[A case of intrasellar pure germinoma]

A 19-year-old male presented with progressive loss of vision and diabetes insipidus due to an intra- and suprasellar tumor. Transsphenoidal exploration revealed a pure germinoma. Seven days after the operation, bleeding from the residual tumor caused headache and right occulomotor palsy. The residual tumor and hematoma were removed using pterional approach. The residual tumor disappeared after postoperative irradiation. After 5 months of radiation, multiple lesions due to dissemination of the germinoma were discovered in the suprasellar region. Adjuvant chemotherapy and whole supratentorial irradiation were performed. All lesions regressed completely. Mid-sagittal magnetic resonance image was useful in our patient for differential diagnosis between intrasellar germinoma and pituitary adenoma. Before initiating an operation for intrasellar germinoma, awareness is needed for the fact of postoperative bleeding. We notice that transsphenoidal surgery should be selected for treatment of postoperative bleeding from intrasellar germinoma.