Aneurisma gigante parasselar simulando tumor de hipófise

Motta, Luiz Augusto Casulari Roxo da; Hermes Jr., Mário de Nazareth; Figueiredo, Marco Antonio de Arruda; Gagliardi, Antonio Ricardo Toledo; Motta, Lucília Domingues Casulari da; Mendonça, José Luiz F. de; Farage Filho, Miguel

doi:10.1590/S0004-282X1988000400015

Resumos

Revisamos 7 pacientes com comprometimento da sela turca ao raio X do crânio que apresentavam aneurisma gigante da porção intracavernosa da artéria carótida (6 casos) e aneurisma da artéria comunicante anterior (1 caso). As alterações encontradas foram: cefaléia (7/7), oftalmoplegia complexa interessando III, IV e VI nervos cranianos (5/7) e comprometimento do V nervo (4/7), dor ocular (4/7). Outras alterações encontradas foram: sinais meníngeos (2/7), cegueira unilateral (1/7), hemiparesia (1/7) cacosmia (1/7) e quadrantanopsia bitemporal inferior (1/7). Cinco pacientes com aneurisma da porção intracavernosa da artéria carótida beneficiaram-se com a ligadura progressiva da artéria carótida interna a nível cervical; o outro paciente faleceu antes da realização da operação. O paciente com aneurisma da artéria comunicante anterior foi submetido a clipagem do aneurisma, tendo boa evolução. Baseados neste estudo e em concordância com a literatura, concluímos que o diagnóstico diferencial entre aneurisma localizado na região parasselar e outras patologias dessa área freqüentemente apresenta dificuldade. O diagnóstico definitivo requer a realização de angiografia cerebral. O tratamento cirúrgico, por ligadura da carótida interna na região cervical, é benéfico e quase desprovido de complicações.

Seven cases of compromised pituitary fossa at the conventional skull X-ray, who had the final diagnosis of giant aneurysm of the intracavernous portion of the carotid artery (6 cases) and one of the anterior communicant artery, are reported. The main findings were: headache (7/7), complex ophtalmoplegia involving the III, IV and VI cranial nerves (5/7), compromised V cranial nerve (4/7) and eyeball pain (4/7). Other manifestations were: meningeal signs (2/7), unilateral blindness (1/7), hemiparesis (1/7), cacosmia (1/7) and inferior bitemporal quadrantanopsia (1/7). Five patients with intracavernous carotid artery aneurysm showed benefits with progressive occlusion of the internal carotid artery at the cervical level. One died before surgery. The case with anterior communicant artery aneurysm improved after its surgical clipping. Our data, in accord with the literature, support the conclusion that the differential diagnosis of aneurysms in the parasellar egion remains a very difficult task. The accurate final diagnosis requires cerebral angiography and the surgical treatment with progressive occlusion at the cervical portion of the internal carotid artery has a relatively low risk with promising results.

Luiz Augusto Casulari Roxo da Motta^I; Mário de Nazareth Hermes Jr.^II; Marco Antonio de Arruda Figueiredo^II; Antonio Ricardo Toledo Gagliardi^III; Lucília Domingues Casulari da Motta^IV; José Luiz F. de Mendonça^V; Miguel Farage Filho^VI

^IProfessor Visitante de Endocrinologia da Universidade de Brasília (UnB), Núcleo de Neuroendocrinologia do Hospital de Base do Distrito Federal (HBDF)

^IIResidente da Unidade de Neurocirurgia do HBDF

^IIIProfessor Assistente de Endocrinologia do HBDF

^IVProfessora Assistente de Ginecología-Obstetrícia da UnB

^VMédico da Unidade de Radiologia do HBDF

^VIChefe da Unidade de Neurocirurgia do HBDF

RESUMO

Revisamos 7 pacientes com comprometimento da sela turca ao raio X do crânio que apresentavam aneurisma gigante da porção intracavernosa da artéria carótida (6 casos) e aneurisma da artéria comunicante anterior (1 caso). As alterações encontradas foram: cefaléia (7/7), oftalmoplegia complexa interessando III, IV e VI nervos cranianos (5/7) e comprometimento do V nervo (4/7), dor ocular (4/7). Outras alterações encontradas foram: sinais meníngeos (2/7), cegueira unilateral (1/7), hemiparesia (1/7) cacosmia (1/7) e quadrantanopsia bitemporal inferior (1/7). Cinco pacientes com aneurisma da porção intracavernosa da artéria carótida beneficiaram-se com a ligadura progressiva da artéria carótida interna a nível cervical; o outro paciente faleceu antes da realização da operação. O paciente com aneurisma da artéria comunicante anterior foi submetido a clipagem do aneurisma, tendo boa evolução. Baseados neste estudo e em concordância com a literatura, concluímos que o diagnóstico diferencial entre aneurisma localizado na região parasselar e outras patologias dessa área freqüentemente apresenta dificuldade. O diagnóstico definitivo requer a realização de angiografia cerebral. O tratamento cirúrgico, por ligadura da carótida interna na região cervical, é benéfico e quase desprovido de complicações.

SUMMARY

Seven cases of compromised pituitary fossa at the conventional skull X-ray, who had the final diagnosis of giant aneurysm of the intracavernous portion of the carotid artery (6 cases) and one of the anterior communicant artery, are reported. The main findings were: headache (7/7), complex ophtalmoplegia involving the III, IV and VI cranial nerves (5/7), compromised V cranial nerve (4/7) and eyeball pain (4/7). Other manifestations were: meningeal signs (2/7), unilateral blindness (1/7), hemiparesis (1/7), cacosmia (1/7) and inferior bitemporal quadrantanopsia (1/7). Five patients with intracavernous carotid artery aneurysm showed benefits with progressive occlusion of the internal carotid artery at the cervical level. One died before surgery. The case with anterior communicant artery aneurysm improved after its surgical clipping. Our data, in accord with the literature, support the conclusion that the differential diagnosis of aneurysms in the parasellar egion remains a very difficult task. The accurate final diagnosis requires cerebral angiography and the surgical treatment with progressive occlusion at the cervical portion of the internal carotid artery has a relatively low risk with promising results.

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Núcleo de Neuroendocrinologia, Unidade de Neurocirurgia, Hospital de Base do Distrito Federal - SMHS, Área Especial - 70335 Brasília DF - Brasil.

1. Anderson RD - Tortuosity of the cavernous carotid arteries causing sellar expansion simulating pituitary adenoma. Am J Roentgenol 126: 1203, 1976.
2. Cohen WA, Pinto RS, Kricheff II - Dynamic CT scanning for visualization of the parasellar carotid arteries. Am J Roentgenol 138: 905, 1982.
3. Bird AC, Nolan B, Gargano FP, David NJ - Unruptured aneurysm of the supraclinoid carotid artery: a treatable cause of blindness. Neurology 20: 445, 1970.
4. Daniels DL, Williams AL, Thornton RS, Meyer GA, Cusick JF, Haughton VM - Differential diagnosis of intrasellar tumors by computed tomography. Radiology 141: 697, 1981.
5. Guiot G - Considerations on the surgical treatment of pituitary adenomas. In Fahlbusch R, von Werder K (eds): Treatment of Pituitary Adenomas. Thieme, Stuttgart, 1978, pg 228.
6. Karnaze GM, Sartor K, Winthrop JD, Gado MH, Hodges FJ III - Suprasellar lesions: evaluation with MR imaging. Radiology 161: 77, 1986.
7. Naidich TP, Pinto RS, Kushner MJ, Lin JP, Kricheff II, Leeds NE, Chase NE - Evaluation of sellar and parasellar masses by computed tomography. Radiology 120: 91, 1976.
8. Raymond LA, Tew J - Large suprasellar aneurysms imitating pituitary tumour. Neurol Neurosurg Psychiat 41: 83, 1978.
9. Reich NE, Zelch JV, Alfidi JR, Meaney TF, Duchesnean PM, Weinstein MA - Tomography computed in the detection of lesions juxtasellar. Radiology 118:333, 1976.
10. Sampaio P - Aneurismas intracraniano: estudo clínico. Experiência com 456 casos clínicos operados. Ars Curandi 124, 1985.

Aneurisma gigante parasselar simulando tumor de hipófise

Giant paraselar aneurysm simulating pituitary tumour

Datas de Publicação

Publicação nesta coleção
21 Jun 2011
Data do Fascículo
Dez 1988

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Anderson RD - Tortuosity of the cavernous carotid arteries causing sellar expansion simulating pituitary adenoma. Am J Roentgenol 126: 1203, 1976.

[2] 2. Cohen WA, Pinto RS, Kricheff II - Dynamic CT scanning for visualization of the parasellar carotid arteries. Am J Roentgenol 138: 905, 1982.

[3] 3. Bird AC, Nolan B, Gargano FP, David NJ - Unruptured aneurysm of the supraclinoid carotid artery: a treatable cause of blindness. Neurology 20: 445, 1970.

[4] 4. Daniels DL, Williams AL, Thornton RS, Meyer GA, Cusick JF, Haughton VM - Differential diagnosis of intrasellar tumors by computed tomography. Radiology 141: 697, 1981.

[5] 5. Guiot G - Considerations on the surgical treatment of pituitary adenomas. In Fahlbusch R, von Werder K (eds): Treatment of Pituitary Adenomas. Thieme, Stuttgart, 1978, pg 228.

[6] 6. Karnaze GM, Sartor K, Winthrop JD, Gado MH, Hodges FJ III - Suprasellar lesions: evaluation with MR imaging. Radiology 161: 77, 1986.

[7] 7. Naidich TP, Pinto RS, Kushner MJ, Lin JP, Kricheff II, Leeds NE, Chase NE - Evaluation of sellar and parasellar masses by computed tomography. Radiology 120: 91, 1976.

[8] 8. Raymond LA, Tew J - Large suprasellar aneurysms imitating pituitary tumour. Neurol Neurosurg Psychiat 41: 83, 1978.

[9] 9. Reich NE, Zelch JV, Alfidi JR, Meaney TF, Duchesnean PM, Weinstein MA - Tomography computed in the detection of lesions juxtasellar. Radiology 118:333, 1976.

[10] 10. Sampaio P - Aneurismas intracraniano: estudo clínico. Experiência com 456 casos clínicos operados. Ars Curandi 124, 1985.