Differential Diagnosis of Arterial Brain Aneurysms with Hormonal Inactive Adenoma of the Pituitary Gland and other Pathological Processes of the Secular Area in Planning Surgical Treatment

The frequency of arterial aneurysm (AA) of the brain is 1-10% of the population. A retrospective analysis of preoperative complex of clinical and instrumental examination was carried out in 882 (100%) patients, 311 (35.3%) of whom were with arterial aneurysms of the brain and 571 (64.5%) had hormonally inactive adenomas of the pituitary during the 5-year period. The need for differential diagnosis (DD) arose in 2.6% of AA of the brain and 7.5% of hormonally inactive pituitary adenoma (HIPA). DD is required for the determination of surgical treatment of AA and HIPA. A combination of neuroimaging techniques is appropriate in the cases of DD AA of the brain with HIPA and other pathologies of the secular area. The optimally effective complex of diagnostic measures was developed and allows conducting differential diagnostics of lesions of the secular area, to determine the further surgical tactics. As a result of our study we can draw the following conclusions: The standard algorithm for complex neuroimaging examination of patients regulated by the standards of medical care for patients with AA or HIPA is expedient to supplement the MP-AG or MSCT-AG according to individualized indications and for differential diagnostics. Differentiated diagnosis of AA of the brain with HIPA or other pathological processes of the secular area is registered in 2.6% (8 patients) with DI 95% in cases of pseudotumorosis disease with typical neuro-ophthalmological manifestations in AA large or hygienic dimensions with lesions of the complex PMA-PSA, paraclinoid and supraclinoid division of BCA. Instead, the necessity of differential diagnostics of HIPA with other pathological processes of the secular area occurs in 7.5%, mainly with benign tumors of the secular localization of 3.4% and AA of the brain – 2.1%. The combination of SMTS, MSCT-AG or MRI, MR-AG with CAG is highly informative and allows conducting differential diagnostics of AA of the brain, HIPA with other lesions of the secular area, to determine the volume and surgical tactics. The use of aggregate data of neuroimaging diagnostic methods (MRI, MSCT, CT-AG, TSAG) for the construction of three-dimensional models of pathology in relation to skeletal and neurovascular structures of the skull base is a promising and expedient stage of planning of surgical intervention after the final differentiation of the process.