Asian journal of neurosurgery最新文献

{"title":"Calvarial Tuberculosis: Shifting Paradigm from Surgical to Conservative Approach","authors":"Vivek Kumar, Varun Aggarwal, Gopal Krishna, Ishwar Singh, Vinay Vinay, Praveen S. Holkar","doi":"10.1055/s-0044-1788987","DOIUrl":"https://doi.org/10.1055/s-0044-1788987","url":null,"abstract":"\u0000 Background Tuberculosis (TB) is an endemic disease in developing countries like India. However, incidence of calvarial TB is very low and it presents in varied forms posing a diagnostic dilemma and delay in management.\u0000 Objectives This article reports a case series of 15 patients with varied presentations of calvarial TB from a tertiary care superspeciality center of Haryana state in India.\u0000 Material and Methods Study is a retrospective analysis of 15 patients with calvarial TB treated between 2018 and 2021 in a tertiary care hospital. Clinical features, radiological findings, surgical and medical management, and outcomes were reviewed.\u0000 Results Of the 15 patients, 9 were males and age ranged between 12 and 45 years. Mean duration of symptoms was 2.9 months (range 1–5 months). The most common presenting symptoms were scalp swelling, discharging sinus, and pain. Four patients were treatment defaulters of pulmonary TB and two patients were found human immunodeficiency virus positive. Brain imaging showed peripherally enhancing extradural collection with bone erosions in most cases. Eleven patients were managed conservatively with fine-needle aspiration cytology (FNAC) or local debridement/sinus excision. Four patients were managed surgically with drainage of collection, excision of necrotic bone, followed by antitubercular therapy. One patient needed cerebrospinal fluid diversion for associated hydrocephalous with tubercular meningitis which could not recover and succumbed.\u0000 Conclusion Calvarial TB is a rare occurrence of common prevalent diseases. Conservative management with FNAC and sinus excision followed by antitubercular treatment are the mainstay of treatment. Surgery should be reserved for extensive lesion or lesion with mass effect.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"44 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141924204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metastatic Malignant Melanoma of Brain: A Rare Case Report.","authors":"Manoj Kumar Seervi, Surendra Jain, Ugan Singh Meena, Devendra Kumar Purohit","doi":"10.1055/s-0044-1788633","DOIUrl":"10.1055/s-0044-1788633","url":null,"abstract":"<p><p>Malignant melanoma is third most common cause of brain metastasis after lung and breast cancer. Most patients with brain metastases from malignant melanoma are diagnosed after treatment for known extracranial metastases and have a poor outcome despite various local and systemic therapeutic approaches. Here we discuss an unusual case of a 61-year-old male patient who presented with a brain metastasis as the initial disease presentation and the presumed primary lesion was later found in the gastrointestinal tract and the scalp. Treatment consisted of a surgical removal of the large intracranial lesion. Further evaluation for primary lesion was done by general physical examination, contrast-enhanced computed tomography (CECT) of the chest and whole abdomen. Apart from that, colonoscopy was done, and a biopsy was taken from a suspicious colonic lesion. The scalp pigmented lesion was also evaluated. Both biopsies were in favor of melanoma. Recently, management of metastatic melanoma of the brain is decided according to the number of lesions, accessibility, visceral metastasis, and resectability of the lesion. Various treatment options are surgical resection, whole brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS). Malignant melanoma is relatively radioresistant, so the results are debatable. In conclusion, the prognosis of intracranial malignant melanoma is determined by the following factors: (1) the type of lesion; (2) the involvement of the leptomeninges; (3) the extent of tumor excised; and (4) the molecular immunology borstel number 1 (MIB 1) antibody index, which is the most relevant factor for prognosis in this type of cancer.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"777-781"},"PeriodicalIF":0.0,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Arrest during Temporary Clipping for Ruptured Internal Carotid Artery Aneurysm: A Case Report.","authors":"Toshihiko Shimizu, Hiroshi Kosaka, Yuji Yamamoto","doi":"10.1055/s-0044-1788974","DOIUrl":"10.1055/s-0044-1788974","url":null,"abstract":"<p><p>Mechanical stimulation of the trigeminal nerve during craniofacial, skull base, or dental surgeries may cause bradycardia, hypotension, or cardiac arrest. This phenomenon is called trigeminal cardiac reflex (TCR). We encountered a rare case of a patient who experienced sinus arrest due to temporary clipping of the intracranial carotid artery during the clipping of a ruptured aneurysm. We discuss possible reasons for the occurrence of TCR in this case. A man in his 30s with no medical history presented with a sudden-onset headache. Computed tomography revealed a subarachnoid hemorrhage in the basal cistern and left Sylvian fissure. Angiography revealed a saccular aneurysm of the left internal carotid-anterior choroidal artery. A left frontotemporal craniotomy and dural incision were performed, followed by a trans-Sylvian approach. Cardiac arrest occurred twice during the temporary clipping of the intracranial carotid artery. After surgery, we performed a cardiac ultrasound echo and a 1-week Holter electrocardiogram. Neither showed abnormalities. No arrhythmia or cardiac events were observed over a one and half-year follow-up period. The cardiac arrest might have been triggered by the stimulation of the trigeminal nerve in the internal carotid artery. The repeated and anatomical features of this case suggest that TCR triggered cardiac arrest. The high probability that cardiac arrest was induced by trigeminal nerve stimulation should be considered during the temporary clipping of the internal carotid artery. However, the predisposing factors and exact underlying mechanisms for these arrhythmias remain unknown and require further investigation.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"787-790"},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are There Left-Right Differences in Ruptured Middle Cerebral Artery Bifurcation Aneurysms? A Single-Center Retrospective Study and Review of the Literature.","authors":"Joji Inamasu, Katsuya Saito","doi":"10.1055/s-0044-1788804","DOIUrl":"10.1055/s-0044-1788804","url":null,"abstract":"<p><p><b>Background</b>  The left (Lt) and right (Rt) middle cerebral artery bifurcation (MCAB) aneurysms have mostly been regarded as identical. Considering substantial Lt-Rt differences in hemispheric infarction, however, the presence of Lt-Rt differences may not be denied totally in patients with ruptured MCAB aneurysms. We herein investigated whether such Lt-Rt differences existed by a single-center retrospective study. <b>Materials and Methods</b>  Clinical data prospectively acquired between 2011 and 2021 on 99 patients with ruptured MCAB aneurysms were analyzed. They were dichotomized based on the laterality, and demographic and outcome parameters were compared. Additionally, a literature review was conducted to elucidate possible Lt-Rt differences in the frequency of ruptured MCAB aneurysms (Rt/Lt ratio). <b>Results</b>  Among the 99 patients, 42 had Lt and 57 had Rt ruptured MCAB aneurysms, with the Rt/Lt ratio of 1.36. Neither demographic, radiographic, nor outcome variables differed significantly between the two groups. A total of 19 studies providing information on the laterality of the ruptured MCAB were retrieved by literature search. A sum total for the Lt and Rt MCAB aneurysms was 671 and 940, making the Rt/Lt ratio of 1.40. After adding our data, a sum total for the Lt and Rt MCAB aneurysms was 713 and 997, making the Rt/Lt ratio of 1.40. <b>Conclusion</b>  The Rt ruptured MCAB aneurysms were 1.40 times more frequent than the Lt-sided counterpart. While there may be some Lt-Rt differences in the MCA anatomy, it remains to be seen whether such anatomical differences are truly responsible for the disproportionately higher frequency of Rt MCAB aneurysms.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"678-684"},"PeriodicalIF":0.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Treatment of Ruptured Broad-Necked Intracranial Aneurysms with Double Microcatheter Technique: Case Series with Brief Review of Literature.","authors":"Mohan Karki, Girish Rajpal","doi":"10.1055/s-0044-1788803","DOIUrl":"10.1055/s-0044-1788803","url":null,"abstract":"<p><p><b>Objective</b>  Treatment of ruptured broad-necked intracranial aneurysms by endovascular therapy is technically burdensome. It is commonly treated with stent- and balloon-assisted coils embolization. The aim of this study was to evaluate clinical and radiological outcomes following double micro-catheter (MC) technique. <b>Materials and Methods</b>  A retrospective study was done on 16 broad-necked (neck diameter ≥ 4 mm and dome-to-neck ratio < 2) ruptured intracranial aneurysms in 16 patients treated with double MC technique at our center between December 2021 and December 2023. Clinical outcome was evaluated by modified Rankin Score, postcoiling radiological outcome was evaluated by Raymond-Roy occlusion grade, and treatment-related complications were assessed. <b>Results</b>  There were 16 patients, 9 females and 7 males; with a mean age of 51.3 years (35-70 years). All the patients underwent dual MC coils embolization for all aneurysms. Raymond-Roy occlusion class I was achieved in 81.3% (13) cases and Raymond-Roy class II was achieved in 18.7% (3) cases immediately after the procedure. There were no serious postprocedure-related complications or recanalization of the aneurysm at the mean follow-up of 4.8 months (range 2-10 months). <b>Conclusion</b>  Our study presents the safety and effectiveness of double MC system for treating ruptured broad-necked intracranial aneurysm. Large numbers of studies with longer follow-up period are required to secure validity of double MC technique.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"672-677"},"PeriodicalIF":0.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unraveling the Mystery of Rathke's Cleft Cyst Presenting with Hyponatremia: A Case Report with a Comprehensive Review of Literature.","authors":"Shayan Huda, Souvik Singha, Ali Haidous, Phillip R Bukberg, Bidyut K Pramanik, Manju Harshan, Luis Medina Mora, Maria Devita, Amy McKeown, John A Boockvar","doi":"10.1055/s-0044-1788618","DOIUrl":"10.1055/s-0044-1788618","url":null,"abstract":"<p><p>Rathke's cleft cyst (RCC) is a benign cystic lesion that is commonly discovered incidentally and remains asymptomatic in most cases. However, its association with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion leading to hyponatremia (HN) is rare and has only been sporadically reported in the medical literature. In this article, we present a unique case of RCC manifesting with HN and discuss the diagnostic and management challenges encountered in a neurosurgical context. Additionally, we provide a comprehensive review of existing literature on RCC presenting with HN to enhance our understanding of this rare presentation. A 56-year-old woman with acute-onset blurry vision, headaches, and low fluid intake was diagnosed with euvolemic HN secondary to SIADH. Further evaluation revealed an intrasellar cystic lesion consistent with RCC, which was successfully resected through endoscopic transnasal transsphenoidal surgery, resulting in a complete recovery without the need for hormone replacement. The most likely explanation for the HN due to SIADH in this case is the release of accumulated antidiuretic hormone (ADH) due to compression by the cyst and the irritating effect of inflammation at this location. Accurate evaluation and classification of HN are essential for proper diagnosis and management, considering the rarity of RCC presenting with HN. A multidisciplinary approach to treatment can lead to favorable functional outcomes; however, further research is necessary to better comprehend this unique clinical entity and optimize neurosurgical approaches.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"767-773"},"PeriodicalIF":0.0,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PL-TOSP, the Novel Entry Point in Transforaminal Endoscopic Spine Surgery: Radiological Analysis with Prospective Surgical Evaluation and Review of Literature of Various Skin Entry Points.","authors":"Prasad Patgaonkar, Kiran Dhole, Sagar Kokate, Vaibhav Goyal, Vivek Patel, Ravi Patel","doi":"10.1055/s-0044-1788680","DOIUrl":"10.1055/s-0044-1788680","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective&lt;/b&gt;  Aim of this study was to analyze variation in angulation of trajectories of various skin entry points in transforaminal endoscopic spine surgery with change in the physical parameters, namely, weight, abdominal girth, and body mass index and to validate our hypothesis that posterolateral (PL)-tip of spinous process (TOSP) entry has minimal variation in the angle of trajectory as compared with currently available skin entry points. The study included an analysis of the functional outcomes of these patients who underwent transforaminal endoscopy using the novel PL-TOSP technique, assessing improvements in pain and disability. Entry point in transforaminal endoscopic lumbar discectomy (TELD) was taken as a rough distance of 10 to 12 cm from midline as proposed by Kambin whereas Yeung and Tsou advised entry point as distance between the center of the disc space and the posterior skin line measured on lateral. But entry points cannot be static as they tend to change according to changes in physical parameters. &lt;b&gt;Materials and Methods&lt;/b&gt;  This study comprises of radiological analysis and a prospective evaluation of these patients operated on using the PL-TOSP entry point. Radiological analytic study was performed on 50 symptomatic preoperative patients who underwent transforaminal endoscopy using the novel PL-TOSP entry point. A lumbar spine magnetic resonance imaging (MRI) field of vision (MRI-FOV) was performed for the patients including the abdominal perimeter. Weight, height, and abdominal girth of the patients were noted prior to MRI. Angulation of trajectory made by four standard entry points used in TELD, namely, 45-45, PL, TOSP), dorsum of facet joint, and our proposed entry point PL-TOSP (which is a midpoint between PL and TOSP entry), were calculated using MRI-FOV at L45 and L5S1 level. For the functional outcome analysis of these 50 patients, preoperative Visual Analogue Score (VAS) for lower limb pain and Oswestry Disability Index (ODI) were recorded. Postoperative VAS and ODI scores were reassessed at 2, 6, and 12 weeks. Statistical analysis was conducted to evaluate the significance of changes in VAS scores and ODI preoperative versus postoperative. A &lt;i&gt;p&lt;/i&gt; -value of &lt; 0.05 was considered statistically significant. &lt;b&gt;Results&lt;/b&gt;  Angle of trajectory with the horizontal for all five entry points varies with physical parameters. PL-TOSP entry point has the least variation with change in physical parameters as compared with other entry points. The range of angle for PL-TOSP entry was 21 to 29 degrees. In our study, there was improvement in postoperative VAS and ODI scoring systems which was statistically significant ( &lt;i&gt;p&lt;/i&gt; -value &lt; 0.05). This suggests reliability of our proposed entry point with consistent postoperative improvement. &lt;b&gt;Conclusion&lt;/b&gt;  The novel PL-TOSP entry point for transforaminal endoscopy demonstrates superior stability in trajectory angle despite variations in physical parameters, and ","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"659-665"},"PeriodicalIF":0.0,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microsurgical Anatomy of Middle Cerebral Artery in Northwest Indian Population: A Cadaveric Brain Dissection Study.","authors":"Srinivasa Rakshith, Kedia Shweta, Salunke Pravin, Sahni Daisy, Basu Eilene, Krishnakutty Muthiraklayil Sareesh Kumar, Suresh Narain Mathuriya","doi":"10.1055/s-0042-1750188","DOIUrl":"10.1055/s-0042-1750188","url":null,"abstract":"<p><p>The introduction of cadaveric dissection of cerebral vasculature as a part of the neurosurgical training module would help the neurosurgical residents to understand the complex neuroanatomy of the brain vasculature and help gain confdence during the surgical procedure.To the best of our knowledge microsurgical anatomical studies of theMCA have not been done among the Northwest Indian population. Anatomical variations of MCA that have not been described before may come in as a surprise during any surgical intervention. Hence, we intend to record the anatomical variations of the MCA anatomy and its implications in contemporary vascular surgery and neurosurgical practice. The objective of this work was to study and compare the microsurgical anatomy and variations of MCA in Northwest Indian cadavers with the available literature.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"626-633"},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Flow Diverter Selection Can Affect the Flow Changes within a Jailed Ophthalmic Artery: A Computational Fluid Dynamics Study.","authors":"Can Ünsal, Görkem Güçlü, Ali Bahadir Olcay, Amir Hassankhani, Cem Bilgin, Bahattin Hakyemez","doi":"10.1055/s-0044-1787868","DOIUrl":"10.1055/s-0044-1787868","url":null,"abstract":"<p><p><b>Introduction</b>  Flow diverter (FD) stents are widely used to treat giant aneurysms by reducing blood flow into the aneurysm sac. However, choosing the optimal FD for a patient can be challenging when a nearby artery, such as the ophthalmic artery (OA), is jailed by the FD placement. This study compares the impact of two FD stents with different effective metal surface area (EMSA) values on OA occlusion. <b>Materials and Methods</b>  A numerical model of a 59-year-old female patient with a giant aneurysm in the left internal carotid artery and a jailed OA was created based on clinical data. Two FD stents, FRED4017 and FRED4518, with different EMSA values at the aneurysm neck and OA inlet, were virtually deployed in the model. Blood flow and occlusion amount in the OA were simulated and compared between the two FD stents. <b>Results</b>  FRED4017 had higher EMSA values than FRED4518 at the aneurysm neck (35% vs. 24.6%) and lower EMSA values at the OA inlet (15% vs. 21.2%). FRED4017 caused more occlusion in the OA than FRED4518 (40% vs. 28%), indicating a higher risk of ocular ischemic syndrome. <b>Conclusion</b>  The EMSA value of FD stents affects the blood flow and occlusion amount in the jailed OA. Therefore, selecting an FD stent with a low EMSA value at the OA inlet may be beneficial for patients with a nearby jailed artery at the aneurysm neck.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 3","pages":"426-434"},"PeriodicalIF":0.0,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ectopic Intrasphenoidal Growth Hormone Releasing Pituitary Adenoma Associated with an Intracranial Aneurysm.","authors":"Hernando Cifuentes-Lobelo, Marcelo A Castañeda-Duarte, Diego Ruiz-Diaz, William Cortes-Lozano","doi":"10.1055/s-0042-1757434","DOIUrl":"10.1055/s-0042-1757434","url":null,"abstract":"<p><p>Pituitary adenomas are a type of of the most frequent intracranial tumors. These tumors can extend outside the sella, but very rarely originate ectopically to the sellar region. A 71-year-old patient presented to our institution, with prior clinical history of noncontrolled arterial hypertension and new-onset high-intensity pulsatile headache. Upon suspicion of a hypertensive emergency with probable brain compromise, a nonenhanced computed tomography of the head was performed. A mass within the sphenoid sinus was found. Endocrinological workup demonstrated a significant elevation of the growth hormone. As an incidental finding, a brain aneurysm was evidenced, which was treated endovascularly prior to the mass treatment. Subsequently, the patient successfully underwent a gross total resection through an endonasal transsphenoidal approach. Histopathological results were consistent with a pituitary ectopic adenoma. A postoperative improvement in levels of somatomedin C was documented postoperatively.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 3","pages":"520-525"},"PeriodicalIF":0.0,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}