Empty sella syndrome as complication of benign intracranial hypertension

Abstract

An empty sella was demonstrated on air study in five patients with the benign intracranial hypertension (BIH) syndrome. All patients had a protracted course and very high cerebrospinal fluid pressure; two required a shunt procedure. No patient had any endocrine symptoms or visual field defects but an air study was done to exclude a mass lesion in the sella region. Among the last 50 patients seen with the BIH syndrome, there were five cases of an associated empty sella (10%). In these cases, the empty sella is a probable consequence of the long-standing intracranial hypertension associated with a congenital deficiency of the diaphragma sellae.

Spontaneous Cerebrospinal Fluid Rhinorrhea Associated With Chronic Renal Failure. Case Report.

“…Increased CSF pressure associated with diaphragma sellae defects is considered to be the main pathogenic factor for empty sella, which occurs in 10% of patients with pseudotumor cerebri. 25,29) The coexistence of pseudotumor cerebri and empty sella was believed to be incidental in our case. Increased intracranial pressure may promote CSF leakage in empty sella, through the sellar floor.…”

Relationships between Intracranial Pressure and Diurnal Prolactin Secretion in Primary Empty Sella

“…Our observations demonstrate that the finding of a normal ICP during wakefulness is not sufficient to rule out an actual increase in ICP, since a rise in the CRF pressure can occur during sleep. Our data also demonstrated a correlation between an abnormal rise in ICP and an absent or blunted nocturnal increment in PRL secretion.The 'primary empty sella' (PES) is defined as an exten sion of the subarachnoid space into the sella turcica in sub jects who have not received surgical or radiotherapeutic procedures [6,17], The pituitary fossa is enlarged and par tially filled with cerebrospinal fluid, while the pituitary gland is compressed against the posterior rim of the fossa.Although it has been suggested, on the basis of clinical signs (headache, with or without papilledema), that a chron ic or intermittent intracranial hypertension can cause the development of the PES [12], an actual increase in cerebro spinal fluid (CSF) pressure has rarely been documented in patients who have developed this syndrome [7,8,10,11,20], It is known, however, that in some pathological conditions (such as normotensive hydrocephalus) an increase in intra cranial pressure (ICP) was revealed only by prolonged re cordings during nocturnal sleep. In particular, the highest ICP was recorded during REM episodes [19],…”

Nontraumatic (Spontaneous) Cerebrospinal Fluid Rhinorrhea from Cribriform Fistula Associated with Primary Empty Sella: Report of Two Cases and Literature Review

“…7,11,14,15 Continuous monitoring has revealed instances of intermittently raised ICP in patients with primary ESS, with no overt symptoms of raised ICP. 5 In some patients, however, monitoring has not shown evidence of raised ICP.…”

“…Although CSF rhinorrhea in association with PES is reported to occur in 9.7% of cases, 7 the review of the literature revealed a report of 58 cases of CSF rhinorrhea in association with PES. In 51 of these cases, rhinorrhea occurred through the sellar floor into the sphenoid sinus, 1,[4][5][6][7][8][9][10]15 and has been attributed to herniation of the pia arachnoid through an incomplete diaphragma sellae, either because of raised ICP or of constant CSF pulsations, eventually resulting in remodelling or erosion of the sellar bone and CSF leak through the sphenoid sinus. Only six cases of PES with CSF leak through the ethmoid fistula 3,10,12,17 have been described in the literature.…”