Empty Sella Is a Sign of Symptomatic Lateral Sinus Stenosis and Not Intracranial Hypertension

Abstract

BACKGROUND AND PURPOSE: Empty sella has been reported in patients with idiopathic intracranial hypertension and is thought to be a sign of elevation of intracranial pressure. However, it can also be found in patients with lateral sinus stenosis presenting with isolated pulsatile tinnitus without signs of intracranial hypertension. We hypothesized that the volume of the sella turcica would be similar in both groups of patients undergoing stent placement for lateral sinus stenosis. MATERIALS AND METHODS: Consecutive patients with idiopathic intracranial hypertension or isolated venous pulsatile tinnitus and undergoing lateral sinus stent placement from January 2012 to December 2017 were included. The primary outcome was the estimated volume of the sella turcica based on preoperative CTA measurements. The ratio of the pituitary gland height/sellar height was calculated on preoperative MR imaging. Sellar volumes were compared among the 3 groups: pulsatile tinnitus, idiopathic intracranial hypertension, and a control group, matched by age and sex.

Association of spontaneous cerebrospinal fluid rhinorrhea with transverse venous sinus stenosis: a retrospective matched case‐control study

“…1,5,25,26 In comparison with previous series of spontaneous CSF leaks, our study showed similar results concerning the age of the patients, sex ratio, rates of obesity, and empty sella. 11,19,24 Of note, the low rate of papilledema and elevated CSF pressure were also in accordance with previous reports. 26 In comparison with an IIH series, our study confirmed that patients with CSF leaks were older (45-65 years vs 25-36 years) and had fewer clinical signs of IIH (in particular, headaches reported in 0-7% vs 75-94%) but had a similar degree of empty sella.…”

“…In comparison with previous series of spontaneous CSF leaks, our study showed similar results concerning the age of the patients, sex ratio, rates of obesity, and empty sella 11,19,24 . Of note, the low rate of papilledema and elevated CSF pressure were also in accordance with previous reports 26 .…”

“…Beyond the clinical signs of IIH from the modified Dandy criteria, we analyzed transient visual field defects, which have been reported to be most specific and sensitive for papilledema 18 . Headache, which is less specific, as well as tinnitus, which is more secondary to VSS than raised intracranial pressure, were not analyzed 19 . When available, a lumbar puncture opening pressure ≥25 mmHg and bilateral papilledema seen on fundoscopy were used as accurate signs of IIH 18 .…”

“…18 Headache, which is less specific, as well as tinnitus, which is more secondary to VSS than raised intracranial pressure, were not analyzed. 19 When available, a lumbar puncture opening pressure ≥25 mmHg and bilateral papilledema seen on fundoscopy were used as accurate signs of IIH. 18 Other signs of intracranial hypotension, including orthostatic headache, diffuse dural enhancement, and venous dilation on cerebral MRI, were also included in the analysis.…”

Venous sinus stenting for the treatment of isolated pulsatile tinnitus: Results of a prospective trial

“…Zetchi et al. 24 demonstrated that the appearance of an empty sella in patients with lateral sinus stenosis, was similar whether the patients had established IIH or isolated PT and hypothesized that this is result of disruption of CSF flow, but not necessarily due to increased intracranial pressure. The authors acknowledge the fact that a lumbar puncture was not performed in the isolated pulsatile tinnitus group and it is possible that some patients in this group had unrecognized intracranial hypertension.…”