2008, Number 1
<< Back Next >>
Gac Med Mex 2008; 144 (1)
Remodelación selar: una opción quirúrgica para el síndrome de la silla turca vacía primaria
Guinto-Balanzar G, Mercado-Atri M, Guinto-Balanzar P, Nishimura-Meguro E, Abdo-Toro M, Aréchiga-Ramos N, Nettel-Rueda B
Language: Spanish
References: 34
Page: 15-22
PDF size: 135.04 Kb.
ABSTRACT
Background: The empty sella is an entity that only rarely presents signs and symptoms. When noted, visual field deficits are an indication for surgical management.
Material and methods: We studied twenty patients with primary empty sella and visual field deficits surgically treated with a technique termed by us as “sellar remodeling.” We treated 19 females and 1 male. Aside from visual deficits, all participants reported headache. We reported an increase in prolactin serum level in three cases. Patients with an increase in cerebrospinal fluid pressure were excluded. The surgical procedure involved placing through a transsphenoidal route an autologus graft formed by fat, aponeurosis and two bone lamina, with precise dimensions according to each patient’s sella turcica.
Results: After surgery, visual deficits improved in 18 patients and headache in 17. Two patients displayed normal prolactin levels. No serious complications were reported during surgery.
Conclusions: Sellar remodeling is a precise, simple, safe and inexpensive technique that significantly improves symptoms such as visual deficits and headache observed in primary empty sella syndrome.
REFERENCES
De Marinis L, Bonadonna S, Bianchi A, Maira G, Giustina A. Primary empty sella. J Clin Endocrinol Metab 2005;90:5471-5477.
Jaffer KA, Obbens EA, El Gammal TA. Empty sella: review of 76 cases. South Med J 1979;72: 294-296.
Kaufman B, Tomsak RL, Kaufman BA, Arafah BU, Bellon EM, Selman WR, et al. Herniation of the suprasellar visual system and third ventricle into empty sellae: morphologic and clinical considerations. AJR Am J Roentgenol 1989;152:597-608.
Neelon FA, Goree JA, Lebovitz HE. The primary empty sella: clinical and radiographic characteristics and endocrine function. Medicine (Baltimore) 1973;52:73-92.
Guinto G, Del Valle R, Nishimura E, Mercado M, Nettel B, Salazar F. Primary empty sella syndrome: the role of visual system herniation. Surg Neurol 2002;58:42-48.
Guinto G, Cohn F, Pérez-de la Torre R, Gallardo M. Pituitary macroadenomas: transsphenoidal approach. En: Sekhar LN, Fessler RG, editors. Atlas of neurosurgical techniques: brain. NY, New York: Thieme Medical Publishers; 2006. pp. 670-679.
Busch W. Die Morphologie der sella turcica und ihre beziehungen zur hypophyse. Virchows Arch 1951;320:437-458.
Kaufman B. The empty sella turcica-a manifestation of the intrasellar subrachnoid space. Radiology 1968;90:931-941.
Leclercq TA, Hardy J, Vezina JL, Mercky F. Intrasellar arachnidocele and the so-called empty sella syndrome. Surg Neurol 1974;2:295-299.
Bjerre P. The empty sella. A reappraisal of etiology and pathogenesis. Acta Neurol Scand Suppl 1990;130:1-25.
Obrador S. The empty sella and some related syndromes. J Neurosurg 1972; 36:162-168.
Drury MI, O’Loughlin S, Sweeney E. Houssay phenomenon in a diabetic. Br Med J 1970;2:709-711.
Maira G, Anile C, Mangiola A. Primary empty sella syndrome in a series of 142 patients. J Neurosurg 2005;103:831-836.
Bergland RM, Ray BS, Torack RM. Anatomic variations in the pituitary gland and adjacent structures in 225 human autopsy cases. J Neurosurg 1968;28: 93-99.
Hubbard JL, McDonald TJ, Pearson BW, Laws ER Jr. Spontaneous cerebrospinal fluid rhinorrhea: evolving concepts in diagnosis and surgical management based on the Mayo Clinic experience from 1970 through 1981. Neurosurgery 1985;16:314-321.
Kaye AH, Tress BM, Brownbill D, King J. Intracranial pressure in patients with the empty sella syndrome without benign intracranial hypertension. J Neurol Neurosurg Psychiatry 1982;45:209-216.
Foley KM, Posner JB. Does pseudotumor cerebri cause the empty sella syndrome? Neurology 1975;25:565-569.
Spaziante R, de Divitiis E, Stella L, Cappabianca P, Genovese L. The empty sella. Surg Neurol 1981;16:418-426.
Del Monte P, Foppiani L, Cafferata C, Marugo A, Bernasconi D. Primary empty sella in adults: endocrine findings. Endocr J 2006; 53: 803-809.
Wood JG, Dogali M. Visual improvement after chiasmapexy for primary empty sella turcica. Surg Neurol 1975; 3: 291-294.
Catarci T, Fiacco F, Bozzao L, Pati M, Magiar AV, Cerbo R. Empty sella and headache. Headache 1994; 34: 583-586.
Maira G, Anile C, Cioni B, Menini E, Mancini A, De Marinis L, Barbarino A. Relationships between intracranial pressure and diurnal prolactin secretion in primary empty sella. Neuroendocrinology 1984; 38: 102-107.
Braatvedt GD, Corrall RJ. The empty sella syndrome: much ado about nothing. Br J Hosp Med 1992;47:523-525.
Olson DR, Guiot G, Derome P. The symptomatic empty sella. Prevention and correction via the transsphenoidal approach. J Neurosurg 1972;37:533-537.
Decker RE, Carras R. Transsphenoidal chiasmapexy for correction of posthypophysectomy traction syndrome of optic chiasm. Case report. J Neurosurg 1977;46: 527-529.
Hamlyn PJ, Baer R, Afshar F. Transsphenoidal chiasmopexy for long standing visual failure in the secondary empty sella syndrome. Br J Neurosurg 1988;2:277-279.
Weiss MH, Kaufman B, Richards DE. Cerebrospinal fluid rhinorrhea from an empty sella: transsphenoidal obliteration of the fistula. J Neurosurg 1973;39:674-676.
Spaziante R, de Divitiis E, Cappabianca P. Reconstruction of pituitary fossa in transsphenoidal surgery: an experience of 140 cases. Neurosurgery 1985;17:453-458.
Kobayashi S, Sugita K, Matsuo K, Inoue T. Reconstruction of the sellar floor during transsphenoidal operations using alumina ceramic. Surg Neurol 1981;15:196-197.
Zona G, Testa V, Sbaffi PF, Spaziante R. Transsphenoidal treatment of empty sella by means of a silastic coil: technical note. Neurosurgery 2002;51:1299-1303.
Nagao S, Kinugasa K, Nishimoto A. Obliteration of the primary empty sella by transsphenoidal extradural balloon inflation: technical note. Surg Neurol 1987;27:455-458.
Spaziante R, Zona G, Testa V. Primary empty sella síndrome. Surg Neurol 2003;60: 177-178.
Gazioglu N, Akar Z, Ak H, Islak K, Kocer N, Seckin MS, et al. Extradural balloon obliteration of the empty sella. Report of three cases (intrasellar balloon obliteration). Acta Neurochir (Wien) 1999;141:487-494.
Barrow DL, Tindall GT. Loss of vision after transsphenoidal surgery. Neurosurgery 1990;27:60-68.