ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 21 of 49
Up
УЖМБС 2018, 3(1): 109–116
https://doi.org/10.26693/jmbs03.01.109
Clinical Medicine

Differential Diagnosis of Arterial Brain Aneurysms with Hormonal Inactive Adenoma of the Pituitary Gland and other Pathological Processes of the Secular Area in Planning Surgical Treatment

Guk N. A., Litvak S. O., Mumlev A. O., Nikiforak Z. M.
Abstract

The frequency of arterial aneurysm (AA) of the brain is 1-10% of the population. A retrospective analysis of preoperative complex of clinical and instrumental examination was carried out in 882 (100%) patients, 311 (35.3%) of whom were with arterial aneurysms of the brain and 571 (64.5%) had hormonally inactive adenomas of the pituitary during the 5-year period. The need for differential diagnosis (DD) arose in 2.6% of AA of the brain and 7.5% of hormonally inactive pituitary adenoma (HIPA). DD is required for the determination of surgical treatment of AA and HIPA. A combination of neuroimaging techniques is appropriate in the cases of DD AA of the brain with HIPA and other pathologies of the secular area. The optimally effective complex of diagnostic measures was developed and allows conducting differential diagnostics of lesions of the secular area, to determine the further surgical tactics. As a result of our study we can draw the following conclusions: The standard algorithm for complex neuroimaging examination of patients regulated by the standards of medical care for patients with AA or HIPA is expedient to supplement the MP-AG or MSCT-AG according to individualized indications and for differential diagnostics. Differentiated diagnosis of AA of the brain with HIPA or other pathological processes of the secular area is registered in 2.6% (8 patients) with DI 95% in cases of pseudotumorosis disease with typical neuro-ophthalmological manifestations in AA large or hygienic dimensions with lesions of the complex PMA-PSA, paraclinoid and supraclinoid division of BCA. Instead, the necessity of differential diagnostics of HIPA with other pathological processes of the secular area occurs in 7.5%, mainly with benign tumors of the secular localization of 3.4% and AA of the brain – 2.1%. The combination of SMTS, MSCT-AG or MRI, MR-AG with CAG is highly informative and allows conducting differential diagnostics of AA of the brain, HIPA with other lesions of the secular area, to determine the volume and surgical tactics. The use of aggregate data of neuroimaging diagnostic methods (MRI, MSCT, CT-AG, TSAG) for the construction of three-dimensional models of pathology in relation to skeletal and neurovascular structures of the skull base is a promising and expedient stage of planning of surgical intervention after the final differentiation of the process.

Keywords: differential diagnosis, arterial aneurysm, hormonally inactive adenoma of the pituitary gland, neoplasms of the secular area, brain

Full text: PDF (Ukr) 838K

References
  1. Duros J, Clark ME, Kufahl RH, Nádvorník P. On the rupture of an aneurysm. Neurological research. 1991; 13 (4): 217-23. https://doi.org/10.1080/01616412.1991.11739995
  2. Laakso A, Hernesniemi J, Yonekawa Y, Tsukahara T. Surgical management of cerebrovascular disease. Springer Science & Business Media, 2010. 107 p.
  3. Yuki I. Spitzer D, Guglielmi G, Duckwiler G, Fujimoto M, Takao H, Vinuela F. Immunohistochemical analysis of a ruptured basilar top aneurysm autopsied 22 years after embolization with Guglielmi detachable coils. Journal of neurointerventional surgery. 2014: 011260. https://doi.org/10.1136/bcr-2014-011260
  4. Takao H, Kadokura S, Suzuki T, Kanbayashi Y, Masuda S, Shinohara K, Murayama Y. What Cfd Parameter is Different Between Growing and No Growing Aneurysm. Stroke. 2014;45:AWP70
  5. McAloon CJ, Boylan LM, Hamborg T, Stallard N, Osman F, Lim PB, Hayat SA. The changing face of cardiovascular disease 2000–2012: An analysis of the world health organisation global health estimates data. International journal of cardiology. 2016; 224: 256-64. https://www.ncbi.nlm.nih.gov/pubmed/27664572. https://doi.org/10.1016/j.ijcard.2016.09.026
  6. Kalkonde YV, Sahane V, Deshmukh MD, Nila S, Mandava P, Bang A.. High Prevalence of stroke in rural Gadchiroli, India: a community-based study. Neuroepidemiology. 2016; 46 (4): 235-9. https://www.ncbi.nlm.nih.gov/pubmed/26974843. https://doi.org/10.1159/000444487
  7. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, et al. Heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation. 2014; 129 (3): e28-e292. https://www.ncbi.nlm.nih.gov/pubmed/24352519. https://www.ncbi.nlm.nih.gov/pmc/articles/5408159. https://doi.org/10.1161/01.cir.0000441139.02102.80
  8. Koton S, Schneider AL, Rosamond WD, Shahar E, Sang Y, Gottesman RF, Coresh J. Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA. 2014 Jul 16;312(3):259-68. https://www.ncbi.nlm.nih.gov/pubmed/25027141. https://doi.org/10.1001/jama.2014.7692.
  9. Khatri P, Yeatts SD, Mazighi M, Broderick JP, Liebeskind DS, Demchuk AM, Amarenco P, Carrozzella J, et al. Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke: an analysis of data from the Interventional Management of Stroke (IMS III) phase 3 trial. The Lancet Neurology. 2014; 13 (6): 567-74. https://www.ncbi.nlm.nih.gov/pubmed/24784550. https://www.ncbi.nlm.nih.gov/pmc/articles/4174410. https://doi.org/10.1016/S1474-4422(14)70066-3
  10. Syro LV, Builes CE, Di Ieva A, Sav A, Rotondo F, Kovacs K. Improving differential diagnosis of pituitary adenomas. Expert Rev Endocrinol Metab. 2014; 9 (4): 377-86. https://doi.org/10.1586/17446651.2014.922412
  11. Zador Z, Coope D, Gnanalingham K, Lawton M. Quantifying surgical access in eyebrow craniotomy with and without orbital bar removal. Acta Neurochir. 2014; 156: 697-702. https://www.ncbi.nlm.nih.gov/pubmed/24327059. https://doi.org/10.1007/s00701-013-1947-y
  12. Losa M, Donofrio CA, Barzaghi R, Mortini P. Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics. Eur J Endocrinol. 2013; 169 (6): 735-42. https://www.ncbi.nlm.nih.gov/pubmed/23999643. https://doi.org/10.1530/EJE-13-0515
  13. Di Ieva A, Rotondo F, Syro LV, Cusimano MD, Kovacs K. Aggressive pituitary adenomas - diagnosis and emerging treatments. Nat Rev Endocrinol. 2014; 10 (7): 423-35. https://www.ncbi.nlm.nih.gov/pubmed/24821329. https://doi.org/10.1038/nrendo.2014.64
  14. Reisch R, Stadie A, Kockro R, Hopf N. The Keyhole concept in neurosurgery. World Neurosurg. 2013; 79 (2): e9-e17. https://www.ncbi.nlm.nih.gov/pubmed/22381839. https://doi.org/10.1016/j.wneu.2012.02.024
  15. Teo C, Sugrhue M. Principles and practice of keyhole brain surgery. Georg Thieme Verlag, 2015. 272 p.