Single-stage purely endoscopic surgery for sellar tumors coexisting with intracranial aneurysm: a case series and technical note

Coexisting intracranial aneurysms may be encountered during sellar tumor surgery, but no consensus has been reached on standardized treatment strategies. The simultaneous treatment of sellar tumors resection and coexisting intracranial aneurysms in a single-stage surgery has rarely been reported. Here, we report a case series of sellar tumors coexisting with intracranial aneurysms during a single-stage via purely endoscopic surgery in a single center between January 2015 and July 2022. The patients’ clinical information, including age, sex, symptoms, as well as aneurysm location, treatment modality, procedure details, clinical and imaging outcome, was collected and analyzed. Among the selected 8 patients with sellar region tumors combined aneurysms, 3 had craniopharyngiomas, 4 had pituitary tumors, and 1 had meningioma. Among the coexisting intracranial aneurysms, 3 were anterior communicating aneurysms, 4 were internal carotid artery (ICA) aneurysms in the ophthalmic artery segment, and 1 was a middle cerebral artery (MCA) bifurcation aneurysm. Seven aneurysms were diagnosed before surgery, and 1 was diagnosed after intraoperative rupture. Postoperative review using computed tomography angiography (CTA) or digital subtraction angiograph (DSA) revealed complete aneurysms clipping, and enhanced magnetic resonance imaging (MRI) revealed tumor resection. Seven patients had a modified Rankin scale (mRS) score of ≤ 1 and one patient died from perioperative complications. Therefore, preoperative cerebrovascular examination is recommended for patients with sellar tumors to exclude the possibility of intracranial aneurysms, and it is feasible to complete tumor resection and aneurysm clipping in one single-stage purely endoscopic surgery.