Experience in the treatment of cerebral aneurysms associated with pituitary adenomas

Abstract

The rare association between cerebral tumors and intracranial aneurysms as well as the poor publication rates found in these entities, make its diagnosis and treatment a real challenge for actual neurosurgeons. Growth hormone and Prolactin -secreting adenomas are related with intracranial aneurysms in first and second place, respectively. Most of these aneurysms are found in the anterior cerebral circulation and in female patients. The mechanisms underlying this association are not clear. Lack of diagnosis of both entities in the same patient may have fatal consequences. Different therapeutic approaches have been described; among these, microsurgical resection and clipping in one stage and initially endovascular treatment followed by transphenoidal resection appear in the literature. We found retrospectively two cases with both pituitary adenoma and cerebral aneurysms treated in the Hospital Valentin Gomez Farias, ISSSTE, Zapopan between 2005 and 2013. Medical treatment with somatostatin in Growth Hormone secreting tumors should be considered, specially in those with minimally or absent compressive effect over the optic chiasm. Microsurgical clipping is a safe procedure, with morbidity and mortality similar to that reported in medical literature. Surgical resection of these tumors may be safely done in both transcranial or transophenoidal approaches.