Skull Base Program, Universidad Nacional Autónoma de México, Mexico City, Mexico; Centro Neurológico ABC, Mexico City, Mexico.
Department of Neurosurgery, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Mexico City, Mexico.
World Neurosurg. 2019 Jun;126:e953-e958. doi: 10.1016/j.wneu.2019.02.195. Epub 2019 Mar 12.
Empty sella is an anatomic finding that is usually asymptomatic. However, when patients with empty sella finding present with visual deficits, surgical treatment may be necessary. The main goal of surgery is to elevate sellar content through a transsphenoidal approach. The aim of this study was to demonstrate a new technique for precise reconstruction of the sellar floor using a heterologous bone block to restore the anatomic elements of the sella turcica.
Three patients with primary empty sella who presented with visual field defects were prospectively included. Surgery was performed through a microsurgical transsphenoidal approach and involved elevating the sellar content by using a tricortical heterologous bone graft, the dimensions of which were obtained considering the exact dimensions of each patient's sella turcica. The graft was premodeled outside the surgical bed and carefully introduced into the sella turcica to achieve the required elevation (chiasmapexy).
Vision of all 3 patients improved, and the improvement persisted throughout the follow-up period. 2 patients, this improvement was noted immediately after surgery, and in the third patient, this change in vision occurred 1 week later. Long-term imaging studies showed the persistence of the bone graft in the sella turcica and the exact elevation of the sellar content at the end of the follow-up period. There were no complications in the present series.
The technique presented here is simple and reproducible and allows an almost exact and persistent elevation of the sellar content.
空蝶鞍是一种通常无症状的解剖学发现。然而，当空蝶鞍患者出现视力缺损时，可能需要手术治疗。手术的主要目标是通过经蝶窦入路升高鞍内容物。本研究旨在展示一种使用异种骨块精确重建鞍底的新技术，以恢复鞍区的解剖结构。
前瞻性纳入 3 例原发性空蝶鞍伴视野缺损患者。手术采用显微经蝶窦入路进行，通过使用三叶异种骨移植物升高鞍内容物，其尺寸根据每个患者鞍区的确切尺寸确定。移植物在手术床外预成型，并小心地引入鞍区以达到所需的升高（视交叉固定）。
所有 3 例患者的视力均有所改善，且在随访期间持续改善。2 例患者在手术后立即出现这种改善，而第 3 例患者在术后 1 周出现这种视力变化。长期影像学研究显示，鞍区的移植物持续存在，且在随访期末鞍内容物的升高确切。本系列中无并发症发生。
本研究介绍的技术简单且可重复，可实现鞍内容物几乎精确且持久的升高。
