Ruptured anterior communicating artery aneurysm encased in a tuberculum sellae meningioma - Case report

This 70-year-old woman suffered a subarachnoid hemorrhage (SAH) from a rupt ured anterior communicating artery aneurysm encased in a meningioma in the tuberculum sellae. Although preoperative magnetic resonance imaging disclos ed that the aneurysmal complex was completely enclosed in the tumor, angiog raphic studies did not reveal arterial narrowing. The embedded aneurysm cau sed diffuse SAH rather than intratumoral hemorrhage. These factors indicate d very little adhesion between the tumor and the encased arteries. Surgery was performed on the 20th day post-SAH. Intraoperative findings revealed th at the tumor did not adhere to the enclosed vasculature except at the point of rupture of the aneurysm. The authors were able to clip the aneurysm saf ely after piecemeal removal of the tumor, which was finally extirpated with out fear of aneurysm rupture. Careful stepwise procedures were essential to treat the aneurysm and the tumor simultaneously.