Transsphenoidal Treatment of Secondary Empty Sella Syndrome using Low Field Strength Intraoperative MRI: Case Report

Abstract

Background: The purpose of this study is to demonstrate the added value of intraoperative MRI in treating secondary empty sella syndrome.

Case Report: We describe the case of a 66-year-old woman who was diagnosed with a prolactinoma stage IIIb. During treatment with cabergoline she presented with a secondary empty sella syndrome resulting in visual symptoms. We performed intraoperative MRI-guided packing of the secondary empty sella. We explain why this is useful in surgical treatment of secondary empty sella syndrome.

Conclusion: Intraoperative MRI helps to achieve adequate sellar packing while avoiding insufficient packing as well as overpacking.

Key words

secondary emtpy sella syndrome - pituitary surgery - neuroendoscopy - intraoperative MRI - image guidance - endoscopy

References

• 1 Spaziante R, Zona G, Testa V. Primary empty sella syndrome.  Surg Neurol. 2003;  60 177-178
• 2 De Marinis L, Bonadonna S, Bianchi A. et al . Primary empty sella.  J Clin Endocrinol Metabolism. 2005;  90 5471-5477
• 3 Maira G, Anile C, Mangiola A. Primary empty sella syndrome in a series of 142 patients.  J Neurosurg. 2005;  103 831-836
• 4 Rudnik A, Zawadzki T, Galuszka-Ignasiak B. et al . Endoscopic transsphenoidal treatment of empty sella turcica syndrome using a silastic coil.  Minim Invas Neurosurg. 2006;  49 376-379
• 5 Zona G, Testa V, Sbaffi PF. et al . Transsphenoidal treatment of empty sella by means of a silastic coil: technical note.  Neurosurgery. 2002;  51 1299-1303
• 6 Gazioglu N, Akar Z, Ak H. et al . Extradural balloon obliteration of the empty sella report of three cases (intrasellar balloon obliteration).  Acta Neurochir (Wien). 1999;  141 487-494
• 7 Chen HC, Lee ST. Need for intrasellar packing in sellar reconstruction of transsphenoidal surgery: less is more?.  J Clin Neurosci. 2006;  13 423-427
• 8 Black PM, Moriarty T, Alexander 3rd E. et al . Development and implementation of intraoperative magnetic resonance imaging and its neurosurgical applications.  Neurosurgery. 1997;  41 831-842
• 9 Steinmeier R, Fahlbusch R, Ganslandt O. et al . Intraoperative magnetic resonance imaging with the magnetom open scanner: concepts, neurosurgical indications, and procedures: a preliminary report.  Neurosurgery. 1998;  43 739-747
• 10 Hadani M, Spiegelman R, Feldman Z. et al . Novel, compact, intraoperative magnetic resonance imaging-guided system for conventional neurosurgical operating rooms.  Neurosurgery. 2001;  48 799-807
• 11 Hardy J. Transphenoidal microsurgery of the normal and pathological pituitary.  Clin Neurosurg. 1969;  16 185-217
• 12 Cappabianca P, Cavallo LM, de Divitiis E. Endoscopic endonasal transsphenoidal surgery.  Neurosurgery. 2004;  55 933-940
• 13 de Divitiis E, Spaziente R, Stella L. Empty sella and benign intrasellar cysts. Advances and technical standards in neurosurgery.. Vienna: Springer-Verlag; 1981
• 14 Nimsky C, von Keller B, Ganslandt O. et al . Intraoperative high-field magnetic resonance imaging in transsphenoidal surgery of hormonally inactive pituitary macroadenomas.  Neurosurgery. 2006;  59 105-114
• 15 Bohinski RJ, Warnick RE, Gaskill-Shipley MF. et al . Intraoperative magnetic resonance imaging to determine the extent of resection of pituitary macroadenomas during transsphenoidal microsurgery.  Neurosurgery. 2001;  49 1133-1143
• 16 Fahlbusch R, Thapar K. New developments in pituitary surgical techniques.  Bailliere's best practice & research. 1999;  13 471-484
• 17 Pergolizzi Jr RS, Nabavi A, Schwartz RB. et al . Intra-operative MR guidance during trans-sphenoidal pituitary resection: preliminary results.  J Magn Reson Imaging. 2001;  13 136-141
• 18 Schwartz TH, Stieg PE, Anand VK. Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging.  Neurosurgery. 2006;  58 ONS44-ONS51

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