scholarly journals Primary empty sella syndrome associated with visual deterioration salvaged by chiasmapexy: Report of a case and discussion of the literature

2020 ◽  
Vol 11 ◽  
pp. 48
Author(s):  
John Ouma
Keyword(s):  
Visual Fields ◽  
Sella Turcica ◽  
Optic Chiasm ◽  
Empty Sella ◽  
Endoscopic Endonasal ◽  
Gradual Improvement ◽  
Empty Sella Syndrome ◽  
Visual Deterioration ◽  
Neurosurgical Technique

Background: Empty sella syndrome (ESS) is a condition in which there is loss of volume of the pituitary gland, which is the normal constituent of the sella turcica. There may be visual and endocrine deficits associated with this condition, and radiologically, there may be downward prolapse of the optic chiasm. It occurs in a primary ESS, poorly understood form, as well as a secondary ESS form that follows medical or surgical treatment of a pituitary macroadenoma, or else spontaneous hemorrhage into such a tumor. Case Description: A 56-year-old man presenting with deficits of both visual acuity and visual fields in the setting of radiological ESS without associated optic chiasm prolapse is discussed. He underwent endoscopic endonasal chiasmapexy with gradual improvement of his visual function over the following 6 months. Conclusion: ESS is a potentially potent cause of visual deterioration that lends itself to reversal through a relatively simple neurosurgical technique. This case illustrates that actual prolapse of the chiasm is neither a prerequisite for visual deterioration nor its reversal the mechanism of visual improvement after chiasmapexy, raising the question of the mechanisms at play in cases such as this. It confirms the role of chiasmapexy in the management of selected cases of ESS.

scholarly journals Symptomatic Primary Tethered Optic Chiasm: Technical Case Report

2020 ◽  
Vol 19 (4) ◽  
pp. E440-E445 ◽  
Author(s):  
Nika Byrne ◽  
Ryan B Kochanski ◽  
Bobby Tajudeen ◽  
Richard W Byrne
Keyword(s):  
Clinical Presentation ◽  
Visual Fields ◽  
Optic Chiasm ◽  
Abdominal Fat ◽  
Empty Sella ◽  
Fat Graft ◽  
Endoscopic Endonasal ◽  
Empty Sella Syndrome ◽  
Graft Harvest ◽  
Magnetic Resonance Imaging Mri

Abstract BACKGROUND AND IMPORTANCE Symptomatic tethering of the optic nerves and chiasm is a rare occurrence and has been reported following both surgical and medical treatment of pituitary adenoma. Here we present a case of primary optic chiasm tethering in a patient with empty sella syndrome. CLINICAL PRESENTATION The patient was a 61-yr-old female who presented with progressively worsening bitemporal hemianopsia. Magnetic resonance imaging (MRI) brain revealed an empty sella with herniation of the optic chiasm into the sella. The patient underwent an endoscopic, endonasal/trans-sphenoidal approach to the sella, where the optic chiasm was then detethered via lysis of arachnoid adhesions and ultimately buttressed with an abdominal fat graft. Postoperatively, the patient did well with subjective and objective improvements in her visual fields. CONCLUSION We report a rare case of primary tethered optic chiasm, which was successfully treated via an endoscopic, endonasal approach with abdominal fat graft harvest.

AYURVEDIC MANAGEMENT OF PARTIAL EMPTY SELLA SYNDROME: A CASE REPORT

2021 ◽  
Vol 12 (4) ◽  
pp. 15-18
Author(s):  
Eswara M P Sarma ◽  
Arathi P K
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Pituitary Gland ◽  
Sella Turcica ◽  
Marked Change ◽  
Empty Sella ◽  
Empty Sella Syndrome ◽  
Lukewarm Water

Empty Sella Syndrome is a disorder that involves the presence of Cerebro-spinal fluid in Sella turcica in an excess amount. In empty Sella syndrome the Sella turcica is either partially filled with cerebrospinal fluid and an atrophied pituitary gland lying in the floor of the Sella (Partial Empty Sella Syndrome) or filled with cerebrospinal fluid which pushes the pituitary gland into a side of Sella turcica resulting in non-visualization of the gland. (Completely empty Sella). A 37-year-old female diagnosed with partial empty Sella syndrome was managed with Pathyakshadhatryadi kashayam 15 ml twice daily in empty stomach with 45 ml lukewarm water, Rasnadi choornam tailam application, mahatraiphala ghritam 10 ml at night after food, Kshirabala 7 Avarti tailam pratimarsha nasyam. After completion of the treatment, there was considerable relief in the primary complaint of the patient which was a recurrent headache and the follow up MRI showed a marked change in the condition. This case report highlights the role of Ayurveda in the management of partial empty Sella syndrome and sheds light for further study on the same.

Empty sella syndrome: does it exist in children?

1999 ◽  
Vol 91 (6) ◽  
pp. 960-963 ◽  
Author(s):  
Ahmed Ammar ◽  
Ali Al-Sultan ◽  
Fatma Al Mulhim ◽  
Abdulla Yousef Al Hassan
Keyword(s):  
Early Stage ◽  
Sella Turcica ◽  
Optic Chiasm ◽  
Empty Sella ◽  
Empty Sella Syndrome ◽  
Content Type ◽  
Suprasellar Arachnoid Cyst ◽  
The Subject ◽  
Hypothalamic Function ◽  
Fine Print

Object. The empty sella syndrome (ESS) is well documented in adults, and although the same phenomenon of herniation of the arachnoid space into the enlarged sella turcica has been noted in children, it is not widely known that children suffer from this syndrome. Therefore, the aims of this paper are to increase neurosurgeons' awareness of the existence of this phenomenon in children and to add to the scant body of literature on the subject.Methods. The authors treated 12 children, ranging in age between 2 and 8 years, in whom neuroradiological studies demonstrated an enlarged sella turcica filled with cerebrospinal fluid and herniation of suprasellar and arachnoid spaces. The causes of ESS in these children were high intracranial pressure, neglected or improperly treated hydrocephalus, and suprasellar arachnoid cyst. Primary ESS was found as well. Most of the children presented with headache, abnormal body weight (the majority being underweight), and short stature. The results of hormone assays were normal in all children.Conclusions. If undiagnosed and untreated, ESS in children may lead to serious consequences, including impairment of pituitary and hypothalamic function and damage to the optic chiasm. It is important to raise awareness in the neurosurgical community about the existence of ESS in children so that it can be diagnosed and treated at an early stage. A classification system for the diaphragma sellae is recapitulated.

scholarly journals Empty sella syndrome: does it exist in children?

1999 ◽  
Vol 7 (2) ◽  
pp. E6
Author(s):  
Ahmed Ammar ◽  
Ali Al-Sultan ◽  
Fatma Al Mulhim ◽  
Abdulla Yousef Al Hassan
Keyword(s):  
Cerebrospinal Fluid ◽  
Body Weight ◽  
Early Stage ◽  
Sella Turcica ◽  
Optic Chiasm ◽  
Empty Sella ◽  
Empty Sella Syndrome ◽  
Suprasellar Arachnoid Cyst ◽  
The Subject ◽  
Hypothalamic Function

The empty sella syndrome (ESS) is well documented in adults and although the same phenomenon of herniation of the arachnoid space into the enlarged sella turcica has been noted in children, it is not widely known that children suffer from this syndrome. Therefore, the aims of this paper are to increase neurosurgeons' awareness of the existence of this phenomenon in children and to add to the scant body of literature on the subject. The authors treated 12 children, ranging in age between 2 and 8 years in whom neuroradiological studies demonstrated an enlarged sella turcica filled with cerebrospinal fluid and herniation of suprasellar and arachnoid spaces. The causes of ESS in these children were high intracranial pressure, neglected or improperly treated hydrocephalus, and suprasellar arachnoid cyst. Primary ESS was found as well. Most of the children presented with headache, abnormal body weight (the majority being underweight), and short stature. The results of hormone assays were normal in all children. If undiagnosed and untreated, ESS in children may lead to serious consequences, including impairment of pituitary and hypothalamic function and damage to the optic chiasm. It is important to raise awareness in the neurosurgical community about the existence of ESS in children so that it can be diagnosed and treated at an early stage. A classification system for the diaphragma sellae is recapitulated.

Primary empty sella syndrome: the role of visual system herniation

2002 ◽  
Vol 58 (1) ◽  
pp. 42-47 ◽  
Author(s):  
Gerardo Guinto ◽  
Ramiro del Valle ◽  
Elisa Nishimura ◽  
Moises Mercado ◽  
Bárbara Nettel ◽  
...  
Keyword(s):  
Visual System ◽  
Empty Sella ◽  
Empty Sella Syndrome ◽  
Primary Empty Sella

scholarly journals The Surgical Results in Pure Endoscopic Endonasal Trans-sphenoidal Surgeries in 403 Pituitary Adenomas: An 8-Years of Experience from a Single Neurosurgical Unit

2021 ◽  
Vol 24 (4) ◽  
pp. 315-321
Author(s):  
Khalid Mahmood ◽  
Muhammad Hassan Raza ◽  
Imran Ali ◽  
Omair Afzal
Keyword(s):  
Pituitary Adenomas ◽  
Pituitary Tumors ◽  
Empty Sella ◽  
Microscopic Approach ◽  
Safe Alternative ◽  
Endoscopic Endonasal ◽  
Empty Sella Syndrome ◽  
Carotid Injury ◽  
The Mean

Objective:  To review and report the results in pure endoscopic endonasal trans-sphenoidal surgery done at our unit for pituitary adenomas (PAs) in last 8 years. Material and Methods:  We reviewed 403 consecutive patients who underwent pure endoscopic endonasal trans-sphenoidal surgery for newly diagnosed pituitary adenomas between August 2012 and July 2020 at our neurosurgical unit. Endocrinological, demographic features and outcomes, their complications, and duration of stay in hospital were assessed in these patients who were operated in our neurosurgical Unit. The Mean Follow-up on average was 3.5 months. Results:  403 consecutive cases were reviewed. Majority of cases were in the 4th decade of life at presentation. 227 (56%) were non-functioning pituitary tumors and 176 (44%) were hormone secreting pituitary adenomas. Thirty-one (7.7%) complications were observed in 28 post-operative patients. The most frequently observed complication was diabetes insipidus (temporary in 19 (5%) and permanent in 3 (0.7%) cases), cerebrospinal fluids leaks (5 cases) (5.7%), Syndrome of inappropriate antidiuretic hormone (1 case) (0.2%), internal carotid injury (1 case) (0.2%), Empty Sella syndrome (1) (0.2%) and post-operative cardiac complication (1 case) (0.2%). The Follow-up on average was 3.5 months. Conclusions:  The pure endoscopic endonasal trans-sphenoidal surgery of pituitary adenomas provides acceptable and reasonable results representing a safe alternative procedure to the traditional Trans-sphenoidal microscopic approach.

Role of secondary empty sella syndrome in the development of erectile dysfunction

2018 ◽  
Vol 6 (3) ◽  
pp. 43-50 ◽  
Author(s):  
T.G. Markosyan ◽  
◽  
S.S. Bolevich ◽  
S.B. Bolevich ◽  
◽  
...  
Keyword(s):  
Erectile Dysfunction ◽  
Empty Sella ◽  
Empty Sella Syndrome

scholarly journals Spontaneous improvement of secondary empty sella syndrome due to re-expansion of an intrasellar cyst: A case report

2020 ◽  
Vol 11 ◽  
pp. 282
Author(s):  
Shodai Yamada ◽  
Kenji Yagi ◽  
Kazuhiro Hirano ◽  
Masaaki Uno
Keyword(s):  
Optic Nerve ◽  
Mr Imaging ◽  
Sella Turcica ◽  
Visual Disturbance ◽  
Empty Sella ◽  
Empty Sella Syndrome ◽  
First Case ◽  
Spontaneous Improvement ◽  
The Right ◽  
Gyrus Rectus

Background: In patients with secondary empty sella syndrome (ESS), optic nerve herniation into the sella turcica is caused by shrinkage of the mass lesion at the sella turcica, resulting in visual disturbance. ESS is often surgically treated using chiasmapexy. Here, we report the first case of spontaneous improvement in a patient with ESS. Case Description: A 69-year-old woman presented with a month-long history of visual disturbance in the right eye, poor visual acuity, and quadrantanopia in her upper temporal visual field. Magnetic resonance (MR) imaging showed herniation of her right optic nerve and gyrus rectus into the sella turcica. The visual disturbance gradually improved, and the patient’s vision became almost normal after a month without any treatment. On repeated MR imaging, it was observed that the herniation of the right optic nerve and gyrus rectus disappeared due to an intrasellar cyst re-expansion. The secondary ESS caused by the shrinkage of the intrasellar cyst resulted in the visual disturbance and re-expansion of the cyst resulted in spontaneous improvement of symptoms. The visual disturbance did not recur for a year. Conclusion: Patients with secondary ESS without severe symptoms may be followed up conservatively. However, surgical treatment should be applied if symptoms deteriorate or do not improve.

Osseous Remodeling Technique of the Sella Turcica: A New Surgical Option for Primary Empty Sella Syndrome

2019 ◽  
Vol 126 ◽  
pp. e953-e958
Author(s):  
Gerardo Guinto ◽  
Barbara Nettel ◽  
Eli Hernández ◽  
David Gallardo ◽  
Norma Aréchiga ◽  
...  
Keyword(s):  
Sella Turcica ◽  
Empty Sella ◽  
Empty Sella Syndrome ◽  
Surgical Option ◽  
Primary Empty Sella

Spontaneous Nasal Cerebrospinal Fluid Leaks and Empty Sella Syndrome: A Clinical Association

2003 ◽  
Vol 17 (2) ◽  
pp. 91-96 ◽  
Author(s):  
Rodney J. Schlosser ◽  
William E. Bolger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Skull Base ◽  
Sella Turcica ◽  
Empty Sella ◽  
Radiographic Appearance ◽  
Radiographic Findings ◽  
Empty Sella Syndrome ◽  
Csf Pressure ◽  
Csf Leaks

Background Spontaneous, idiopathic nasal meningoencephaloceles are herniations of arachnoid/dura and cerebrospinal fluid (CSF) through anatomically fragile sites within the skull base. Empty sella syndrome occurs when intracranial contents herniate through the sellar diaphragm filling the sella turcica with CSF and giving the radiographic appearance of an absent pituitary gland. The objective of this study was to examine the association between spontaneous encephaloceles/CSF leaks and empty sella syndrome because of their similar clinical features and potential common pathophysiology. Methods Retrospective. Results Sixteen patients were treated for spontaneous encephaloceles between 1996 and 2001. All 16 patients had associated CSF leaks. Five patients had multiple simultaneous encephaloceles. Fifteen patients with imaging of the sella turcica had empty (10 patients) or partially empty (5 patients) sellas. One patient did not have complete imaging of the sella. Three patients had lumbar punctures with measurement of CSF pressure during computed tomography cisternograms because of multiple skull base defects. Mean CSF pressure was 28.3 cm of water (range, 19–34 cm; normal, 0–15 cm). Thirteen of 16 patients (81%) were obese women (mean body mass index, 35.9 kg/m2; normal, <25 kg/m2). Mean follow-up was 14.2 months with 100% success in closure of the defects after one procedure. Conclusion Spontaneous meningoencephaloceles and CSF leaks are strongly associated with radiographic findings of an empty sella and suggest a common pathophysiology. The underlying condition probably represents a form of intracranial hypertension that exerts hydrostatic pressure at anatomically weakened sites within the skull base. Otolaryngologists should be familiar with this disease entity and the implications intracranial hypertension has on patient management.

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