An empty sella can be primary or secondary... What is meant by this? Give examples.
Primary empty sella refers to those without antecedent causes, whereas patients with secondary empty sella have an identifiable cause e.g. prior tumours / radiotherapy / surgery / haemorrhage.
What are some treatment options for these patients?
Treatment options include CSF letting, acetazolamide and lumboperitoneal shunts. In patients with progressive visual deterioration optic nerve fenestration to preserve vision. Venous sinus stenting has also been tried although it is controversial as to whether apparent venous sinus stenosis is the cause or the effect of benign intracranial hypertension.
Empty enlarged sella is best seen on sagittal images (red arrow). On axial T2 images, the optic nerve sheaths are dilated and the region of the optic disc flattened and even slightly bulging into the globe (pink arrows), the MRI equivalent of fundoscopic features of papilloedema.
The right transverse sinus is stenotic / compressed distally (blue arrow) whereas the left is absent / hypoplastic (green arrows). The latter can be predicted based on the skull grooves, which is small on the left (yellow arrow) where as the right is sizeable and normal (orange arrow).