Treatment of primary empty sella with intractable headache via the transspehnoidal approach

Two cases of primary empty sella with intractable headache were treated via the transsphenoidal approach. One patient was a 53-year-old female with right upper nasal quadrantanopsia and intractable retrobulbar pain and the other was 46-year-old female with continuous retrobulbar pain with a history of transient right temporal hemianopsia. Both cases were diagnosed by metrizamide CT cisternography. They had normal endocrinological functions. They did not respond to drug therapy and were treated surgically. In each case, the dura mater of the floor of the sella was elevated with lyophilized human dura mater and bone fragments obtained during the procedure. In the former case, significant improvement of visual field defect was not obtained but the retrobulbar pain disappeared completely after the operation. In the latter case which had intractable headache for six months, the symptom disappeared just after the operation. Until now, retroorbital pain has not recurred in either case for several months. Primary empty sella has been considered to be a benign condition except in some cases with CSF rhinorrhea or with visual disturbance. Headache which often accompanies primary empty sella has rarely been treated surgically because it is difficult to know whether the headache is related to the empty sella or not. Another reason may be that there is little available data concerning the efficacy of surgical treatment. Headache caused by stretching of the dura of the floor of the sella is usually frontal or retrobulbar, continuous, profound and intractable. It is rational to relax the dural tension by elevating the dura of the floor of the sella by extradural packing via the transsphenoidal approach. These two cases presented here with dramatic improvement show the possibility of surgical treatment of primary empty sella with headache which does not respond to drug therapy.