Challenging Diagnosis and Surgical Management of a Symptomatic Sellar Spine

Sellar spine: A rare Bony variant of the Sella Turcica

“…3,4.5,11,12,14 In most of the cases, the sellar spine arose from the inferior aspect of the anterior dorsum sellae with only two cases reported to be arising from the superior aspect. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 To our knowledge, this is the first case, reported, where the sellar spine arises from the mid-anterior aspect giving a ‘figure of 3’ sign of the dorsum sellae in the sagittal plane ( Figure 1 ). The spine most commonly projects in an anterosuperior orientation, with one case observed to be in a more horizontal orientation and one case in an anteroinferior orientation.…”

“…In all the described cases, the sellar spine was located in the midline in keeping with the foremost theory that it is an ossified remnant of the notochord. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 The most consistent imaging morphology of the bony spur among the literature was that of a narrow cylindrical bony stalk with a mildly distended tip and a flattened triangular base in continuity with the dorsum sellae. 1 , 2 , 3 , 9 , 11 , 12 , 13 In most cases, the tip had a smooth contour; however, in one of the cases, it was irregular.…”

“…To our knowledge, this is the first reported sellar spine that arises from the mid-ventral aspect of the dorsum sellae, with most of the previously described cases in the literature arising from the inferior ventral aspect of the dorsum sellae and two arising from the superior aspect of the dorsum sellae. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 Secondly, the history of puerpural alactogenesis and mild hypoprolactinaemia has not yet been described in any of the known reported cases in the literature.…”

Incidentally detected sellar spine in a patient with Cushing’s syndrome: a case report

“…One report described successful surgical resection of sellar spine in a patient with headache and bitemporal visual field defects, leading to resolution of these symptoms. 6 However, because of the rarity of symptomatic sellar spine, no definite treatment guideline exists.…”

“…Most cases of sellar spine are incidentally detected based on radiologic findings, but several studies have described sellar spine and concurrent endocrinopathies or neuro-ophthalmological manifestations such as hypopituitarism or precocious puberty. [4][5][6][7][8][9][10][11] To the best of our knowledge, however, no reports have described sellar spine in a patient with Cushing's syndrome. We herein present a case of incidentally detected sellar spine mimicking a pituitary adenoma on radiologic examinations during the evaluation of a patient with Cushing's syndrome.…”