Accurate localization of an insulinoma by preoperative selective intra-arterial calcium injection and intraoperative glucose monitoring

The role of pre- and intraoperative procedures for the localization of insu linomas has been extensively debated. We report a case of successful treatm ent using preoperative selective intra-arterialcalcium injection and intrao perative glucose monitoring. A 12-year-old boy with hypoglycemic attacks ha d a large insulinoma in the head of the pancreas on computed tomography. Pr eoperative selective angiography combined with arterial stimulation-venous sampling (ASVS) by intraarterial injection of calcium revealed no other ins ulinomas in the body and tail of the pancreas. Elevation of serum glucose o n intraoperative monitoring confirmed complete enucleation of the insulinom a. Preoperative ASVS can accurately localize an insulinoma, and may help to increase the success rate of surgery and avoid blind pancreatectomy.