A Steerable Microcatheter Effectively Worked in Tumor Embolization.

Objective: A Leonis Mova (LM; SB Kawasumi, Kanagawa, Japan), one of the steerable microcatheters, has a remote-controlled flexible catheter tip manipulated with a dial in the hand grip, which enables operators to overcome complicated branching in endovascular surgeries. We report a case of a pituitary tumor in which the LM worked effectively as a distal access catheter (DAC) in tumor embolization. Case Presentation: A female patient in her 70s complained of bitemporal hemianopsia, and an MRI revealed a pituitary tumor that appeared hypervascular. The right internal carotid artery angiography demonstrated a prominent stain from a tumor vessel derived from the meningohypophyseal trunk (MHT). Tumor embolization was scheduled before its removal due to the hypervascularity. In the tumor embolization, the tip of the LM was bent toward the orifice of the right MHT, through which a 1.3F-1.8F 155 cm microcatheter along with a 0.010-inch 200 cm microguidewire was advanced. Locking the LM tip provided good support for the microcatheter and the microguidewire to proceed to the tumor vessel. Successful tumor embolization was achieved with an injection of 0.21 ml of 12.5% n-butyl-cyanoacrylate. Thanks to the tumor embolization, gross total removal of the pituitary tumor was transshenoidally accomplished with the least blood loss. Histopathological diagnosis of pituicytoma was made, and the intraoperative blood loss of 100 ml seemed small for this histology. The patient recovered from the bitemporal hemianopsia and was discharged without a blood transfusion. Conclusion: This is the first report in which the LM was used and well worked in tumor embolization as a DAC.