New Technique for Chiasmapexy Using Iliac Crest Bone Graft: 2 Cases of Visual Impairment Caused by Empty Sella Syndrome

Tsukiyama, Atsushi; Hattori, Yujiro; Tahara, Shigeyuki; Ishisaka, Eitaro; Morimoto, Daijiro; Oyama, Kenichi; Teramoto, Akira; Morita, Akio

doi:10.1016/j.wneu.2017.08.080

Cited by 9 publications

(11 citation statements)

References 6 publications

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“…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%

“…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]. However, the use of artificial substances may bring a risk of graft infection, and after surgery, fat and muscle may be absorbed over the long term [35]. There is also the possibility that bone and cartilage may be unavailable in sufficient quantities [35].…”

Section: Discussionmentioning

confidence: 99%

“…However, the use of artificial substances may bring a risk of graft infection, and after surgery, fat and muscle may be absorbed over the long term [35]. There is also the possibility that bone and cartilage may be unavailable in sufficient quantities [35]. One advantage of iliac bone is its reduced likelihood of absorbing and becoming infected compared to synthetic materials [35].…”

Section: Discussionmentioning

confidence: 99%

“…There is also the possibility that bone and cartilage may be unavailable in sufficient quantities [35]. One advantage of iliac bone is its reduced likelihood of absorbing and becoming infected compared to synthetic materials [35]. This approach may be suitable for reoperative cases, especially in patients whose septal cartilage has been removed in a previous surgery [35].…”

Section: Discussionmentioning

confidence: 99%

“…One advantage of iliac bone is its reduced likelihood of absorbing and becoming infected compared to synthetic materials [35]. This approach may be suitable for reoperative cases, especially in patients whose septal cartilage has been removed in a previous surgery [35]. This method halts visual deterioration and may be worth considering as an option for chiasmapexy operations [35].…”

Section: Discussionmentioning

confidence: 99%

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Adrenal Insufficiency due to Total Primary Empty Sella Syndrome

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Adrenal Insufficiency due to Total Primary Empty Sella Syndrome

et al. 2020

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Chiasmal herniation following treatment of pituitary macroadenoma

et al. 2020

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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.

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