title: Preoperative embolization and immediate removal of a giant pituitary adenoma: a case report.
abstract: BACKGROUND
  Giant pituitary adenomas, with maximum diameter of at least 40 mm, continue to involve high surgical risks despite recent advances in microsurgical and/or endoscopic surgery. We treated a case of giant pituitary adenoma with preoperative endovascular embolization in an attempt to reduce blood loss.
  
  
  METHODS
  A 48-year-old Japanese Woman presented with severe right visual disturbance. Magnetic resonance imaging revealed a giant pituitary adenoma with maximum diameter of 82 mm. Angiography revealed significant tumor stain, with blood supply mainly from the branches of the right meningohypophyseal trunk. These feeding arteries were endovascularly embolized with n-butyl cyanoacrylate. Subsequently, the tumor was safely removed by transsphenoidal surgery in two stages. The patient showed significant improvement of visual disturbance postoperatively, and was discharged without other neurological deficit. The surgical policy was explained preoperatively to the patients and written informed consents were obtained.
  
  
  CONCLUSIONS
  Preoperative embolization of a giant pituitary adenoma is a useful procedure that can potentially decrease the morbidity and mortality of this devastating tumor.
authors.affiliation: Department of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachiminami, Taihaku-ku, Sendai, Miyagi, 982-8523, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Omodaka
authors.affiliation: Department of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachiminami, Taihaku-ku, Sendai, Miyagi, 982-8523, Japan. yogawa@kohnan-sendai.or.jp.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Ogawa
authors.affiliation: Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery*; D000792:Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D011182:Postoperative Care; D011300:Preoperative Care; D014057:Tomography, X-Ray Computed
keywords: Giant pituitary adenoma; Meningohypophyseal trunk; N-butyl cyanoacrylate; Preoperative embolization