Intracranial aneurysm coexisting with pituitary adenoma: a systematic review

The simultaneous occurrence of intracranial aneurysms (IA) and primary brain tumors (BT) is frequently reported, with an estimated incidence of 0.5-7.4%. Among the tumor types associated with IA, pituitary adenomas (PA) are the most prevalent. The authors selected articles, published from 1960 to December 2023, on the Medline, Embase, Scopus, Cochrane Library, and Web of Science databases. The extraction form contains information specific to the aneurysm and tumor, rupture of the aneurysm, treatment proposal for both and order of treatment and outcome. The study evaluated 118 patients from 25 articles. The most frequent types of tumors were non-functioning hormone (NFA) producers, present in 45.8% ( =54) of the cases, and growth hormone (GH) secretors, which represent 23.0% ( =27) of the cases. The main treatment used was surgery, with subtotal resection (STR) performed in 4.2% ( =5) of cases, gross total resection (GTR) in 3.4% ( =4), and transsphenoidal resection (TSR) in 7.6% ( =9). 16.0% ( =19) of patients had two or more aneurysms concomitant with the adenoma. IA treatment was performed before PA surgery in 25 patients (21.2%) and 15 patients received simultaneous treatment to IA and PA (12.7%). Patients with PAs have a considerable prevalence of IAs. Hormonal imbalances and mechanical changes induced by tumor growth, particularly influenced by GH and IGF-1, contribute to this coexistence. Surgical intervention is common, requiring meticulous precautions to avoid complications. More longitudinal studies including close follow-up with a description of outcomes are necessary to guide treatment protocols for this condition.