Transsphenoidal chiasmapexy for correction of posthypophysectomy traction syndrome of optic chiasm: Case report

Published on Apr 1, 1977in Journal of Neurosurgery
· DOI :10.3171/jns.1977.46.4.0527
Robert E. Decker7
Estimated H-index: 7
,
Robert Carras14
Estimated H-index: 14
Abstract
✓ Postoperative improvement occurred as a result of transsphenoidal chiasmapexy in a patient with posthypophysectomy visual loss. Traction injury of the optic chiasm may have been caused by a deficient diaphragma sellae and inadequate packing and repair of the sella floor. A cartilaginous seal is recommended.
  • References (7)
  • Citations (20)
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References7
Published on Nov 1, 1972in Journal of Neurosurgery
Donald R. Olson1
Estimated H-index: 1
,
Gerard Guiot5
Estimated H-index: 5
,
Patrick Derome9
Estimated H-index: 9
✓ Visual difficulty in association with an empty sella, resulting from downward migration of the optic system and secondary stretching or kinking of the optic nerves, is presented as a surgical entity best managed by the transsphenoidal approach. Pertinent case reports with characteristic pneumoencephalograms and schematic drawings are used to develop this thesis.
65 Citations Source Cite
Published on May 1, 1970in Journal of Neurosurgery
Richard Mortara1
Estimated H-index: 1
,
Horace Norrell17
Estimated H-index: 17
n EPORTS concerning the "empty sella turclca s " . ~ " yndrome have produced confusing as well as conflicting hypotheses as to the etiology of this entity. Busch's 6 anatomical description of the incomplete sellar diaphragm and Kaufman's 24 explanation of the physiological mechanisms producing the "empty" sella have done much to clarify this condition. The purpose of this paper is to further elaborate this entity and to discuss the consequences that many occur as a result of an incomplete or abs...
86 Citations Source Cite
Published on Jan 1, 1971in Radiology 7.47
Thomas P. Hayes2
Estimated H-index: 2
,
Richard A. Davis1
Estimated H-index: 1
,
Antolin Raventos3
Estimated H-index: 3
Abstract The authors review the treatment of chromophobe adenomas at the Hospital of the University of Pennsylvania from 1950 through 1967. Only 6% of the early group received postoperative radiotherapy, whereas 46% of the later group were treated in this manner. In each period, one-third received irradiation alone. As in several other published series, the results of irradiation alone and planned postoperative radiation therapy were the same. Radiation therapy alone is recommended for the initi...
40 Citations Source Cite
Published on Dec 1, 1971in Journal of Neurosurgery
Keasley Welch21
Estimated H-index: 21
,
John C. Stears13
Estimated H-index: 13
✓ A patient recovered full vision after evacuation of a chromaphobe adenoma and subsequent irradiation, but experienced delayed visual loss in the left eye associated with descent of the diaphragm of the sella and the optic nerves and chiasm into the tumor bed. More normal anatomical relationships were restored by inserting silicone sponge beneath the diaphragm of the sella. Vision improved rapidly thereafter and has been maintained for more than 3½ years.
46 Citations Source Cite
Published on Jun 1, 1975in Surgical Neurology
Wood Jg1
Estimated H-index: 1
,
Dogali M1
Estimated H-index: 1
22 Citations
Published on Jan 1, 1974in Neurosurgery 4.47
William F. Collins15
Estimated H-index: 15
20 Citations Source Cite
  • References (7)
  • Citations (20)
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Cited By20
Published on Sep 1, 1994in Journal of Neurosurgery
Edwin G. Fischer20
Estimated H-index: 20
,
Umberto DeGirolami2
Estimated H-index: 2
,
James N. Suojanen1
Estimated H-index: 1
✓ Delayed chiasmal syndromes after emptying of a Rathke's cleft cyst have not been reported previously. When these deficits occur following the treatment of parasellar lesions they are usually associated with the descent of a scarred optic system into an empty sella, and vision often improves promptly when the optic system is elevated. Two months after transsphenoidal surgery with emptying of a large intrasellar cyst, a 22-year-old man developed recurrent bitemporal visual field deficits over a ...
17 Citations Source Cite
Published on Jan 1, 2008in Gaceta Medica De Mexico 0.34
Gerardo Guinto-Balanzar4
Estimated H-index: 4
,
Moisés Mercado-Atri2
Estimated H-index: 2
+ 4 AuthorsBárbara Nettel Rueda1
Estimated H-index: 1
SUMMARY 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...
Published on Apr 1, 2016in Journal of Neurosurgery
G. Rene Alvarez Berastegui1
Estimated H-index: 1
,
Shaan M. Raza17
Estimated H-index: 17
+ 1 AuthorsTheodore H. Schwartz55
Estimated H-index: 55
(Cornell University)
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 dopamine...
5 Citations Source Cite
Published on Aug 1, 2015in World Neurosurgery 1.92
Brandon D. Liebelt8
Estimated H-index: 8
(Houston Methodist Hospital),
Meng Huang3
Estimated H-index: 3
(Houston Methodist Hospital),
David S. Baskin31
Estimated H-index: 31
(Houston Methodist Hospital)
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 t...
8 Citations Source Cite
Published on Jun 1, 2002in Journal of Neuro-ophthalmology 2.15
Hideki Chuman3
Estimated H-index: 3
(University of Michigan),
Wayne T. Cornblath10
Estimated H-index: 10
(Visual Sciences)
+ 1 AuthorsStephen S. Gebarski34
Estimated H-index: 34
A patient who had achieved marked improvement in vision and shrinkage of a prolactinoma following treatment with pergolide (0.1 mg/day) suffered a marked worsening of vision 7 months after continued treatment at the same dose. Brain magnetic resonance imaging (MRI) at the time of visual loss showed further shrinkage of the tumor and prolapse of the chiasm into the pituitary fossa. The dose of pergolide was cut in half(0.05 mg/day); 12 months later, vision had completely recovered. Brain MRI at t...
10 Citations Source Cite
Published on Jul 1, 2002in Surgical Neurology
Gerardo Guinto11
Estimated H-index: 11
,
Ramiro del Valle1
Estimated H-index: 1
+ 3 AuthorsFortino Salazar1
Estimated H-index: 1
Abstract BACKGROUND It has been traditionally accepted that ophthalmologic alterations in cases of primary empty sella syndrome are caused by the herniation of the visual system in the pituitary fossa, but this cannot be stated categorically. METHODS Two female patients with primary empty sella syndrome and visual field defects were included in this series. The peculiarity of these cases was that in neither of them was there an evident herniation of the visual system. In the absence of other cau...
21 Citations Source Cite
Published on Oct 1, 2004in Acta Neurochirurgica
C. Thomé2
Estimated H-index: 2
(Heidelberg University),
D. Zevgaridis2
Estimated H-index: 2
(Heidelberg University)
Background. Delayed visual deterioration after pituitary surgery has been attributed to secondary empty sella syndrome and downward herniation of the optic nerves and chiasm, but the pathophysiological basis of this condition is still a matter of debate.
4 Citations Source Cite
Published on Feb 1, 1997in Neurosurgery 4.47
Ivan Ciric25
Estimated H-index: 25
(NorthShore University HealthSystem),
Ann Ragin2
Estimated H-index: 2
(NorthShore University HealthSystem)
+ 1 AuthorsD. Pierce2
Estimated H-index: 2
(NorthShore University HealthSystem)
OBJECTIVE: The primary objectives of this report were, first, to determine the number and incidence of complications of transsphenoidal surgery performed by a cross-section of neurosurgeons in the United States and, second, to ascertain the influence of the surgeon's experience with the procedure on the occurrence of these complications. The secondary objective was to review complications of transsphenoidal surgery from the standpoint of their causation, treatment, and prevention. METHODS: Quest...
698 Citations Source Cite
Published on Oct 1, 2000in Clinical Endocrinology 3.08
S. E. Jones1
Estimated H-index: 1
,
R. A. James6
Estimated H-index: 6
+ 1 AuthorsP. Kendall-Taylor21
Estimated H-index: 21
The initial presentation of macroprolactinoma with visual field impairment, especially in males, is well recognized. Successful treatment with dopamine agonist therapy is characterized by a reduction in hyperprolactinaemia and often rapid and progressive resolution of the visual impairment. A small proportion of patients may subsequently develop a secondary deterioration in both their visual fields and visual acuities despite normalization of prolactin levels and tumour shrinkage. When pituitary...
38 Citations Source Cite
Published on Jan 25, 1999in Acta Neurochirurgica
Thomas Czech37
Estimated H-index: 37
(University of Vienna),
S. Wolfsberger1
Estimated H-index: 1
(University of Vienna)
+ 1 AuthorsH. Görzer1
Estimated H-index: 1
(University of Vienna)
Despite its description in the literature there remains uncertainty about the incidence, the pathophysiological basis and the best management of a delayed visual deterioration in the presence of an empty sella after surgery for pituitary adenomas. Out of a series of 501 patients with pituitary adenomas operated on at our institution between 1984 and 1996, four patients (0.8%) developed a worsening of their visual function 3 to 37 months after surgery in the absence of tumour recurrence. None of ...
16 Citations Source Cite
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