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Herniation of the suprasellar visual system and third ventricle into empty sellae: morphologic and clinical considerations. AJR Am J Roentgenol 1989 Mar;152(3):597-608 PMID: 2783814

Pubmed ID

2783814

Abstract

Intrasellar herniation of the optic nerve, optic chiasm, optic tract (suprasellar visual system, SVS), and anteroinferior third ventricle can occur into primary or secondary empty sellae. The anatomic part of this study evaluated the appearance of the SVS in subjects with normal sellae (n = 52), the patterns and prevalence of SVS herniation in enlarged primary empty sellae (n = 24), and the patterns of intrasellar herniation of the SVS in secondary empty sellae (n = 8). The clinical part of this study was to correlate the visual status with the anatomic patterns of the intrasellar herniated SVS. High-resolution MR and CT were used to define the anatomy. MR was superior to CT in all groups in defining accurately the SVS relationship to the sella turcica. In the normal group, the SVS invariably had a straight-line appearance formed by the optic nerve, optic chiasm, and floor of the third ventricle and was above the sella. The SVS was herniated in three of 24 enlarged primary empty sellae. A difference in the appearance of the hypothalamic and infundibular recesses in the primary empty sella group with SVS herniation (dilated recesses and formation of an obtuse angle) and in the secondary empty sella group with SVS herniation (nondilated recesses and formation of an acute angle) was observed. Visual disturbances in primary empty sellae with SVS herniation were present in two of three subjects. Visual disturbances may be absent or minimal in primary empty sellae and secondary empty sellae with herniation of the SVS. Progression of the symptoms--visual field defects, optic atrophy, and loss of vision--is not inevitable. There was no correlation between the severity of visual symptoms and the degree of herniation of the SVS in either the primary or secondary sellae. We found that intrasellar herniation of the SVS into a primary or secondary empty sella is well delineated with MR, and MR should facilitate decisions concerning surgery or therapy. Visual disturbances proved to be an unreliable indicator of herniation.

Author List

Kaufman B, Tomsak RL, Kaufman BA, Arafah BU, Bellon EM, Selman WR, Modic MT

Author

Bruce A. Kaufman MD Professor in the Neurosurgery department at Medical College of Wisconsin




Scopus

2-s2.0-0024577011   44 Citations

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Cerebral Ventricles
Empty Sella Syndrome
Encephalocele
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Optic Chiasm
Optic Nerve
Visual Pathways
jenkins-FCD Prod-336 69ef4a6b262d135130251597d5d39873903802b5