Transsphenoidal treatment of empty sella by means of a silastic coil: technical note.
OBJECTIVE
Several methods have been proposed to achieve transsphenoidal arachnoid mobilization and chiasmapexy in symptomatic empty sella (primary or secondary empty sella syndrome). These procedures are often difficult to perform and have not always had satisfactory long-term outcomes because of the difficulty of achieving adequate and long-lasting sellar filling over time. The volume of fat or muscle packing decreases over time as a result of scar retraction. The same problem may occur with intrasellar balloon placement because of deflation of the balloon.


METHODS
We propose extradural packing accomplished through a transsphenoidal approach, using a Silastic (Dow Corning, Auburn, MI) coil, fashioned by means of a ventricular catheter arranged as a spiral.


RESULTS
This technique was used in four patients with satisfactory and long-lasting clinical results. It presents several advantages over previous methods: it can be tailored to each patient; Silastic is an inert substance, and therefore scarring, with consequent shrinkage, does not occur; and because the coil is very elastic, it presents few risks of inflammatory complications or of excessive compression of sellar, parasellar, and suprasellar structures. Furthermore, this technique does not require a supplementary skin incision to harvest autologous tissues (fat, muscle, or fascia lata). A skilled neurosurgeon can perform the procedure in a few minutes with more ease and less expense than other techniques.


CONCLUSIONS
The reported technique is a valid alternative to classic transsphenoidal extradural packing.
Zona
Gianluigi
G
Neurosurgical Unit, Department of Neurological and Visual Sciences, University of Genoa, Genoa, Italy.
Testa
Vincenzo
V
Sbaffi
Pier Filippo
PF
Spaziante
Renato
R
D000328:Adult; D000368:Aged; D004129:Dimethylpolysiloxanes; D004652:Empty Sella Syndrome / Q000175:diagnosis / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019635:Neurosurgical Procedures; D019736:Prostheses and Implants; D012828:Silicones; D012886:Skull / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
D004129:Dimethylpolysiloxanes; D012828:Silicones; C013830:baysilon