded by Pseudoaneurysm of the Cavernous Carotid Artery Treated with a Tailored Therapeutic Scheme.
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巨大泌乳素瘤嵌在假性动脉瘤的海绵状颈动脉与一个定制的治疗方案。
DOI：
10.1055/s-0042-1749662
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发表时间：
2022-07
影响因子：
1.4
通讯作者：
D'Angelo, Luca
中科院分区：
文献类型：
--
作者：
Mercuri, Valeria;Armocida, Daniele;Paglia, Francesco;Patrizia, Gargiulo;Santoro, Antonio;D'Angelo, Luca
颅内动脉瘤(IA)的并存通常被认为是脑垂体腺瘤(PAS)患者中最高的。不同的机制可能在动脉瘤的形成中起作用，但PA是否参与了动脉瘤的形成仍不清楚。在文献中，有许多这种关联的报道案例；然而，对动脉粥样硬化、动脉瘤和治疗管理的特征的分析很少，而且仅限于有限数量的病例报告。我们报告了一例罕见的巨大催乳素瘤的嵌入性动脉瘤，根据患者的临床、神经和放射学特征进行了治疗。为了选择最好的治疗方法，我们回顾了文献，报道了唯一一例描述了动脉瘤的放射学特征、动脉粥样硬化、治疗管理和患者结局的病例。我们的目标是了解决定最佳治疗方法和最佳结果的变量是什么。大型颈内动脉假性动脉瘤完全嵌在巨大的催乳素瘤中是罕见的，需要量身定制的治疗策略。术前了解无症状性IA与PA并存的重要性，可避免手术切除时动脉瘤的意外破裂，并可指导制定最佳治疗方案。需要高度怀疑相关的动脉瘤，如果磁共振成像显示一些不典型的特征，必须在考虑任何干预措施之前进行数字减影血管成像，以避免医源性动脉瘤破裂。据我们所知，我们采用小剂量卡麦角林一线治疗来获得催乳素正常化，同时将动脉瘤破裂的风险降至最低，并随后进行血管内分流治疗的多模式方法尚未在其他地方得到描述。在这种情况下，我们建议采用量身定制的小剂量卡麦角林治疗方案，以避免细胞减少时的破裂，并启动密切的神经放射随访计划。
The coexistence of intracranial aneurysm (IA) is generally thought to be highest in patients with pituitary adenomas (PAs). Different mechanisms may play a role in aneurysm formation, but whether the PA contributes to aneurysm formation is still unclear. In the literature, there are numerous reported cases of this association; however, the analyses of the characteristics of PAs, aneurysms, and treatment management are rare and limited to a restricted number of case reports. We report a rare case of an embedded aneurysm in a macroprolactinoma treated with therapeutic management tailored to the clinical, neurological, and radiological characteristics of the patient. To select the best treatment, we reviewed the literature and reported the only cases in which the radiological characteristics of aneurysms, PAs, therapeutic management, and patient outcome are described. We aimed to understand what are the variables that determine the best therapeutic management with the best possible outcome. The presence of a large pseudoaneurysm of the internal carotid artery completely embedded in a giant macroprolactinoma is rare and needs a tailored treatment strategy. The importance of the preoperative knowledge of asymptomatic IA coexisting with PA can avoid accidental rupture of the aneurysm during surgical resection and may lead to planning the best treatment. A high degree of suspicion for an associated aneurysm is needed, and if magnetic resonance imaging shows some atypical features, digital subtraction angiography must be performed prior to contemplating any intervention to avoid iatrogenic aneurysmal rupture. Our multimodal approach with the first-line therapy of low-dose cabergoline to obtain prolactin normalization with minimum risks of aneurysms rupture and subsequent endovascular treatment with flow diverter has not been described elsewhere to our knowledge. In the cases, we suggest adopting a tailored low-dose cabergoline therapy scheme to avoid rupture during cytoreduction and initiate a close neuroradiological follow-up program.