Introduction Traumatic intracranial pseudoaneurysm following transphenoidal surgery has been described, but these typically involve the internal carotid artery and avulsion of the anterior communicating artery (AComm) is a very unusual complication. We present a case managed with endovascular repair.
A 80 year-old man underwent endoscopic transphenoidal surgery for endocrinologically-active pituitary adenoma. This patient had received pre- and post-op CTA. On postoperative CT angiography, the patient was noted to have a dramatic conformation change of the ACOM complex with splaying and a small new A1/A2 junction pseudoaneurysm indicating iatrogenic avulsion of the ACOM as the probable cause. The pseudoaneurysm had a narrow neck, therefore we elected to coil it. Other options including sacrifice of the A1/A2, flow diversion and surgery were considered and the pros and cons of these treatment options discussed. Under biplane fluoroscopic guidance, the pseudoaneurysm was accessed via microcatheter technique and coil embolization was performed. Following completion angiography to confirm no residual pseudoaneurysm, the patient was transferred in stable condition to the neuro-intensive care unit. At 6 month follow-up, the patient is well and possesses no neurological deficit. MR angiography showed no coil migration or residual pseudoaneurysm.
Discussion Traditionally, this type of injury might be treated by vessel sacrifice or surgical intervention. Flow diversion might also be considered. We report here successful repair with conventional coiling approach with parent artery preservation for this very unusual iatrogenic injury.
Disclosures A. Dmytriw: None. D. Sarma: None. W. Montanera: None. M. Cusimano: None. A. Bharatha: None.
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