Transsphenoidal Treatment of Empty Sella by Means of a Silastic Coil: Technical Note

Zona, Gianluigi; Testa, Valeria; Sbaffi, Pier Filippo; Spaziante, Renato

doi:10.1097/00006123-200211000-00032

Cited by 25 publications

(9 citation statements)

References 16 publications

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“…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.…”

Section: 19mentioning

confidence: 99%

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

Berastegui¹,

Raza²,

Anand³

et al. 2016

JNS

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Visual deterioration after dopamine-agonist treatment of prolactinomas associated with empty sella syndrome and secondary optic apparatus traction is a rare event. Chiasmapexy has been described as a viable treatment option, although few cases exist in the literature. Here, a novel endonasal endoscopic approach to chiasmapexy is described and its efficacy is demonstrated in a case report. A 55-year-old female patient with a history of a giant prolactinoma and 14 years of treatment using dopaminergic agonist therapy presented to our institution with a 1-month history of visual changes. Neuroophthalmological examination confirmed severe bitemporal field defects, and MRI revealed a large empty sella with downward optic chiasmal herniation. Endoscopic endonasal chiasmapexy was performed by elevating the chiasm with lumbar drainage and filling the clival and sellar defect with an extradural liquid (HydroSet; a cranioplasty bone cement), and a piece of AlloDerm was used to cover and cushion the chiasm. Postoperative imaging demonstrated successful anatomical elevation of the optic apparatus, and the patient showed functional improvement in the visual field at 3 months postoperatively. Although rare, massive empty sellar and chiasmal descent from macroadenoma treatment can result in progressive visual loss. Here, a novel technique of endonasal endoscopic extradural cranioplasty aided by lumbar drainage is reported, which appears to be an effective technique for stabilizing and possibly reversing anatomical and visual deterioration.

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Section: 19mentioning

confidence: 99%

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

Berastegui¹,

Raza²,

Anand³

et al. 2016

JNS

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“…Silicone is a biocompatible material and is widely used in the living body for prostheses, so the safety has been documented. 11,12,16) Silicone is not absorbable like fat or muscle, so there is little risk of re-descent of the sella and subsequent recurrence of the symptoms. 16) Silicone plate is easy to shape by cutting with scissors during the operation, so can be fitted into a bony opening of any shape.…”

Section: Discussionmentioning

confidence: 99%

“…11,12,16) Silicone is not absorbable like fat or muscle, so there is little risk of re-descent of the sella and subsequent recurrence of the symptoms. 16) Silicone plate is easy to shape by cutting with scissors during the operation, so can be fitted into a bony opening of any shape. 12,13) Silicone plate is elastic, so is easy to insert, even if larger than the bone window.…”

Section: Discussionmentioning

confidence: 99%

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

Kubo

Hasegawa

Inui

et al. 2005

Neurol. Med. Chir.(Tokyo)

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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.

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“…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.…”

Section: Cefalea Y Alteraciones Visuales En La Hipertensión Intracranunclassified

Silla turca vacía primaria: clínica, fisiopatología y tratamiento

González-Tortosa

2009

Neurocirugía

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ResumenEn este artículo se revisa el concepto, clínica, fisiopatología y manejo de la silla turca vacía primaria y los distintos problemas que plantea, a la luz de la bibliografía que se ha considerado más relevante sobre el tema. ConceptoCuando en las pruebas radiológicas de imagen se encuentra una invaginación de los espacios subaracnoideos hacia el interior de la silla turca, rellenándose ésta de lcr, de manera total o parcial, se habla de Silla Turca Vacía (STV). Este concepto implica una comunicación libre entre el líquido intraselar y el de la cisterna supraselar 55 . La silla turca se encuentra normalmente ocupada en su totalidad por la hipófisis y el diafragma separa a la glándula de la cisterna supraselar. Este diafragma tiene un pequeño orificio por el que pasa el tallo hipofisario con sus vasos porta y las arterias de la trabécula 107 , normalmente situadas en ambos lados de su cara anterior. También suele haber unos repliegues subaracnoideos alrededor del tallo, que se insinúan hacia el interior de la silla turca por debajo del diafragma sellar, entre éste y la glándula.Sin embargo, este orificio diafragmático puede estar ampliado y, en un 20% de las personas, se encuentra casi ausente 16 , dejando de servir de barrera entre los espacios subaracnoideos de la base de cráneo y el contenido de la silla turca. En estos casos, si la glándula no ocupa todo el volumen sellar, el líquido cefalorraquídeo se introduce en su interior, en ocasiones ocupando todo el espacio de la fosa, dando la impresión de estar "vacía" en las pruebas de imagen, aunque siempre existe un resto glandular que, incluso en los casos extremos, tapiza su fondo. Silla turca vacía primaria y secundaria.Hay que distinguir dos tipos de silla vacía. Una originada de un proceso patológico, que puede ser o no de índole tumoral, aunque en la mayoría de los casos se trata de un adenoma que después sufre una involución, bien espontánea (apoplejía) o bien como consecuencia de su tratamiento ( Fig. 1 y 2).La consecuencia es que la cisterna aracnoidea de la base de cráneo se introduce en un espacio que ha quedado vacío dentro de la silla turca, aprovechando la dilatación del orificio diafragmático o la ausencia del diafragma de la silla. A estos casos se le denomina "Silla Turca Vacía Secundaria" (STVS).El segundo tipo de silla vacía es aquel en el que no ha existido ningún proceso patológico previo, al menos conocido. Se le denomina "Silla Turca Vacía Primaria" (STVP) y tanto su patogenia como su repercusión clínico-quirúrgica, al no estar totalmente aclaradas, son objeto de debate y sobre ellas se centrará la revisión bibliográfica de este artículo.

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Transsphenoidal Treatment of Empty Sella by Means of a Silastic Coil: Technical Note

Abstract: The reported technique is a valid alternative to classic transsphenoidal extradural packing.

Cited by 25 publications

References 16 publications

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

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

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

Silla turca vacía primaria: clínica, fisiopatología y tratamiento

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