THE EMPTY SELLA SYNDROME

Clinical data correlated with radiological and operative findings in 14 patients with empty sella syndrome （ESS） are presented. Accordingly, four clinical types are described: （1）one presenting headache and endocrine abnormalities: （2）one showing chiasmal traction; （3）another one manifesting partially empty sellas coexisted with pituitary adenomas; and （4）the last type either secondary to pituitary surgery or following radiation. It occurs more commonly in obese middle-aged women, but the etology of primary one remains unknown.
Anatomically, the opening of the diaphragma sellae is larger than normal, thus allowing extension of the suprasellar cistern into the sella turcica.
Routine polytomography and angiography are of little help in differentiating ESS from pituitary tumors, since changes resulted from these lesions may be similar. Traditionally, the definitive examination for the diagnosis of ESS has been pneumoencphalography. Recently, CT scan is used more often, demonstrationg a low-density area within the sella. For the surgical treatment transsphenoidal and subfrontal approach has been used, the technical aspects of which are discussed in detail.