Türk Nöroşirürji Dergisi 2019 , Vol 29 , Num 1
Superior Hypophyseal Artery Aneurysms: Hypophyseal Insufficiency and Visual Findings, Endovascular? Surgical Treatment?
1Sağlık Bilimleri Üniversitesi Ankara Numune Eğitim ve Araştırma Hastanesi, Beyin ve Sinir Cerrahisi Kliniği, Ankara, Türkiye Superior hypophyseal artery aneurysms (SHA) are typically intradural and risk factor for subarachnoid hemorrhage (SAH). Patient"s age, comorbidity, complex anatomy of the paraclinoid region, dural folds, intimate relation with optic nerves are major difficulties for surgical clipping. Aneurysm angle is a technical difficulty for endovascular treatment. Similarly, the use of stents and flow diverters at this segment is difficult due to unintended kinks. The risk of hypophyseal insufficiency associated with sellar aneurysm is reported to be 0.17%. Inferomedial growth and pressure on diaphragma sella might induce hypopituitarism. Pressure on superior hypophyseal artery and vascular reasons are other risk factors. It is not certain that symptoms and signs resolve after decompression. Standart treatment includes hormonal replacement plus endovascular or microsurgical treatment which hopefully resulted in aneurysm obliteration. Hypophyseal functions might not reach normal range despite successful treatment and long-term follow-up. Anahtar Kelimeler : Superior hypophyseal artery aneurysm, Endovascular treatment, Surgical clipping, Hypophyseal insufficiency, Flow diverters