Need for intrasellar packing in sellar reconstruction of transsphenoidal surgery: Less is more?

Background: This study investigated patients with pituitary macroadenomas who received transsphenoidal surgery using two different sellar reconstruction methods, to determine the need for intrasellar packing. Methods: The authors reviewed 53 patients with pituitary macroadenomas at a single institution between January 1999 and November 2002. On tumour removal, the group 1 patients underwent traditional sellar reconstruction (intrasellar and sphenoid sinus packing), while the group 2 patients did not undergo intrasellar packing. Results: The two groups did not differ significantly in terms of complications. There was no mortality; notably, no delayed empty sella syndrome occurred in the group 2 patients. Conclusions: Simplified reconstruction of the sella floor using only sphenoid bone without intrasellar packing is thought to be safe and effective. This technique obviates the need for a second surgical incision, risk of overpacking, complications associated with packing material and interference on postoperative magnetic resonance imaging.