Treatment of empty sella associated with visual impairment: a systematic review of chiasmapexy techniques

Barzaghi, Lina Raffaella; Donofrio, Carmine Antonio; Panni, Pietro; Losa, Marco; Mortini, Pietro

doi:10.1007/s11102-017-0842-6

Cited by 20 publications

(14 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…is procedure is usually done via a transsphenoidal route and involves introduction of materials -both synthetic and natural (fat, fibrous tissue) into the sella in the space below the chiasm. [3,5] Recently, success with the use of iliac bone grafts has been reported by one group. [10] e reversal of this patient's visual decline following chiasmapexy procedure lends credence to the belief that, at least in some cases where there is visual deterioration associated with the appearance of an empty sella on MRI examination, the situation can be helped by this procedure.…”

Section: Discussionmentioning

confidence: 99%

Primary empty sella syndrome associated with visual deterioration salvaged by chiasmapexy: Report of a case and discussion of the literature

Ouma¹

2020

Surgical Neurology International

View full text Add to dashboard Cite

Background: Empty sella syndrome (ESS) is a condition in which there is loss of volume of the pituitary gland, which is the normal constituent of the sella turcica. There may be visual and endocrine deficits associated with this condition, and radiologically, there may be downward prolapse of the optic chiasm. It occurs in a primary ESS, poorly understood form, as well as a secondary ESS form that follows medical or surgical treatment of a pituitary macroadenoma, or else spontaneous hemorrhage into such a tumor. Case Description: A 56-year-old man presenting with deficits of both visual acuity and visual fields in the setting of radiological ESS without associated optic chiasm prolapse is discussed. He underwent endoscopic endonasal chiasmapexy with gradual improvement of his visual function over the following 6 months. Conclusion: ESS is a potentially potent cause of visual deterioration that lends itself to reversal through a relatively simple neurosurgical technique. This case illustrates that actual prolapse of the chiasm is neither a prerequisite for visual deterioration nor its reversal the mechanism of visual improvement after chiasmapexy, raising the question of the mechanisms at play in cases such as this. It confirms the role of chiasmapexy in the management of selected cases of ESS.

show abstract

Section: Discussionmentioning

confidence: 99%

Primary empty sella syndrome associated with visual deterioration salvaged by chiasmapexy: Report of a case and discussion of the literature

Ouma¹

2020

Surgical Neurology International

View full text Add to dashboard Cite

show abstract

“…The main goal of this surgery is to elevate sellar content through a transsphenoidal approach [22]. Currently, chiasmapexy is an effective surgical method for treating visual deterioration caused by ESS, to correct the downward displacement of the suprasellar visual system into an ES, which causes visual impairment, and various materials are used for the elevation of the optic chiasm [33][34][35]. Intradural chias-mapexy is indicated in treatment of SES, while the extradural approaches are suggested for surgical management of PES [33].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, chiasmapexy is an effective surgical method for treating visual deterioration caused by ESS, to correct the downward displacement of the suprasellar visual system into an ES, which causes visual impairment, and various materials are used for the elevation of the optic chiasm [33][34][35]. Intradural chias-mapexy is indicated in treatment of SES, while the extradural approaches are suggested for surgical management of PES [33]. Endoscopic endonasal chiasmapexy with septal cartilage and sphenoidal sinus bone is also worth considering as an option, as it is minimally invasive, and involves a decreased risk of infection [34].…”

Section: Discussionmentioning

confidence: 99%

Adrenal Insufficiency due to Total Primary Empty Sella Syndrome

et al. 2020

View full text Add to dashboard Cite

A 64-year-old woman was transported suffering from persistent lower abdominal pain, vomiting, and low-grade fever. Magnetic resonance imaging revealed an empty sella (ES) and hormone tests revealed a disappearance of diurnal variation of cortisol, low cortisol and adrenocorticotropic hormone (ACTH) secretion especially in the morning, and poor ACTH-cortisol axis reaction, as well as normal hypothalamus-pituitary gland-thyroid or adrenal gland axis hormone reaction. The cause of ES remained unclear; however, based on a diagnosis as adrenal insufficiency due to inappropriate ACTH secretion caused by total primary ES syndrome, we started hydrocortisone (15 mg/ day). Afterwards, she immediately became symptom-free and was discharged.

show abstract

“…The most accepted hypotheses regarding the pathophysiological mechanism of the secondary downward displacement of the optic chiasm and its relation with deteriorating VF and VA is based on tethering of scar tissue, enlargement of the sella turcica and a deficient sellar diaphragm, the roof of the sella turcica or a combination. This results in downward displacement of the optic chiasm, stretching the optic nerves and causing deterioration of the VF [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Chiasmal herniation following treatment of pituitary macroadenoma

et al. 2020

View full text Add to dashboard Cite

Purpose To evaluate whether the occurrence of chiasmal herniation coincides with visual field (VF) deterioration and to compare the course of VF defects in patients with and without radiological chiasmal herniation following treatment of pituitary adenoma. Methods This retrospective cohort study included 48 pituitary macroadenoma patients with chiasm compression, divided into three groups: Group 1 (N = 12), downward displaced optic chiasm and deteriorated VFs; Group 2 (N = 16), downward displaced optic chiasm; Group 3 (N = 20), control-group matched for tumour size and follow-up VFs, in mean deviation (dB). VFs were compared over time and a severity index, Chiasm Herniation Scale (CHS), for herniation based on radiological parameters was designed. Results After treatment, all groups showed improvement of VFs (Gr1: 2.97 dB p = 0.097, Gr2: 4.52 dB p = 0.001 and Gr3: 5.16 dB p = 0.000), followed by long-term gradual deterioration. The course of VFs between patients with and without herniation was not significantly different (p = 0.143), neither was there a difference in the course before and after herniation (p = 0.297). The median time till onset of herniation was 40 months (IQR 6 month-10 years) and did not significantly differ (p = 0.172) between the groups. There was no relation between VFs and the degree of herniation (p = 0.729). Conclusion Herniation does not appear to have clinical relevance with respect to VF outcome. The newly designed CHS is the first scoring system to quantify the severity of herniation and, in the absence of alternatives, may be useful to describe MRI findings to serve future added value in larger sized outcome studies.

show abstract

Treatment of empty sella associated with visual impairment: a systematic review of chiasmapexy techniques

Abstract: The intradural chiasmapexy is indicated in treatment of SESS, instead the extradural approaches are suggested for surgical management of PESS.

Cited by 20 publications

References 45 publications

Primary empty sella syndrome associated with visual deterioration salvaged by chiasmapexy: Report of a case and discussion of the literature

Primary empty sella syndrome associated with visual deterioration salvaged by chiasmapexy: Report of a case and discussion of the literature

Adrenal Insufficiency due to Total Primary Empty Sella Syndrome

Chiasmal herniation following treatment of pituitary macroadenoma

Contact Info

Product

Resources

About