Mimicking aneurysm in a patient with chronic occlusion of the left middle cerebral artery: A case report.

BACKGROUND: With the popularization of various cerebrovascular imaging methods and increased attention to the field, more cerebrovascular diseases are being detected in asymptomatic patients. Different cerebrovascular diseases are typically isolated but occasionally occur simultaneously, causing difficulties in diagnosis and treatment. Morphological changes in the collateral circulation of blood vessels in chronic cerebral artery occlusion patients are slow and dynamic, intercepting morphological development at a specific moment. Excessive reliance on single imaging tests such as digital subtraction cerebral angiography (DSA) can lead to misdiagnosis. CASE SUMMARY: We report a 52-year-old male who was admitted to our department for treatment of an unruptured aneurysm during a follow-up examination for brain trauma after 1 mo. Computed tomography (CT) scan was negative, but CT angiography (CTA) revealed a sac-like bulge at the bifurcation of the left middle cerebral artery. DSA revealed an unruptured aneurysm with unique scapular morphology. The stump of a middle cerebral artery occlusion was observed during exposure during aneurysm clipping surgery, and the diagnosis of chronic cerebral artery occlusion was confirmed intraoperatively. This case was confusing because of the peculiar morphology of the arterial stump and compensatory angiogenesis due to multiple cerebral artery stenoses observed on preoperative CTA and DSA. The surgery did not cause secondary damage to the patient, and medical treatment for risk factors was continued postoperatively. CONCLUSION: Multiple cerebral arterial stenoses can occur in conjunction with aneurysms or arteriovenous malformations, and their unique morphology can lead to misdiagnosis.

Surgical management of growth hormone-secreting pituitary adenomas: A retrospective analysis of 33 patients.

The endoscopic endonasal transsphenoidal approach (EETA) is the primary treatment for growth hormone (GH) adenoma. This study aimed to investigate the outcomes of EETA in 33 patients with GH-secreting pituitary adenoma (PA).Thirty-three patients who underwent EETA in Eighth People's Hospital of Shenzhen between January 2013 and December 2017 were included in the comprehensive analysis. Factors affecting the extent of resection and postoperative remission rates were also reviewed.The total cut rate was 63.6% (21), and the total remission rate was 66.7% (22) in all patients after surgery. The cure rate was 60.6% (20) for 33 patients. The total removal rate and remission rate were significantly different (P = .01, P = .007) for microadenomas, macroadenomas, and giant adenomas. In addition, the total removal rate and remission rate were significantly different (P = .004, P = .007) for patients with noninvasive and invasive GH-secreting PAs. Furthermore, there were significant differences (P = .003, P = .005) in the total removal rate and remission rate of patients with different preoperative GH levels. All patients with hypertension and diabetes mellitus were normalized. Three patients exhibited recurrence after surgery. Several patients suffered from postoperative complications, including transient diabetes insipidus in 3 (9.1%) patients and postoperative transient cerebrospinal fluid leakage in 2 (6.1%) patients.EETA is an effective therapeutic approach for treating patients with GH-secreting PA with high remission and low complication rates. Therefore, EETA should be considered a primary treatment for patients with GH-secreting PA.