Transnasal Transsphenoidal Elevation of Optic Chiasm in Secondary Empty Sella Syndrome Following Prolactinoma Treatment

Publication date: April 2018
Source:World Neurosurgery, Volume 112
Author(s): Mary In-Ping Huang Cobb, Rachael Mintz-Cole, Aatif M. Husain, Miles Berger, David Jang, Patrick Codd
BackgroundProlactinomas are typically treated nonsurgically with a dopamine agonist. Once the tumor shrinks, adjacent eloquent structures, such as the optic apparatus, can become skeletonized and herniate into the dilated parasellar space.Case DescriptionA 48-year-old man with a prolactin-secreting macroadenoma treated with cabergoline presented with progressive bitemporal hemianopsia. Magnetic resonance imaging showed no recurrence of disease and a stretched optic chiasm herniating into an empty sella. Elevation of the optic chiasm via a transnasal transsphenoidal approach with ALLODERM graft and septal cartilage strut was performed. The patient was discharged home the next day with significant improvement in vision; magnetic resonance imaging showed interval elevation of the optic chiasm.ConclusionsWe review secondary empty sella syndrome and discuss surgical strategies for optic chiasmapexy.



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