[An operated case of giant pituitary adenoma (author's transl)]

A case of giant pituitary adenoma was reported. The patient was a 47-year-old man with visual disturbance. CT scan revealed the huge tumor, about 6 cm in diameter, at the midportion over the sella turcica, extending to the frontal, temporal, posterior and hypothalamic region. Total resection of the tumor was successfully carried out and the difficult post-operative complications were overcome. In this paper we mainly discussed the operative procedure for giant pituitary region tumor, which usually involve the main cerebral arteries, i.e., A1 and A2 portion of the anterior cerebral artery (ACA), anterior communicating artery (ACOMA) and intracranial internal carotid artery (ICA). We used to expose the internal carotid artery at the neck for the temporary occlusion prior to craniotomy. Prolongation of the temporary occlusion time is achieved by intravenous administration of 800 ml-20% mannitol solution. After bifrontal craniotomy, we approach the tumor interhemispherically and expose the A2 portion of ACA. Then anterior communicating artery, A1 portion of ACA and ICA are exposed as the tumor is extirpated. Under the bifrontal craniotomy, as we separate bilateral Sylvian fissure and interhemisphere, we can get the wide operative field and we can also approach the tumor from various direction. Therefore, even the tumor is huge, it is possible to remove the tumor without brain damage, vessel and cranial nerve injury.