Is an empty sella life-threatening?

In recent years, the incidence of empty sella has been getting higher and higher. Most patients with mild empty sella generally do not have obvious physical symptoms. If the condition worsens, it will cause symptoms such as headache, decreased vision or endocrine dysfunction. For patients with empty sella syndrome, if the symptoms are relatively mild, they generally do not need treatment. Pay more attention to observation and follow-up. Patients with empty sella are not in danger of life.

Empty sella syndrome is a series of clinical manifestations caused by sella turcica defect or pituitary atrophy, in which the subarachnoid space protrudes into the sella turcica under the impact of cerebrospinal fluid pressure, resulting in enlargement of the sella turcica and compression of the pituitary gland.

Clinically, it can be divided into two categories:

Occurring in the sella or parasellar surgery or radiotherapy, the latter is secondary vacuolar sella syndrome;

Primary vacuolar sella syndrome is caused by no obvious cause and is not caused by surgery or radiotherapy. It is generally believed that if the symptoms are mild, no special treatment is required, but if there is obvious visual impairment, surgical exploration should be performed. If it is adhesion around the optic nerve, adhesion lysis can improve vision to a certain extent. It can be treated with an artificial septum sellae. For patients with cerebrospinal fluid rhinorrhea, a transsphenoidal approach can be used to fill the pituitary fossa with muscle and transplanted bone. For non-neoplastic cysts, the cyst can be opened and the cyst capsule can be partially removed. If accompanied by endocrine dysfunction, replacement therapy should be given as appropriate. If there is benign intracranial hypertension, benign intracranial hypertension should be treated. Empty sella turcica filling surgery was performed when necessary.

Clinical manifestations of empty sella syndrome:

It is more common in middle-aged obese women, and headache (70%) is often the main clinical manifestation. Mostly in the frontal and orbital region. The pain is irregular and there is no nausea or vomiting. There may be visual impairment, rarely visual field loss. Obese body types account for 40% to 70%. Generally, there is no endocrine dysfunction. When the blood prolactin level increases, it affects ovarian function and may cause amenorrhea, galactorrhea, and infertility. There may be hypertension, cerebral fluid rhinorrhea, benign intracranial hypertension, epilepsy and dysentery, impaired consciousness, and hirsutism in women. Diabetes insipidus is rare.

Empty sella turcica diagnosis

Coronal and sagittal imaging are preferred for MR examination. T1WI can perfectly display the morphology of the pituitary gland and the anatomy of the sellar region as well as the position of the optic nerve and pituitary stalk; T2WI can observe the signal changes of the pituitary gland and the sellar region. Its main manifestations are:

①The sella turcica is enlarged and the sella turcica floor is thinned;

② The sella turcica is filled with cerebrospinal fluid, which shows a watery signal with long T1 and long T2, and the signal intensity is similar to that of cerebrospinal fluid;

③ The pituitary gland is compressed and flattened, and is closely attached to the bottom of the sella turcica, with a concave upper edge. It is arc-shaped in the sagittal plane, and the pituitary stalk is extended in the coronal plane. It is connected to the thin paper-like pituitary gland attached to the bottom of the sella turcica, and looks like an anchor;

④The pituitary stalk is centered and can be extended and moved posteriorly.

The X-ray appearance of an empty sella can be easily confused with an enlarged sella caused by an intrasellar tumor or chronic intracranial hypertension. Intrasellar tumors enlarge the sella turcica and cause it to become cup-shaped, spherical or flat. The tuberculum sellae moves forward, the bottom of the sella turcica sinks, and the back of the sella turcica becomes upright. Therefore, typical intrasellar tumors are not difficult to distinguish from this disease. However, in some cases of spherical enlargement, the differentiation is more difficult. The enlargement of the sella turcica caused by chronic increased intracranial pressure is often accompanied by bone absorption, which is also difficult to distinguish from this disease. Finally, CT and MRI examinations are required to confirm the diagnosis.