case_images: PMC9479505_01
case_images: (a) Magnetic resonance angiography showing a giant right cavernous internal carotid artery (ICA) aneurysm. The aneurysm is surrounded by arrowheads. (b) T1-weighted coronal magnetic resonance imaging showing a thrombotic aneurysm measuring 26.4 mm at the largest diameter, as indicated by white line. The asterisk refers to the pituitary gland that is ablated by an aneurysm. (c) Digital subtraction angiography shows the right cavernous ICA aneurysm. (d) 3D rotational angiography shows aneurysm excluded thrombosis measuring at 19.3 mm at largest diameter, as indicated by green line. The height of the aneurysm is 8.2 mm, indicated by the orange line.
case_images: SNI-13-378-g001.jpg
case_images: PMC9479505_01_SNI-13-378-g001.jpg
case_images: F1
case_images: MRI and magnetic resonance angiography showed a significant mass effect on the pituitary gland, with a giant right cavernous ICA thrombotic aneurysm measuring 26.4 mm at the largest diameter [Figures 1a and b]. Digital subtraction angiography revealed a right cavernous ICA aneurysm [Figures 1c and d].
case_images: (a) The working angle of digital subtraction angiography (DSA) before flow diverter deployment is presented. (b) DSA immediately after deployment of the flow-diverting stent for the aneurysm showing an eclipse sign. (c) A flow-diverting stent was deployed and radiographs were taken. The flow diverter was confirmed to cover the neck of the aneurysm. Arrowheads indicate flow-diverting stents.
case_images: SNI-13-378-g002.jpg
case_images: PMC9479505_01_SNI-13-378-g002.jpg
case_images: F2
case_images: Immediately after pipeline placement, the flow-diverting effect and good patency of the stent were confirmed [Figures 2a-c].
case_images: (a) Contrast-enhanced T1-weighted imaging 1 week after endovascular surgery is presented. It shows a tendency toward thrombosis, but the pituitary gland is compressed and cannot be seen clearly. (b) Contrast-enhanced T1-VISTA imaging performed 9 months after the endovascular surgery. The aneurysm shrank significantly. The pituitary stalk, circled by arrowheads, can now be observed. (c) Contrast-enhanced T1-weighted image 16 months after endovascular surgery the aneurysm was further reduced compared to 9 months after endovascular surgery. (d) Contrast-enhanced T1-weighted image 24 months after endovascular surgery. The aneurysm was generally unchanged in size 16 months after endovascular surgery.
case_images: SNI-13-378-g003.jpg
case_images: PMC9479505_01_SNI-13-378-g003.jpg
case_images: F3
case_images: MRI at 1 week, 9 months, 16 months, and 24 months after endovascular surgery showed that the cerebral aneurysm thrombosed and shrank accordingly [Figures 3a-d].
case_images: Time series graphs of hormone load tests. The solid and dotted lines indicate the date 1 week and 6 months after the operation, respectively. In the thyrotropin-releasing hormone loading test, the normal maximum thyroid-stimulating hormone level was more than 6 muIU/mL, but the measured value did not reach the normal value at 1 week and 6 months after surgery. In the corticotropin-releasing hormone loading test, the normal apex value of adrenocorticotropic hormone is more than twice the preloading value at more than 30 pg/mL, but the measured value did not reach the normal value at 1 week and 6 months after surgery. In the growth hormone-releasing peptide-2 loading test, the normal maximum growth hormone level is more than 9 ng/mL, but the measured value did not reach the normal value at 1 week and 6 months after surgery. In the follicle-stimulating hormone loading test, the normal maximum luteinizing hormone level is more than 5 times the preloading value, but the measured value did not reach the normal value at 1 week and 6 months after surgery. However, there is an improvement in responsiveness in all loading tests at 6 months compared to 1 week postoperatively.
case_images: SNI-13-378-g004.jpg
case_images: PMC9479505_01_SNI-13-378-g004.jpg
case_images: F4
case_images: Although complete functional recovery of the pituitary gland was not achieved at 6 months postoperatively, the hormone loading test confirmed functional improvement of the pituitary gland [Figure 4].