Endoscopic Transsphenoidal Treatment of Empty Sella Turcica Syndrome Using a Silastic Coil

Abstract

An empty sella turcica is due to the presence of an arachnoid diverticulum with its fluid content in the sella turcica, exerting pressure on the pituitary gland. In most cases this condition has an asymptomatic course, and is discovered by accident. Some patients, however, develop empty sella turcica syndrome with headaches, mild dishormonose, dysopsia and, rarely, spontaneous rhinorrhoea. Surgical treatment of empty sella turcica consists of filling the sella, through the transsphenoid route, with tissues collected from the patient or with artificial material. The aim of this report is to present our own experience of endoscopic extradural sella elevation using a silicone spiral, in 4 patients with primary empty sella turcica syndrome. The main indication for surgery was progressing dysopsia. The microinvasive endoscopic transsphenoidal method has been used, based upon the Jho technique with our own modifications. For the elevation of the sella, we used a coiled section of a Pudenz valve intraventricular silicone drain, adjusting its size to the dimensions of the operated sella. Both the implantation of the helix, and the postoperative course were uncomplicated for all surgically treated patients. The follow-up of several months confirmed improvement of the dysopsia in all surgically treated patients. MR examinations confirmed the correct location of the silicone spiral placed in the sella. It seems that the good results achieved are due to a correct indication for surgical treatment. The follow-up period ranges from 12 to 30 months and, so far, the clinical improvement is stable and satisfying both for the patients who underwent treatment and for the neurosurgeons.

Endoscopic Transsphenoidal Treatment of a Prolactinoma Patient With Brain and Optic Chiasmal Herniations

“…5 Transsphenoidal sellar packing or chiasmopexy has been the most frequently used treatment. 6,7 To date, a wide variety of materials have been used for this purpose, including fascia, fat, fragments of cartilage or bone, bioabsorbable materials, dural substitutes, silastic coils, and inflated balloons. 6,7 Nevertheless, there is a delicate balance between underpacking and overpacking: underpacking does not treat the chiasmal herniation appropriately, whereas overpacking may cause visual worsening.…”

“…6,7 To date, a wide variety of materials have been used for this purpose, including fascia, fat, fragments of cartilage or bone, bioabsorbable materials, dural substitutes, silastic coils, and inflated balloons. 6,7 Nevertheless, there is a delicate balance between underpacking and overpacking: underpacking does not treat the chiasmal herniation appropriately, whereas overpacking may cause visual worsening. 8 For this reason, some authors have advocated intraoperative fluoroscopic visualization of the sellar region, 9 although in real time, this technique does not allow direct or indirect visualization of the chiasm or its relation with any introduced material.…”

Transsphenoidal Treatment of Secondary Empty Sella Syndrome using Low Field Strength Intraoperative MRI: Case Report

“…It is generally agreed that in patients with progressive visual deterioration surgery is warranted, and should consist of chiasmapexy [1] or sellar packing. A wide variety of materials has been used for this purpose, including muscle, fat, fragments of cartilage or bone, bioabsorbable materials, dural substitutes, silastic coils [4,5] and infl ated balloons [6] . Sellar packing has both the risk of insuffi cient packing due to retraction of the packing over time, and overpacking with compression on the optic chiasm and worsening visual outcome [5,7] .…”

“…opaque (such as a silastic coil) [4,5] . Other authors using intrasellar balloon obliteration have estimated the sellar volume on preoperative MR scans, then selected a balloon of an appropriate size, and then fi lled the balloon with contrast medium for intraoperative fl uoroscopic confi rmation of sellar obliteration [6] .…”