Is it better to do a Ventriculo peritoneal shunt and wait or perform a chiasmopexy straight away?
A VP shunt should be done first to reduce the ICP . This would decrease the chances of CSF rhinorrhoea if a trans-sphenoidal chiasmopexy is eventually required.
chiasmopexy is rather uneffective and may be dangerous without VP shunting. as far as empty sella is a secondary condition in hydrocephalic patients, VP shunting was enough to control the situiation (I`m talking about only my own experiense)
If the empty sella is the only pathological condition, I recommend an oculistic examination with visual field. Only if these are pathological I suggest a VP shunt. I personnally treated successfully 10 cases in this way (10 operations)
Chiasmopexy is only rarely performed today. If neuro-opthalmologist believes the visual deterioration is truly from visual pathway disruption and the only pathology is raised ICP, a ventriculoperitoneal shunt make sense as first step.
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