Robert Alan Koenigsberg DO, Presenter: Nothing to Disclose

Nakul Vakil, Abstract Co-Author: Nothing to Disclose

Barbara Hum MD, Abstract Co-Author: Nothing to Disclose

Tom Hong, Abstract Co-Author: Nothing to Disclose

The superior hypophyseal aneurysm is an uncommon entity accounting for 1% of intracranial aneurysms. Superior hypophyseal aneurysms arise from the segment of the internal carotid artery giving rise to perforating vessels supplying the hypophysis and optic chiasm. We present our experience with the endovascular treatment of superior hypophyseal artery aneurysms and review pertinent radiological anatomy

We reviewed 5 patients that presented for endovascular treatment of superior hypophyseal artery aneurysms. Three patients presented with headache, 1 with subarachnoid hemorrhage from a ruptured bilobed aneurysm, and 1 patient with pituitary apoplexy from intrasellar rupture of a giant aneurysm previously diagnosed as a pituitary macroadenoma. Embolization with detachable coils was performed electively on three aneurysms, emergently for subarachnoid hemorrhage in one patient, and emergently for the ruptured giant aneurysm discovered intraoperatively during attempted transphenoidal resection.

Complete occlusion was obtained in the 3 aneurysms and in the inferior lobe of the bilobed aneurysm with a 2mm residual neck in the superior lobe. Occlusion was achieved with a residual unilateral neck in the giant aneurysm at 6 month post-procedure; this was followed by re-growth requiring re-packing and parent artery occlusion. Transient complications included one case of post-procedure blurry vision ipsilateral to the coiled aneurysm. All patients demonstrated improvement of presenting symptoms.

Our experience demonstrates that endovascular treatment can be used to effectively manage superior hypophyseal aneurysms and their related symptomatology. Appropriate imaging anatomy is reviewed.

Koenigsberg, R, Vakil, N, Hum, B, Hong, T, Superior Hypophyseal Aneurysms: Anatomy and Endovascular Management.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4404027.html