Endonasal Endoscopic Transsphenoidal Chiasmapexy With Silicone Plates for Empty Sella Syndrome-Technical Note-

Abstract

Silicone plates sutured together to form blocks were used for extradural elevation of the sella floor in two patients who underwent chiasmapexy for visual disturbance associated with empty sella syndrome. A 36-year-old woman had been treated for prolactinoma for about 19 years with bromocriptine and then presented with left visual disturbance. A 79-year-old man presented with right blurred vision of unknown cause other than empty sella. The sella turcica was accessed via the endonasal transsphenoidal approach under endoscopic guidance. The bony sellar floor was opened with a drill. Two or three pieces of 1-mm-thick silicone plate were sutured to make a block. Two or three blocks were inserted into the epidural space to elevate the sellar contents. Visual symptoms improved in both patients. Silicone is biocompatible and not absorbable. Silicone plates are elastic and easy to handle during insertion, but firm enough to support the sella. The elevation can be adjusted by changing the number of plates in the block. The endonasal endoscopic approach is minimally invasive and particularly suitable for transsphenoidal extradural chiasmapexy for empty sella syndrome.

Endonasal endoscopic transsphenoidal chiasmapexy using a clival cranial base cranioplasty for visual loss from massive empty sella following macroprolactinoma treatment with bromocriptine: case report

“…In 1985, Moster reported a case of transsphenoidal hypophysectomy with poor postoperative visual outcome, which was possibly due to worsening empty sella and thus chiasm traction. Twenty years later, Kubo et al 15 described performing endoscopic transsphenoidal chiasmapexy in 2 patients, one with primary empty sella and the other with secondary empty sella caused by bromocriptine for the treatment of prolactinoma; visual function recovered in both patients. Finally, Gkekas et al 10 described a transglabellar approach in which "left eye visual function substantially improved.…”

“…7 Bone and cartilage are good choices because they are rigid and not as susceptible to reabsorption, but these are not always available and difficult to conform into exactly the correct size and shape. Since 1971, synthetic materials such as silicone sponge, 25 silicone plates, 15 and silastic coils 26 have been described that are softer and more malleable. However, these materials require a buttress on which to rest, such as a residual clivus or other rigid component of the skull base.…”

Silla turca vacía primaria: clínica, fisiopatología y tratamiento

“…En los pocos pacientes operados por este motivo, con resultados variables, se ha encontrado un quiasma descolgado hacia el interior de la silla 5,105 , nervios ópticos adelgazados, o bien aracnoiditis 23 a la que se ha atribuido el deterioro de la vascularización óptica. Pero también se han operado casos en los que se ha constatado una situación normal de las vías ópticas, obteniéndose, sin embargo, una mejoría del cuadro visual tras la operación 44,57 . Muchas de estas publicaciones se han producido cuando aún no era conocida la implicación de una hipertensión intracraneal benigna y subclínica, en algunos pacientes afectos de este síndrome.…”

“…Para obviar el problema de la reabsorción del injerto, se han utilizado balones epidurales rellenados con silicona 39,73 . Por último, dada la posibilidad de que se desinflen 39 , se ha propuesto utilizar coils de silicona 110 o láminas adosadas del mismo material 57 . La escasa casuística basada fundamentalmente en casos aislados, con resultados variables, no permiten sacar conclusiones referente a la eficacia de esta cirugía.…”

“…Se han publicado casos esporádicos 48,57,73 en los que la elevación de la dura madre del suelo de la silla turca, sin apertura de la cisterna aracnoidea, ha curado la cefalea en pacientes con STVP que, en ocasiones, es grave y no responde al tratamiento médico 48 .…”