Giant tuberculum sellae meningioma with unruptured anterior communicating artery aneurysm encased Case report and review of the literature

This 64-year-old man presented with symptoms of optic chiasm and nerve compression from a giant tuberculum sellae meningioma with unruptured anterior communicating artery aneurysm encased. Preoperative magnetic resonance imaging disclosed that the aneurysm was completely enclosed in the tumor, but angiographic studies did not reveal any important arterial narrowing. The embedded aneurysm caused neither SAH nor intratumoral hemorrhage. All of these factors pointed to little adhesion between the tumor and the encased arteries. Surgery was performed a week after admission and the intraoperative findings revealed that the tumor did not adhere too much to the enclosed vasculature except for a little part attached to the left ICA. The aneurysm was safely clipped after piecemeal removal of the tumor, which was finally extirpated without fear of aneurysm rupture, and with a good visual outcome. To treat both the tumor and aneurysm simultaneously, careful stepwise operative procedures were essential.