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Endonasal endoscopic transsphenoidal chiasmapexy using a clival cranial base cranioplasty for visual loss from massive empty sella following macroprolactinoma treatment with bromocriptine: case report.
J Neurosurg. 2016 Apr; 124(4):1025-31.JN

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 descent from macroadenoma treatment can result in progressive visual loss. Here, a novel technique of endonasal endoscopic extradural cranioplasty aided by lumbar drainage is reported, which appears to be an effective technique for stabilizing and possibly reversing anatomical and visual deterioration.

Authors+Show Affiliations

Departments of 1 Neurosurgery.Departments of 1 Neurosurgery.Otolaryngology, and.Departments of 1 Neurosurgery. Otolaryngology, and. Neuroscience, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

26339851

Citation

Alvarez Berastegui, G Rene, et al. "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, vol. 124, no. 4, 2016, pp. 1025-31.
Alvarez Berastegui GR, Raza SM, Anand VK, et al. Endonasal endoscopic transsphenoidal chiasmapexy using a clival cranial base cranioplasty for visual loss from massive empty sella following macroprolactinoma treatment with bromocriptine: case report. J Neurosurg. 2016;124(4):1025-31.
Alvarez Berastegui, G. R., Raza, S. M., Anand, V. K., & Schwartz, T. H. (2016). 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, 124(4), 1025-31. https://doi.org/10.3171/2015.2.JNS142015
Alvarez Berastegui GR, et al. Endonasal Endoscopic Transsphenoidal Chiasmapexy Using a Clival Cranial Base Cranioplasty for Visual Loss From Massive Empty Sella Following Macroprolactinoma Treatment With Bromocriptine: Case Report. J Neurosurg. 2016;124(4):1025-31. PubMed PMID: 26339851.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endonasal endoscopic transsphenoidal chiasmapexy using a clival cranial base cranioplasty for visual loss from massive empty sella following macroprolactinoma treatment with bromocriptine: case report. AU - Alvarez Berastegui,G Rene, AU - Raza,Shaan M, AU - Anand,Vijay K, AU - Schwartz,Theodore H, Y1 - 2015/09/04/ PY - 2015/9/5/entrez PY - 2015/9/5/pubmed PY - 2016/8/16/medline KW - ACoA = anterior communicating artery KW - CTA = CT angiography KW - bromocriptine KW - chiasmapexy KW - empty sella KW - endonasal KW - endoscopic KW - pituitary surgery KW - plasty KW - prolactinoma KW - transsphenoidal SP - 1025 EP - 31 JF - Journal of neurosurgery JO - J Neurosurg VL - 124 IS - 4 N2 - 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 descent from macroadenoma treatment can result in progressive visual loss. Here, a novel technique of endonasal endoscopic extradural cranioplasty aided by lumbar drainage is reported, which appears to be an effective technique for stabilizing and possibly reversing anatomical and visual deterioration. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/26339851/Endonasal_endoscopic_transsphenoidal_chiasmapexy_using_a_clival_cranial_base_cranioplasty_for_visual_loss_from_massive_empty_sella_following_macroprolactinoma_treatment_with_bromocriptine:_case_report_ DB - PRIME DP - Unbound Medicine ER -