Herniation of the optic chiasm and third ventricle into a partial empty sella

Case contributed by Dr Bruno Di Muzio

Presentation

Known history of pituitary prolactinoma a few years ago. Treated conservatively with dopamine agonists. Lost clinical follow-up, presenting now with visual impairment.

Patient Data

Age: 53-year-old
Gender: Male

There is a prominent enlarged sella, which is partially empty, and has an associated downward herniation of the floor of the third ventricle, optic chiasm and proximal segments of the anterior cerebral arteries within. The pituitary gland shows to be relatively enlarged and displaced peripherally against the sellar walls.

The remainder of the brain is unremarkable.

Case Discussion

Herniations into the sella have been described associated either with primary or secondary empty sella. Such as in this case, visual disturbances have been well documented associated with secondary empty sella (medical/surgical therapy of a sellar tumour like marcoadenoma). 

Unfortunately, previous imaging were not available to make a clear correlation with the tumour (documented macroadenoma).

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Case Information

rID: 45573
Case created: 30th May 2016
Last edited: 20th Mar 2017
Inclusion in quiz mode: Included

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