頭痛にて発症したprimary empty sellaの外科的治療法(Guiot法)

Abstract

Primary empty sella is frequently seen in middle-aged women. It is widely accepted that patients with this disease are indicated for surgical treatment if their visual field or acuity has been disturbed. However, there is no agreement about the surgical indication of this disease presenting as headache. In two cases of this disease with a chief complaint of frequent headaches in the early morning, we recently performed extradural intrasellar plugging (Guiot's technique) via transsphenoidal approach. The results of this operation were excellent with complete disappearance of headaches. The conclusions may be summarized as follows : 1) Extradural intrasellar plugging is recommended in cases of progressive headaches especially early in the morning. 2) A tendency to headache early in the morning is thought to be due to physiological intracranial hypertension in REM sleep. 3) Before surgery, differential diagnosis of this condition from glaucoma or migraine should be made by confirming that the intraocular tension is mormal and that headache is not relieved by flunarizine therapy.