Treatment of visual defects in empty sella syndrome with detachable balloon

Full text: To report a detachable balloon chiasmopexy treatment of a patient with significant visual defects, with descent of the optic chiasm into an empty sella. A 48 year old female had pituitary adenoma surgery in 1990, presents with severe deterioration of vision in the three months prior to therapy. MRI revealed descent of the optic chiasm into an empty sella. Intra-operatively, a window was made into the bone of the anterior sella turcica. An ITC detachable balloon (Target) 1cm long, 0.6cm wide was placed into the base of the sella. The balloon was filled with iso-osmolar non-ionic contrast. The patient's vision improved, but the balloon deflated after one day. At re-operation, a longitudinal tear was found in the balloon, presumably from pressure from the edge of the bone window. Another detachable balloon was inserted, now filled with 0.6mls of solution of 80% lipiodol and 20% histo-acryl glue (Braun).The balloon stayed inflated, and her vision improved. Check CT at 3 months revealed good balloon position and inflation. There have been two previous literature reports in using detachable balloon chiasmopexy to treat this rare problem. Co-operation between radiology and surgery has successfully treated significant visual impairment in an empty sella syndrome patient. Copyright (2002) Blackwell Science Pty Ltd