Endonasal endoscopic transsphenoidal chiasmapexy using a clival cranial base cranioplasty for visual loss from massive empty sella following macroprolactinoma treatment with bromocriptine: case report

Journal of Neurosurgery
G Rene Alvarez BerasteguiTheodore H Schwartz

Abstract

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 dopaminergic agonist therapy presented to our institution with a 1-month history of visual changes. Neuroophthalmological examination confirmed severe bitemporal field defects, and MRI revealed a large empty sella with downward optic chiasmal herniation. Endoscopic endonasal chiasmapexy was performed by elevating the chiasm with lumbar drainage and filling the clival and sellar defect with an extradural liquid (HydroSet; a cranioplasty bone cement), and a piece of AlloDerm was used to cover and cushion the chiasm. Postoperative imaging demonstrated successful anatomical elevation of the optic apparatus, and the patient showed functional improvement in the visual field at 3 months postoperatively. Although rare, massive empty sellar and chiasmal ...Continue Reading

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Citations

Aug 7, 2017·European Journal of Endocrinology·S ChiloiroL De Marinis
May 10, 2020·Operative Neurosurgery·Nika ByrneRichard W Byrne
Oct 16, 2020·Pituitary·Marjolein TabakIrene C Notting
Jul 27, 2021·Frontiers in Medicine·David A PaulBradford Z Mahon

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Methods Mentioned

BETA
dissection

Software Mentioned

AlloDerm

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