1 3 CorrespondenCe received: 5 June 2013 / Accepted: 4 August 2014 © springer-Verlag Berlin Heidelberg 2014 Endovascular Management of Cavernous Internal Carotid Artery Pseudoaneurysms Following Transsphenoidal Surgery: A Report of Two Cases and Review of the Literature A. M. Mortimer · K. Klimczak · R. J. Nelson · S. A. Renowden Clin neuroradiol doI 10.1007/s00062-014-0332-4 lateral quadrant of the pituitary fossa fenestration. This was controlled with surgicel and surgical packs were inserted. Then, 3 days post-operatively, the patient was investigated with magnetic resonance angiography (MrA) which dem- onstrated a small left cavernous ICA pseudoaneurysm (Fig. 1a). Digital subtraction angiography (DSA) confrmed the presence of 4 × 3 mm aneurysm with a defned neck aris- ing from the distal cavernous carotid just before the second genu (Fig. 1b). The aneurysm was selectively catheter- ised using an echelon 10 microcatheter (Covidien, UsA). A series of soft and ultrasoft coils (Boston, now stryker, UsA) were sequentially deployed into the pseudoaneurysm achieving complete occlusion (Fig. 2). Follow-up MrA performed 2 weeks later demonstrated a tiny neck remnant and repeat MrA at 6 weeks showed com- plete obliteration of the aneurysm. dsA at 4 months con- frmed satisfactory occlusion (Fig. 3). The patient remains well 5 years after the surgery and intervention. Case 2 A 43-year-old man with acromegaly underwent endoscopic transsphenoidal resection of a pituitary macroadenoma. Intra-operatively, brisk bleeding was encountered from a vessel arising from the medial aspect of left internal carotid artery at the junction of the dura and cavernous sinus. This was controlled with bipolar coagulation and surgical packs. on the second post-operative day the patient developed a left third nerve palsy and left retro-orbital discomfort. Computed tomography angiography (CTA) demonstrated a left parasel- lar haematoma but no vascular lesion. Formal dsA demon- strated mild narrowing of the cavernous ICA only (Fig. 4). On the ffth post-operative day the packs were removed and the patient was subsequently discharged. He represented Vascular complications of transsphenoidal surgery are rare [1] but are associated with signifcant morbidity and mor- tality [2]. The cavernous internal carotid artery (ICA) is most commonly injured [2]. Following initial control of haemorrhage, defnitive treatment increasingly relies upon endovascular techniques aimed at preserving the parent vessel. We describe our experience managing two patients who developed pseudoaneurysms following transsphenoi- dal surgery. We employed unassisted coiling in one patient and coiling with fow diversion in the second. We have also reviewed the literature to explore other endovascular treat- ment options. Case 1 A 41-year-old male presenting with a bitemporal hemiano- pia underwent microsurgical transsphenoidal resection of a non-functioning pituitary macroadenoma. Following dural opening, arterial bleeding was noted from the left supero- Author Contributions: Author contributions to the study and manuscript preparation include the following. Conception and design: rJ nelson, sA renowden. Analysis and interpretation of data: all authors. drafting the article: AM Mortimer, KJ Klimczak. Critically revising the article: all authors. A. M. Mortimer, FrCr () · K. Klimczak, MBChB · s. A. renowden, FrCr department of neuroradiology, southmead Hospital, north Bristol nHs Trust, southmead road, Bristol, Bs10 5nB, UK e-mail: alex_mortimer@hotmail.com r. J. nelson, FrCs department of neurosurgery, southmead Hospital, north Bristol nHs Trust, southmead road, Bristol, Bs10 5nB, UK