[The surgical treatment of primary empty sella]

Two cases of the primary empty sella complaining of intractable headache for many years are reported. Case 1. A 73-year-old female was admitted on August 23, 1983 because of intractable headache. Plain skull radiograph showed slightly enlarged sella with deepening of the floor. Metrizamide CT scan demonstrated the sella cavity filled with metrizamide extensively. Operation was done performing intrasellar intradural plugging via transsphenoidal route (Hardy's technique). Postoperatively headache was improved. Case 2. A 43-year-old female was admitted on July 24, 1984 after many years of intractable headache. Craniogram demonstrated deep sella of slightly increased volume and unaltered dorsum sellae. On metrizamide CT scan, contrast medium occupied greater parts of the sellar cavity. Extradural intrasellar plugging (Guiot's technique) was performed. Postoperative course was uneventful. Surgical procedure on the primary empty sella relieved headache by decreasing intrasellar pressure and alleviating pulsatile pressure on the dulla. Operation via transsphenoidal method was the suitable procedure because of less trauma on the optic nerve and advantageous plugging of the sellar cavity. Guiot's technique with extradural intrasellar plugging may be more preferable because of accompanying no postoperative cerebrospinal fluid rhinorrhea.