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Graillon T, Passeri T, Boucekine M, Meyer M, Abritti R, Bernat AL, Labidi M, Dufour H, Froelich S. Chiasmapexy for secondary empty sella syndrome: diagnostic and therapeutic considerations. Pituitary 2021; 24:292-301. [PMID: 33136230 DOI: 10.1007/s11102-020-01104-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Secondary empty sella syndrome (SESS) following pituitary surgery remains a diagnostic and therapeutic challenge. The aim of this study was to specify the diagnostic criteria, surgical indications and results of chiasmapexy in the SESS. METHODS Three cases from two experienced neurosurgical centers were collected and the available literature was reviewed. RESULTS The 3 patients were operated for a giant non-functioning pituitary adenoma, a cystic macroprolactinoma, and an arachnoid cyst respectively. Postoperative visual outcome was initially improved, and then worsened progressively. At the time of SESS diagnosis, visual field defect was severe in all cases with optic nerve (ON) atrophy in 2 cases. Patients were operated via an endoscopic endonasal extradural approach. One patient was re-operated because of early fat reabsorption. Visual outcome improved in 1 case and stabilized in 2 cases. Statistical analyses performed on 24 cases from the literature review highlighted that patient age and severity of the preoperative visual defect were respectively significant and nearly significant prognostic factors for visual outcome, unlike the surgical technique. CONCLUSION T2-weighted or CISS/FIESTA sequence MRI is mandatory to visualize adhesions, ON kinking and neurovascular conflict. TS approach is the most commonly used approach. The literature review could not conclude on the need for an intra or extradural approach suggesting case by case adapted strategy. Intrasellar packing with non-absorbable material such as bone should be considered. Severity of the visual loss clearly decreases the visual outcome suggesting early chiasmapexy. In case of severe and long standing symptoms before surgery, benefits and surgical risks should be carefully balanced.
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Affiliation(s)
- Thomas Graillon
- Neurosurgery Department, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France.
| | - Thibault Passeri
- Neurosurgery Department, Hôpital Lariboisiere, APHP, Université Paris Diderot, Paris, France
| | - Mohamed Boucekine
- EA 3279 CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille Univ, School of Medicine - La Timone Medical Campus, |27 bd Jean Moulin Cedex 05, 13385, Marseille, France
| | - Mikael Meyer
- Neurosurgery Department, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France
| | - Rosaria Abritti
- Neurosurgery Department, Hôpital Lariboisiere, APHP, Université Paris Diderot, Paris, France
| | - Anne-Laure Bernat
- Neurosurgery Department, Hôpital Lariboisiere, APHP, Université Paris Diderot, Paris, France
| | - Moujahed Labidi
- Neurosurgery Department, Hôpital Lariboisiere, APHP, Université Paris Diderot, Paris, France
| | - Henry Dufour
- Neurosurgery Department, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France
| | - Sébastien Froelich
- Neurosurgery Department, Hôpital Lariboisiere, APHP, Université Paris Diderot, Paris, France
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Beltrán JQ, Ogando-Rivas E, Nettel-Rueda B, Velasco-Campos F, Navarro-Olvera JL, Aguado-Carrillo G, Soriano-Sánchez JA, Alpizar-Aguirre A, Carrillo-Ruiz JD. Women in Neurosurgery: First Neurosurgeon in Latin America and Current Mexican Leaders. World Neurosurg 2021; 150:114-120. [PMID: 33781943 DOI: 10.1016/j.wneu.2021.03.102] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/19/2021] [Accepted: 03/20/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND History has taught us that Mexican culture has been largely supported by women, despite gender prejudice from the society. Neurosurgery has not been the exception. Therefore, we investigated the challenges and influence of female neurosurgeons in Mexico. METHODS We conducted a review of the literature and an analysis of the internal database of the Mexican Society of Neurological Surgery focusing on 3 topics: 1) the historical presence of women and gender inequality in Mexico; 2) the life and legacy of the woman who became the first neurosurgeon in Mexico and in Latin America; and 3) the participation of women in neurosurgery in the past 3 decades. RESULTS In Latin America, the first woman in neurosurgery was María Cristina García-Sancho, who completed her neurosurgical training in 1951. Currently, women represent 6.2% of the total members of the Mexican Society of Neurological Surgery (MSNS). This percentage is still low, although data collected in this study suggest that it might increase in the next few years because 16.7% of Board Directors of the MSNS are women, the next elected president is a female neurosurgeon, and 14.5% of neurosurgery residents are women. CONCLUSIONS Although a steady increase has occurred of women in neurosurgery in Mexico, there is still work to do, especially to overcome the barriers related to the old assumptions of the cultural and social roles of women.
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Affiliation(s)
- Jesús Q Beltrán
- Unit for Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico; Direction of Research, General Hospital of Mexico, Mexico City, Mexico
| | - Elizabeth Ogando-Rivas
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA; Brain Tumor Immunotherapy Program, University of Florida, Gainesville, Florida, USA
| | - Barbara Nettel-Rueda
- Department of Neurosurgery, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | - Francisco Velasco-Campos
- Unit for Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
| | - José L Navarro-Olvera
- Unit for Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
| | - Gustavo Aguado-Carrillo
- Unit for Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
| | - José A Soriano-Sánchez
- Spine Clinic, The American-British Cowdray Medical Center IAP, Campus Santa Fe, Mexico City, Mexico
| | | | - José D Carrillo-Ruiz
- Unit for Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico; Direction of Research, General Hospital of Mexico, Mexico City, Mexico; Direction of Faculty of Health Sciences, Anahuac University, Mexico City, Mexico.
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Extradural Remodeling in Empty Sella Syndrome: 3-Dimensional Operative Video. World Neurosurg 2021; 147:66. [PMID: 33359078 DOI: 10.1016/j.wneu.2020.12.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/22/2022]
Abstract
Sellar arachnoidocele is a term used to define the herniation of the subarachnoid space to the sella.1 This is a rare radiologic finding that, in most cases, does not require treatment.2-5 When symptoms appear, the term empty sella syndrome is used. Two varieties exist: primary and secondary empty sella syndrome.2 The aim of this 3-dimensional operative video (Video 1) is to demonstrate the extradural microsurgical remodeling of the sellar fossa with autologous bone in 2 cases of primary empty sella syndrome. Both patients signed an informed consent for the procedures and agree with the use of their images for research purposes. In both cases, magnetic resonance imaging scans showed herniation of the subarachnoid space into the pituitary fossa and an anchor-like silhouette on coronal view. Patients evolved favorably, improving their visual deficit after the surgery, as can be observed in the postoperative visual field study. If surgery is indicated due to visual loss, the procedure is known as chiasmapexy. Recently, Guinto et al3 described a technique for chiasmapexy. Our team considers this procedure to be useful, technically simple, and low cost. Being autologous, rejection possibilities are almost null. This 3D video serves as a complement to illustrate the technique.
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4
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Mehla S, Chua AL, Grosberg B, Evans RW. Primary Empty Sella. Headache 2020; 60:2522-2525. [PMID: 33038281 DOI: 10.1111/head.13987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sandhya Mehla
- Hartford Healthcare Headache Center University of Connecticut School of Medicine West Hartford CT USA
| | - Abigail L. Chua
- Hartford Healthcare Headache Center University of Connecticut School of Medicine West Hartford CT USA
| | - Brian Grosberg
- Hartford Healthcare Headache Center University of Connecticut School of Medicine West Hartford CT USA
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5
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Yilmaz A, Gok M, Altas H, Yildirim T, Kaygisiz S, Isik HS. Retinal nerve fibre and ganglion cell inner plexiform layer analysis by optical coherence tomography in asymptomatic empty sella patients. Int J Neurosci 2019; 130:45-51. [PMID: 31462116 DOI: 10.1080/00207454.2019.1660328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To investigate the clinical importance of the thicknesses of the retinal nerve fibre (RNFL) and ganglion cell and inner plexiform layer (GCL+) by spectral domain optic coherence tomography (SD-OCT) in asymptomatic empty sella (ES) patients.Materials and methods: In this cross-sectional, non-randomized prospective study, 44 ES patients and 74 age- and sex-matched healthy individuals were evaluated. All the patients and controls competed an automated 30-2 visual field (VF) test. The mean deviation (MD), pattern standard deviation (PSD), RNFL, and GCL + thickness values obtained with SD-OCT were compared statistically between the two groups.Results: No marked VF defects were found in either group, and there was no statistically significant between-group difference in MD or PSD values. In terms of RNFL thickness, the average and superior quadrant RNFL values of the ES patients were thinner than those of the controls, with statistical significance (p = 0.013 and p = 0.043, respectively). Although other measured RNFL quadrant thicknesses and foveal thickness (FT), macular volume (MV), and average macular thickness (AMT) values were reduced in the ES group, these differences were not statistically significant. The average GCL + value and GCL + values in six sectors in the patient group were significantly lower than those in the control group.Conclusions: Asymptomatic ES patients have a risk of primary ES syndrome and should be followed up using a multidisciplinary approach. Objective and quantitative RNFL and GCL + thickness measurements obtained with OCT can provide valuable data for monitoring these patients.
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Affiliation(s)
- Ali Yilmaz
- Department of Neurosurgery, Ministry of Health - Ordu University Research and Training Hospital, Ordu, Turkey
| | - Mustafa Gok
- Department of Ophthalmology, Ministry of Health - Ordu University Research and Training Hospital, Ordu, Turkey
| | - Hilal Altas
- Department of Radiology, Ministry of Health - Ordu University Research and Training Hospital, Ordu, Turkey
| | - Timur Yildirim
- Department of Neurosurgery, Ministry of Health - Ordu University Research and Training Hospital, Ordu, Turkey
| | - Sukran Kaygisiz
- Department of Neurology, Ministry of Health - Ordu University Research and Training Hospital, Ordu, Turkey
| | - Hasan Serdar Isik
- Department of Neurosurgery, Ministry of Health - Ordu University Research and Training Hospital, Ordu, Turkey
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Guinto G, Nettel B, Hernández E, Gallardo D, Aréchiga N, Mercado M. Osseous Remodeling Technique of the Sella Turcica: A New Surgical Option for Primary Empty Sella Syndrome. World Neurosurg 2019; 126:e953-e958. [DOI: 10.1016/j.wneu.2019.02.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 11/30/2022]
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Nizamani WM, Siddiqui M, Ali Momin SN, Waqas M, Jooma R. Resolution of symptomatic secondary empty sella syndrome following lumbar-peritoneal shunt. Surg Neurol Int 2018; 9:72. [PMID: 29721351 PMCID: PMC5909097 DOI: 10.4103/sni.sni_267_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 03/05/2018] [Indexed: 12/05/2022] Open
Abstract
Background: Post-surgical empty sella is related to the removal of pituitary tumors either from the transcranial or transphenoidal route, rendering diaphragma sellae incompetent at the end of the procedure. This subsequently leads to herniation of the third ventricle and optic apparatus into the empty sella. Studies have shown that in 50% of the cases, individuals with primary and secondary empty sella syndrome have developed defects in the visual fields. Benign increased intracranial pressure, cerebrospinal rhinorrhea, papilledema, and abnormalities affecting visual acuity may also occur as a result of empty sella. Case Description: This case report discusses a rare treatment option for the symptomatic secondary empty sella syndrome. Patient underwent lumbar drain placement and that resulted in astonishingly significant improvement in vision. Keeping in view the beneficial effect of lumbar drain, lumbar–peritoneal (LP) shunt was inserted which showed drastic improvement in vision. Conclusion: The surgical outcome of symptomatic cases of ESS is favorable. Various common surgical options were reported in literature; however, we have discussed an unconventional surgical option with an impressive outcome.
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Affiliation(s)
| | | | | | - Muhammad Waqas
- Department of Neurosurgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Rashid Jooma
- Department of Neurosurgery, The Aga Khan University Hospital, Karachi, Pakistan
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Barzaghi LR, Donofrio CA, Panni P, Losa M, Mortini P. Treatment of empty sella associated with visual impairment: a systematic review of chiasmapexy techniques. Pituitary 2018; 21:98-106. [PMID: 29027644 DOI: 10.1007/s11102-017-0842-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Chiasmapexy is a poorly described surgical procedure adopted to correct the downward displacement of suprasellar visual system (SVS) into an empty sella (ES) causing visual worsening. The aim of our study is to define the indications for extradural and intradural chiasmapexy. METHODS A systematic literature review has been performed on MEDLINE database (US National Library of Medicine), including only articles that depicted cases of surgically treated patients affected by ES and progressive delayed visual worsening. Moreover, we have reported three cases of secondary ES syndrome (SESS) with visual worsening treated in our Department with transsphenoidal (TS) microsurgical intradural approach. Finally, we have compared the results of extradural and intradural chiasmapexy described in literature. RESULTS The etiology of visual impairment is different in primary and secondary ESS. In primary ESS (PESS) the only predisposing factor is a dehiscence of diaphragma sellae, and the anatomical distortion caused by displacement of optic chiasm or traction of pituitary stalk and infundibulum may determine a direct injury of neural fibers and ischemic damage of SVS. In PESS the mechanical elevation of SVS performed through extradural approach is sufficient to resolve the main pathologic mechanism. In SESS, arachnoidal adhesions play an important role in addition to downward herniation of SVS. Consequently, the surgical technique should provide elevation of SVS combined to intradural release of scar tissue and arachnoidal adhesions. In treatment of SESS, the intradural approaches result to be more effective, guaranteeing the best visual outcomes with the lowest complications rates. CONCLUSIONS The intradural chiasmapexy is indicated in treatment of SESS, instead the extradural approaches are suggested for surgical management of PESS.
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Affiliation(s)
- Lina Raffaella Barzaghi
- Pituitary Unit of the Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Carmine Antonio Donofrio
- Pituitary Unit of the Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
| | - Pietro Panni
- Pituitary Unit of the Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Losa
- Pituitary Unit of the Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Pietro Mortini
- Pituitary Unit of the Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
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9
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Evans RW. Incidental Findings and Normal Anatomical Variants on MRI of the Brain in Adults for Primary Headaches. Headache 2017; 57:780-791. [PMID: 28294311 DOI: 10.1111/head.13057] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 01/18/2023]
Abstract
When MRI scans of the brain are obtained for evaluation of primary headaches in adults, incidental findings are commonly present. After a review of the prevalence of incidental findings and normal anatomical variants, 21 types are presented.
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Affiliation(s)
- Randolph W Evans
- Department of Neurology, Baylor College of Medicine, 1200 Binz #1370, Houston, TX, 77004, USA
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Berriel MRDS, Lima GAB, Melo ASAD, Santos MLVD, Rahhal H, Taboada GF. Prolactinomas may have unusual presentations resulting from massive extrasellar tumor extension. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:544-8. [PMID: 27487374 DOI: 10.1590/0004-282x20160083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/16/2016] [Indexed: 11/22/2022]
Abstract
The purpose of this case series is to report eight patients with giant prolactinomas emphasizing presentations and a treatment complication. The study group included six men and two women. The median age was 29 years (18-54 years); median serum prolactin level was 4,562 ng/ml (1,543-18,690 ng/ml); three patients (37.5%) had panhypopituitarism; median tumor diameter was 50 mm (41-60 mm). Five patients (62.5%) had visual field defects and three had improvement during treatment; six patients (75%) reached prolactin normalization, with a median time of 10.5 months (7-84 months) and median dose of 2.0 mg/week (1.0 to 3.0 mg/week). One patient presented as a true incidentaloma. One patient presented a cerebrospinal fluid leakage during medical treatment and refused surgery, however this resolved with conservative measures. This case series illustrate a rare subtype of macroprolactinomas, the importance of considering unusual presentations at the diagnosis, the effectiveness of pharmacological treatment and its possible complications.
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Affiliation(s)
| | | | | | | | - Hassan Rahhal
- Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Unidade de Endocrinologia, Niterói RJ, Brasil
| | - Giselle Fernandes Taboada
- Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Unidade de Endocrinologia, Niterói RJ, Brasil
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Delgado-Hernández A, Verduzco-Mendoza A, Luna-Reyes FA, Márquez-Palacios S, Arch-Tirado E. Analysis of the joint and a posteriori probability between primary empty sella, its comorbidities and audiovestibular pathology. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.circen.2015.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Alvarez Berastegui GR, Raza SM, Anand VK, Schwartz TH. Endonasal endoscopic transsphenoidal chiasmapexy using a clival cranial base cranioplasty for visual loss from massive empty sella following macroprolactinoma treatment with bromocriptine: case report. J Neurosurg 2015; 124:1025-31. [PMID: 26339851 DOI: 10.3171/2015.2.jns142015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
| | | | | | - Theodore H Schwartz
- Departments of 1 Neurosurgery.,Otolaryngology, and.,Neuroscience, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
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13
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Delgado-Hernández A, Verduzco-Mendoza A, Luna-Reyes FA, Márquez-Palacios S, Arch-Tirado E. [Analysis of the joint and a posteriori probability between primary empty sella, its comorbidities and audiovestibular pathology]. CIR CIR 2015; 83:459-66. [PMID: 26194748 DOI: 10.1016/j.circir.2015.04.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/08/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Primary empty sella is a herniation of the sellar diaphragm into the pituitary space. It is an incidental finding and patients may manifest neurological, ophthalmological and/or endocrine disorders. Episodes of vertigo, dizziness, and hearing loss, have been reported. OBJECTIVE To determine the conditional probability, as well as the statistical dependency, through the Bayesian analysis in patients with primary empty sella and audiovestibular disorders. PATIENTS Individuals who attended the National Rehabilitation Institute from January 2010 to December 2011, diagnosed with primary empty sella and audiovestibular disorders. MATERIAL AND METHODS An analysis was performed on a sample of 18 patients with a diagnosis of primary empty sella confirmed with magnetic resonance studies and who had signs of vertigo, hearing loss and dizziness. RESULTS Of the 18 patients studied, 3 (16.66%) had primary empty sella as the only clinical evidence. In 9 patients (50%) empty sella was associated with vertigo, and 16 patients (88.88%) were diagnosed with hearing loss, with sensorineural hearing loss being the most frequent (77.77%). The intersection between the proportions of primary empty sella with the presence and type of hearing loss was calculated. Thus for sensorineural hearing loss, the calculated ratio was P(AB)=0.6912, and for conductive and mixed hearing loss the value of P(AB)=0.0493 in both cases. CONCLUSIONS Bayesian analysis and conditional probability enables the dependence between two or more variables to be calculated. In this study both mathematical models were used to analyse comorbidities and audiovestibular disorders in patients diagnosed with primary empty sella.
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Affiliation(s)
- Alhelí Delgado-Hernández
- Audiología, Foniatría y Otoneurología, Centro de Rehabilitación Integral Desarrollo Integral de la Familia Jalisco (Centro de Rehabilitación Integral Jalisco), Guadalajara, Jalisco, México
| | | | | | - Salvador Márquez-Palacios
- Organismo público descentralizado, Servicios de Salud del Municipio de Zapopan (OPDSSMZ), Zapopan, Jalisco, México
| | - Emilio Arch-Tirado
- Servicio de Neurobiología, Instituto Nacional de Rehabilitación, México, D.F., México.
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Sellar Floor Reconstruction with the Medpor Implant Versus Autologous Bone After Transnasal Transsphenoidal Surgery: Outcome in 200 Consecutive Patients. World Neurosurg 2015; 84:240-5. [PMID: 25731796 DOI: 10.1016/j.wneu.2015.02.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 02/13/2015] [Accepted: 02/15/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The Medpor porous polyethylene implant provides benefits to perform sellar floor reconstruction when indicated. This material has been used for cranioplasty and reconstruction of skull base defects and facial fractures. We present the most extensive use of this implant for sellar floor reconstruction and document the safety and benefits provided by this unique implant. METHODS The medical charts for 200 consecutive patients undergoing endonasal transsphenoidal surgery from April 2008 through December 2011 were reviewed. Material used for sellar floor reconstruction, pathologic diagnosis, immediate inpatient complications, and long-term complications were documented and analyzed. Outpatient follow-up was documented for a minimum of 1-year duration, extending in some patients up to 5 years. RESULTS Of the 200 consecutive patients, 136 received sellar floor cranioplasty using the Medpor implant. Postoperative complications included 6 complaints of sinus irritation or drainage, 1 postoperative cerebrospinal fluid leak requiring operative re-exploration, 1 event of tension pneumocephalus requiring operative decompression, 1 case of aseptic meningitis, 1 subdural hematoma, and 1 case of epistaxis. The incidence of these complications did not differ from the autologous nasal bone group in a statistically significant manner. CONCLUSIONS Sellar floor reconstruction remains an important part of transsphenoidal surgery to prevent postoperative complications. Various autologous and synthetic options are available to reconstruct the sellar floor, and the Medpor implant is a safe and effective option. The complication rate after surgery is equivalent to or less frequent than other methods of reconstruction and the implant is readily incorporated into host tissue after implantation, minimizing infectious risk.
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Guitelman M, Garcia Basavilbaso N, Vitale M, Chervin A, Katz D, Miragaya K, Herrera J, Cornalo D, Servidio M, Boero L, Manavela M, Danilowicz K, Alfieri A, Stalldecker G, Glerean M, Fainstein Day P, Ballarino C, Mallea Gil MS, Rogozinski A. Primary empty sella (PES): a review of 175 cases. Pituitary 2013; 16:270-4. [PMID: 22875743 DOI: 10.1007/s11102-012-0416-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The term primary empty sella (PES) makes reference to the herniation of the subarachnoid space within the sella turcica in patients with no history of pituitary tumor, surgery or radiotherapy. To retrospectively assess clinical features, radiological findings and the biochemical endocrine function from the records of 175 patients with a diagnosis of PES. One hundred seventy-five patients (150 females) were studied. The mean age at diagnosis was 48.2 ± 14 year. Most diagnoses were made by magnetic resonance imaging (n = 172). In most patients, the pituitary function was assessed by basal pituitary hormones measurements. Pituitary scans were ordered for different reasons: headache (33.1 %), endocrine disorders (30.6 %), neurological symptoms (12.5 %), visual disturbances (8.75 %), abnormalities on sella turcica radiograph (8.75 %) and others (6.25 %). Multiple pregnancies were observed in 58.3 % of women; headaches, obesity, and hypertension were found in 59.4, 49.5, and 27.3 % of the studied population, respectively. Mild hyperprolactinemia (<50 ng/ml) was present in 11.6 % of women and 17.3 % of men. Twenty-eight percent of our patients had some degree of hypopituitarism. In the male population, hypopituitarism represented 64 % of cases, whereas it accounted for 22 % of all females. PES seems to be more commonly found in middle-aged women, with a history of multiple pregnancies. In most patients, PES was discovered as an incidental finding on imaging studies, while in almost a quarter of patients PES was found during the diagnostic evaluation of anterior pituitary deficiency, which was more common in men.
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Affiliation(s)
- M Guitelman
- Departamento de Neuroendocrinología, Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889, C1200AAF Ciudad Autónoma de Bs As, Argentina.
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Gopinathan Nair A, Bassi SR, Olma Noronha V, Moodambikana K, Suresh Bapu KR. What Comes Down Must Go Up—Chiasmal Prolapse: A Field Report. Neuroophthalmology 2011. [DOI: 10.3109/01658107.2011.594482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
A 50-year-old female presented with progressive painless vision loss in the left eye and was subsequently diagnosed to have a pituitary macroadenoma, consistent with a prolactinoma, which was compressing the chiasm primarily on the left and involving the left cavernous sinus. She was treated with oral bromocriptine, resulting in marked shrinkage of the tumor and significant visual field recovery. Subsequently, she again began noting progressive vision loss in both eyes and was initially thought to have pituitary tumor regrowth. Repeat brain MRI, however, showed chiasmal prolapse with inferior tethering into an empty sella. Surgical fat padding to reposition the chiasm resulted in visual improvement with a different visual field pattern in the left eye. The clinical manifestations and etiopathogenesis of the empty sella syndrome are discussed.
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Kubo S, Hasegawa H, Inui T, Tominaga S, Yoshimine T. Endonasal endoscopic transsphenoidal chiasmapexy with silicone plates for empty sella syndrome: technical note. Neurol Med Chir (Tokyo) 2005; 45:428-32; discussion 432. [PMID: 16127264 DOI: 10.2176/nmc.45.428] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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.
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Affiliation(s)
- Shigeki Kubo
- Endoscopic Neurosurgery Center, Tominaga Hospital, Osaka, Japan.
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Abstract
PURPOSE OF REVIEW This review of the more recent literature and testing strategies in patients with chiasmal syndromes focuses on the clinical evaluation and management of these patients. Visual loss is often the initial manifestation of disorders involving the optic chiasm. Hemianopic defects and preferential involvement of the temporal visual field are the earliest and most common visual deficits. Progression of the lesion may cause compression of adjacent structures, including the optic nerves and cavernous sinuses, and may result in more profound visual loss, ocular motor deficits, and hypopituitarism. RECENT FINDINGS Although a number of modalities have been used to assess visual function in patients with chiasmal disorders, perimetry remains the most effective means of detecting and following the visual deficit. SUMMARY Most chiasmal syndromes can be categorized as intrinsic (thickening of the chiasm itself) or extrinsic (compression of the chiasm from an adjacent structure). Magnetic resonance imaging is the best mode of neuroimaging for most chiasmal lesions and may also provide clues to the etiology of an isolated chiasmal syndrome.
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Affiliation(s)
- Rod Foroozan
- Cuullen Eye Institute, Baylor College of Medicine, Houston, Texas 77030, USA
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