Saturday 18 February 2012

Secondary Empty Sella MRI

Term Empty sella was first applied by Busch in 1951 to an anatomic finding of severely flattened Pituitary gland against the floor of the sella at autopsy.

Primary Empty Sella Syndrome is an anatomical variation where the wide aperture of the diaphragma sella, through which the pituitary stalk reaches pituitary. When this aperture is wide, the cardio pulmonary pulsations with time make the sella wide with flattening of the pituitary gland at the floor of sella. When an isolated finding has no clinical significance and pt's are usually asymptomatic.

MRI is investigation of choice. Midline sagittal T1 and T2 images show sella occupied by fluid isointense to Csf, infundibular stalk traversing the sellar cavity to the residual pituitary tissue which is flattened at the floor of hypophyseal fossa.
On MRI other findings like slit like ventricles, prominent subarachnoid space around the optic nerves, tortuosity of the optic nerves, compressed dural venous sinuses should be looked for, presence of which may suggest the clinical diagnosis of Idiopathic Intracranial hypertension in symptomatic patients with papillodema clinically.

Secondary empty sella syndrome occurs when the sella is empty because the pituitary gland has been damaged by either Radiotherapy or Surgery.
MRI Sagittal T2 image shows Empty Sella secondary to surgery as pt's previous clinical details reveals operative notes mentioning a pituitary adenoma excised with trans sphenoid approach.   

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