We report case of a patient who suffered a pseudo internal carotid artery (IC)
aneurysm following transsphenoidal surgery. He was successfully treated with bypass surgery and IC occlusion involving the
pseudoaneurysm using Guglielmi detachable coils (GDCs). This 50-year-old man with recurrent FSH-releasing
pituitary adenoma suffered profuse arterial
bleeding during transsphenoidal surgery. The
hemorrhage was managed, using
oxidized cellulose with bio-bond. His postoperative course was uneventful, but, he developed massive
epistaxis 20 days after surgery. Cerebral angiograms showed a
pseudoaneurysm arising from the C4 portion of the left IC. He could not tolerate the balloon occlusion test. Using GDCs, we immediately performed left IC occlusion involving the
pseudoaneurysm followed by bypass surgery between the left EC and the left middle cerebral artery. Postoperative angiograms showed that the
pseudoaneurysm was completely occluded and the bypass was fully patent. When massive arterial
bleeding is encountered during transsphenoidal surgery, the patient should be carefully monitored to detect early the development of a
pseudoaneurysm. When such an
aneurysm is found or has ruptured, interventional surgery has proved effective in the management of this complication.