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Neurochirurgie
Vol 49, N° 6  - décembre 2003
pp. 611-615
Doi : NCHIR-12-2003-49-6-0028-3770-101019-ART08
ANÉVRYSME INTRA-CRÂNIEN RÉVÉLÉ PAR UN PANHYPOPITUITARISME
Considérations sur la prise en charge thérapeutique à propos d'un cas et revue de la littérature
 

Ph. MÉTELLUS [1], V. DICOSTANZO [2], L. MANERA [3], S. FUENTES [1], H. DUFOUR [1], F. GRISOLI [1]
[1]  Département de Neurochirurgie (Pr Grisoli),
[2]  Département d'Endocrinologie et des Maladies Métaboliques,
[3]  Département de Neuro-Radiologie, Hôpital de La Timone, 264, rue Saint-Pierre, 13385 Marseille Cedex 05.

Tirés à part : Ph. Métellus [1]

[4]   à l'adresse ci-dessus.

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Les auteurs rapportent un cas d'anévrysme intra-crânien révélé par un panhypopituitarisme. Il s'agissait d'un anévrysme paraclinoïdien non rompu. Le bilan pré-thérapeutique a consisté en un test de clampage carotidien interne homolatéral qui a été bien toléré par le patient. L'anévrysme a pu être embolisé à l'aide de coïls de type « Guglielmi detachable coils » (GDC), sans qu'une occlusion carotidienne soit réalisée. Les suites ont été simples, et le patient a pu regagner son domicile à la 48 e heure. L'angiographie de contrôle réalisée un an plus tard montre une exclusion satisfaisante de la malformation. Une revue exhaustive de la littérature nous permettra de discuter de la prise en charge thérapeutique de cette pathologie rare.

Abstract
Intracranial aneurysm revealed by panhypopituitarism. Considerations on therapeutic management based on a case report and review of the literature

We report a case of an unruptured intracranial aneurysm in paraclinoidal location which was a unmasked by severe panhypopituitarism. An ipsilateral internal carotid artery (ICA) clamp test was performed in the pretreatment stage. The test was well tolerated and the aneurysm could be embolized with GDC (Guglielmi detachable coils) without necessitating an occlusion of the ICA. The postoperative course was uneventful and the patient was discharged after 48 hours. At one year, cerebral angiograms confirmed complete obliteration of the aneurysm. Therapeutic management of this rare entity is discussed along with a careful and exhaustive review of the literature.

Keywords: intracranial aneurysm , panhypopituitarism , endovascular embolisation






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