Intra-Operative Rupture of Remote Aneurysm during Transphenoidal Resection of Pituitary Macroadenoma

Rupture of intracranial aneurysm resulting in subarachnoid hemorrhage is well known to carry significant risk of poor outcome. Intra-operative rupture of an unknown intracranial aneurysm during a neurosurgical procedure is a rare occurrence that can lead to devastating consequences if not recognized and managed appropriately. Here we describe to our knowledge, the first reported case of previously unknown, remote from the surgical site, intra-operative posterior cerebral artery aneurysm rupture during transnasal endoscopic transphenoidal resection of a pituitary macroadenoma, review relevant literature, and discuss strategies to reduce surgical risk and improve patient outcomes.

Predicting asymptomatic coronary artery stenosis by aortic arch plaque in acute ischemic cerebrovascular disease:beyond the cervicocephalic atherosclerosis?

Background:Asymptomatic coronary artery stenosis(ACAS)≥50%is common in patients with acute ischemic cerebrovascular disease(AICVD),which portends a poor cardiovascular and cerebrovascular prognosis.Identifying ACAS>50%early may optimize the clinical management and improve the outcomes of these high-risk AICVD patients.This study aimed to investigate whether aortic arch plaque(AAP),an early atherosclerotic manifestation of brain blood-supplying arteries,could be a predictor for ACAS>50%in AICVD.Methods:In this cross-sectional study,atherosclerosis of the coronary and brain blood-supplying arteries was simultaneously evaluated using one-step computed tomography angiography(CTA)in AICVD patients without coronary artery disease history.The patients were divided into ACAS≥50%and non-ACAS≥50%groups according to whether CTA showed stenosis≥50%in at least one coronary arterial segment.The AAP characteristics of CTA were depicted from aspects of thickness,extent,and complexity.Results:Among 118 analyzed patients with AICVD,29/118(24.6%)patients had ACAS≥50%,while AAPs were observed in 86/118(72.9%)patients.Increased AAP thickness per millimeter(adjusted odds ratio[OR]:1.56,95%confidence interval[CI]:1.18-2.05),severe-extent AAP(adjusted OR:13.66,95%CI:2.33-80.15),and presence of complex AAP(adjusted OR:7.27,95%CI:2.30-23.03)were associated with ACAS≥50%among patients with AICVD,independently of clinical demographics and cervicocephalic atherosclerotic stenosis.The combination of AAP thickness,extent,and complexity predicted ACAS≥50%with an area under the receiver-operating characteristic curve of 0.78(95%CI:0.70-0.85,P<0.001).All three AAP characteristics provided additional predictive power beyond cervical and intracranial atherosclerotic stenosis for ACAS≥50%in AICVD(all P<0.05).Conclusions:Thicker,severe-extent,and complex AAP were significant markers of the concomitant ACAS≥50%in AICVD,possibly superior to the indicative value of cervical and intracranial atherosclerotic stenosis.As an integral part of atherosclerosis of brain blood-supplying arteries,AAP should not be overlooked in predicting ACAS≥50%for patients with AICVD.