Review of empty sella syndrome and its surgical management

Abstract

Introduction: Empty sella syndrome (ESS) is a condition in which the sella turcica is partially or completely filled with CSF resulting in a displacement of the normal pituitary gland.
Objective: This study was done to evaluate the clinical features, surgical management and outcome in a consecutive 20 cases with ESS.
Methods: This retrospective study included 20 adult patients suffering from manifestations due to ESS. 12 patients (60%) had symptomatic primary ESS and the rest 8 patients (40%) had manifestations due to secondary ESS. The male to female ratio was 1–3 and their ages ranged from 20 till
56 years with mean age of 41 years. As regards the clinical presentation, manifestations of increase the intracranial pressure were found in 12 patients (60%), visual manifestations in 10 patients (50%), CSF rhinorrhea in 10 cases (50%), and endocrinological dysfunction in 7 patients (35%).
All patients had preoperative plain X-ray, CT scan and MRI of the brain. Different surgical procedures were done according to the mode of presentation and the radiological findings. Mean postoperative follow-up period was 30 months, including both clinical and radiological  examinations.

Results: After surgery 10 patients (50%) were asymptomatic, 6 patients (30%) improved, and 4 patients (20%) stabilized. (85.3%) of patients with preoperative complaint of headache respond well to surgery, (12 cases out of 14). While 60% of the patients with preoperative visual field defect improved. No patients with preoperative fl visual acuity (4 cases) have improved after surgery. Postoperative MRI studies after extradural transsphenoidal packing revealed that the sellar contents appeared satisfactory elevated with upward lifting of suprasellar structures in all cases. Conclusion: The surgical outcome of cases with ESS is favorable. Visual disturbances and CSF rhinorrhea are the main indications for surgery. The type of surgery depends on clinical presentation and radiological findings.