Transsphenoidal treatment of empty sella by means of a silastic coil: technical note.

OBJECTIVE AND IMPORTANCE: Several methods have been proposed to achieve transsphenoidal arachnoid mobilization and chiasmapexy in symptomatic empty sella (primary or secondary empty sella syndrome). These procedures are often difficult to perform and have not always had satisfactory long-term outcomes because of the difficulty of achieving adequate and long-lasting sellar filling over time. The volume of fat or muscle packing decreases over time as a result of scar retraction. The same problem may occur with intrasellar balloon placement because of deflation of the balloon. TECHNIQUE: We propose extradural packing accomplished through a transsphenoidal approach, using a Silastic (Dow Corning, Auburn, MI) coil, fashioned by means of a ventricular catheter arranged as a spiral. RESULTS: This technique was used in four patients with satisfactory and long-lasting clinical results. It presents several advantages over previous methods: it can be tailored to each patient; Silastic is an inert substance, and therefore scarring, with consequent shrinkage, does not occur; and because the coil is very elastic, it presents few risks of inflammatory complications or of excessive compression of sellar, parasellar, and suprasellar structures. Furthermore, this technique does not require a supplementary skin incision to harvest autologous tissues (fat, muscle, or fascia lata). A skilled neurosurgeon can perform the procedure in a few minutes with more ease and less expense than other techniques. CONCLUSION: The reported technique is a valid alternative to classic transsphenoidal extradural packing.

The puzzling afterglow of GRB 050721: a rebrightening seen in the optical but not in the X-ray.

We present here the analysis of the early and late multiwavelength afterglow emission, as observed by Swift a small robotic telescope and very large telescope (VLT). We compare early observations with late afterglow observations obtained with Swift and the VLT and we observe an intense rebrightening in the optical band at about 1 day after the burst, which is not present in the X-ray band. The lack of detection in X-ray of such a strong rebrightening at lower energies may be described with a variable external density profile. In such a scenario, the combined X-ray and optical observations allow us to derive that the matter density located at approximately 1017 cm from the burst is approximately a factor of 10 higher than in the inner region. This is the first time in which a rebrightening has been observed in the optical afterglow of a gamma-ray burst that is clearly absent in the X-ray afterglow.