What Exactly Is An Empty Sella?
What you need to know if you have chronic IH
Maybe this sounds familiar: you’ve just had an MRI and as your physician discusses the results, she mentions that you have an empty sella. If this has happened to you, you’re not alone. In fact, approximately 70% of individuals with chronic IH develop empty sellas.
But what is an empty sella and what does it mean for someone who has chronic IH? The sella turcica (cell-ah tur-sick-ah) is a saddle-shaped space depression in the floor of the skull that houses the pituitary gland. (Its name means “Turkish saddle” in Latin.) The pituitary gland, which is responsible for the body’s hormonal function, resides within the sella turcica. The gland is suspended by a stalk from the base of the brain above into the sella.
Normally, the relatively round pituitary gland is visible within the sella turcica on imaging studies such as MRIs, CT scans and skull X-rays. But chronically high cerebrospinal fluid pressure can push through the membrane that covers the roof of the sella, which then causes the pituitary gland to flatten like a pancake against the walls of the sella and gives the appearance that the sella is empty. Occasionally, this can lead to altered endocrine function; however, the pituitary gland often continues to work normally, despite its appearance.
An empty sella can be caused by other factors besides chronic IH, so the discovery of an empty sella alone does not confirm an IH diagnosis. At the same time, if one is found, intracranial hypertension should be considered as a possiblity. It is generally thought that it takes time before high intracranial pressure creates an empty sella.
If you have an empty sella and chronic IH, it’s important to work with your doctor to keep your intracranial pressure under control. In a small number of empty sella cases, high intracranial pressure can cause bone erosion and result in cerebrospinal fluid leaking from the nose (CSF rhinorrhea). In such cases, surgery is necessary to repair this problem.
To Learn More:
To view a picture of an empty sella, click here. (Scroll down the page to see the picture of the empty sella and click to enlarge for detail.)
For additional information on empty sellas, please see:
Maira, G., Anile C., Mangiola, A. Primary empty sella syndrome in a series of 142 patients. J Neurosurg. 2005 Nov; 103(5): 831-6.