Transsphenoidal treatment of empty sella by means of a silastic coil : technical note

OBJECTIVE AND IMPORTANCE: 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 selfar 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 ballon placement because of deflation of the TECHNIQUE: We propose extradural packing accomplished through a transsphencidal approach, using a Silastic (Dow Coming, Auburn, MI) coil, fashioned by means of a ventricular catheter arranged as a spiral. RESULTS: This technique was used in four patient with statisfactory 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 required 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. CONCLUSION: The reported technique is a valid alternative to classic transsphenoidal extradural packing.