MR imaging of pituitary morphology in idiopathic intracranial hypertension

Yuh, William T. C.; Zhu, Min; Taoka, Toshiaki; Quets, Jerome P.; Maley, Joan E.; Muhonen, Michael G.; Schuster, Michael; Kardon, Randy H.

doi:10.1002/1522-2586(200012)12:6<808::aid-jmri3>3.0.co;2-n

Cited by 126 publications

(137 citation statements)

References 14 publications

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“…1). 29 Data were summarized with means, medians, and ranges, or frequency counts and percentages. Comparisons among categorical data were made using chi-square and Fisher exact tests, whereas group comparisons that involved analyzing continuous data were made using unpaired t-tests; p values of < 0.05 were considered statistically significant.…”

Section: Data Collectionmentioning

confidence: 99%

Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid–middle cranial fossa approach

Carlson¹,

Copeland

Driscoll

et al. 2013

JNS

116

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Object The goals of this study were to report the clinical presentation, radiographic findings, operative strategy, and outcomes among patients with temporal bone encephaloceles and cerebrospinal fluid fistulas (CSFFs) and to identify clinical variables associated with surgical outcome. Methods A retrospective case series including all patients who underwent a middle fossa craniotomy or combined mastoid–middle cranial fossa repair of encephalocele and/or CSFF between 2000 and 2012 was accrued from 2 tertiary academic referral centers. Results Eighty-nine consecutive surgeries (86 patients, 59.3% women) were included. The mean age at time of surgery was 52.3 years, and the left side was affected in 53.9% of cases. The mean delay between symptom onset and diagnosis was 35.4 months, and the most common presenting symptoms were hearing loss (92.1%) and persistent ipsilateral otorrhea (73.0%). Few reported a history of intracranial infection (6.7%) or seizures (2.2%). Thirteen (14.6%) of 89 cases had a history of major head trauma, 23 (25.8%) were associated with chronic ear disease without prior operation, 17 (19.1%) occurred following tympanomastoidectomy, and 1 (1.1%) developed in a patient with a cerebral aqueduct cyst resulting in obstructive hydrocephalus. The remaining 35 cases (39.3%) were considered spontaneous. Among all patients, the mean body mass index (BMI) was 35.3 kg/m2, and 46.4% exhibited empty sella syndrome. Patients with spontaneous lesions were statistically significantly older (p = 0.007) and were more commonly female (p = 0.048) compared with those with nonspontaneous pathology. Additionally, those with spontaneous lesions had a greater BMI than those with nonspontaneous disease (p = 0.102), although this difference did not achieve statistical significance. Thirty-two surgeries (36.0%) involved a middle fossa craniotomy alone, whereas 57 (64.0%) involved a combined mastoid–middle fossa repair. There were 7 recurrences (7.9%); 2 patients with recurrence developed meningitis. The use of artificial titanium mesh was statistically associated with the development of recurrent CSFF (p = 0.004), postoperative wound infection (p = 0.039), and meningitis (p = 0.014). Also notable, 6 of the 7 cases with recurrence had evidence of intracranial hypertension. When the 11 cases that involved using titanium mesh were excluded, 96.2% of patients whose lesions were reconstructed with an autologous multilayer repair had neither recurrent CSFF nor meningitis at the last follow-up. Conclusions Patients with temporal bone encephalocele and CSFF commonly present with persistent otorrhea and conductive hearing loss mimicking chronic middle ear disease, which likely contributes to a delay in diagnosis. There is a high prevalence of obesity among this patient population, which may play a role in the pathogenesis of primary and recurrent disease. A middle fossa craniotomy or a combined mastoid–middle fossa approach incorporating a multilayer autologous tissue technique is a safe and reliable method of repair that may be particularly useful for large or multifocal defects. Defect reconstruction using artificial titanium mesh should generally be avoided given increased risks of recurrence and postoperative meningitis.

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Section: Data Collectionmentioning

confidence: 99%

Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid–middle cranial fossa approach

Carlson¹,

Copeland

Driscoll

et al. 2013

JNS

116

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“…59,63 The term "empty sella" should be reserved for studies in which the pituitary gland is not visible, and these cases tend to be later manifestations of increased ICP. 64 There is a wide spectrum of pituitary height changes; thus, many cases of empty sella may, in fact, be better described as a partially empty sella or a compressed pituitary gland. The wide range of sensitivities and specificities reported reflects this ambiguity.…”

Section: Mr Imagingmentioning

confidence: 99%

Pseudotumor Cerebri: Brief Review of Clinical Syndrome and Imaging Findings

Degnan

Levy

2011

AJNR Am J Neuroradiol

236

179

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SUMMARY: PTC is a clinical entity of uncertain etiology characterized by intracranial hypertension. The syndrome classically manifests with headaches and visual changes in women with obesity. Traditionally, imaging ruled out secondary causes of elevated CSF pressure but now may reveal findings frequently seen in patients with PTC, including the following: flattening of the globe, an empty sella, an enlarged ONS, protrusion and enhancement of the optic nerve head, and increased tortuosity of the optic nerve. Novel imaging methods, including MR venography, have additionally identified sinovenous stenosis as a potential indicator of PTC.ABBREVIATIONS: BMI ϭ body-mass index; CN ϭ cranial nerve; HIV ϭ human immunodeficiency virus; ICP ϭ intracranial pressure; IIH ϭ idiopathic intracranial hypertension; ISF ϭ interstitial fluid; MRI ϭ MR imaging; ONS ϭ optic nerve sheath; ONSF ϭ optic nerve sheath fenestration; IOP ϭ intraocular pressure; PCOS ϭ polycystic ovary syndrome; PTC ϭ pseudotumor cerebri syndrome

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“…In our study, 68% of the IIH group had complete or partially empty sella. The incidence of empty sella in cases of IIH varies widely (10-94%), probably related to discrepancies in definition 26 . Although empty sella is associated with IIH, it is also present in 5-6% of normal individuals 26,45 .…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, the role of imaging in the evaluation of IIH has been to exclude secondary causes of increased intracranial pressure (ICP) and papilledema 7,20 . Several radiological findings have been described in the literature that may aid in establishing the diagnosis such as: flattening of the posterior aspect of the globe, increased perioptic nerve sheath dimensions, and the presence of an empty sella 19,[21][22][23][24][25][26][27][28] . Previous reports suggest that most of these findings aid in the diagnosis of IIH, but lack sufficient specificity 29 .…”

Section: Introductionmentioning

confidence: 99%

Idiopathic Intracranial Hypertension: Diagnostic Accuracy of the Transverse Dural Venous Sinus Attenuation on CT Scans

et al. 2014

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SUMMARY -Idiopathic intracranial hypertension (IIH) is a clinical disorder of unknown etiology. It may exhibit several non-specific imaging findings. We observed that patients with intracranial hypertension demonstrate intracranial venous sinus attenuation with changes in the contour and caliber of the distal transverse sinus. This can be seen on routine non-contrast sagittal reformatted CT images of the brain. We have termed this the venous attenuation sign (VAS). This study evaluated the VAS as a marker for IIH assessing the transverse sinuses on sagittal reformatted non-contrast CT for the presence of a VAS in 25 patients with IIH and 24 control patients. Scans were independently assessed in a blinded fashion by three readers. The readers identified the VAS

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MR imaging of pituitary morphology in idiopathic intracranial hypertension

Cited by 126 publications

References 14 publications

Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid–middle cranial fossa approach

Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid–middle cranial fossa approach

Pseudotumor Cerebri: Brief Review of Clinical Syndrome and Imaging Findings

Idiopathic Intracranial Hypertension: Diagnostic Accuracy of the Transverse Dural Venous Sinus Attenuation on CT Scans

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