Perisellar tumor coexisting with unruptured cerebral aneurysm: single-stage or staged surgery?

Abstract

Abstract Objective The coexistence of perisellar tumors and intracranial aneurysms was previously considered a rare phenomenon. In this study, we introduce our experience with surgical strategies for the treatment of such coexisting pathologies. Methods This retrospective study reviews the medical records and intraoperative videos of patients with coexisting pathologies of perisellar tumors and aneurysms from Nov 2017 to Oct 2022. Results Our study involved 20 patients, including 9 males and 11 females, with an average age of 53 years. All tumors were completely resected through the endoscopic endonasal approach (EEA) with the exception of 2 asymptomatic pituitary microadenomas with aneurysms in the internal carotid artery (ICA) C1 and C4 segments; for the latter, conservative management was chosen. Thirteen patients chose tumor resection first through the EEA with embolization or aneurysm conservation. Three patients selected the single-stage EEA, including one with a type of MP trigeminal schwannoma with an anterior communicating aneurysm, one with a pleomorphic xanthoastrocytoma with a left ICA paraclinoid aneurysm, and one with a recurrent pituitary adenoma with a right ICA paraclinoid aneurysm. In addition, there were 2 cases in which daughter aneurysms formed after embolization and before tumor resection. Of those, one patient who chose to treat the aneurysm conservatively experienced aneurysm rupture during the follow-up period. No CSF rhinorrhea, severe intracranial infection or surgical-related hemorrhage were found in any of the patients. Conclusion Staged surgery or conservative treatment for aneurysms can be considered a safe and effective strategy for the treatment of coexisting pathologies. It is necessary to decide the sequence of staged surgery according to whether the tumor causes obvious neurological symptoms or aneurysms with small processes. However, in very selected cases, the single-stage EEA can be used as part of a comprehensive treatment for such coexisting pathologies.