Sinus vein thrombosis conundrum: Persistent empty sella vs. flexible optic nerve sheath

Our objective was to investigate the potential effect of thrombotic burden on pituitary gland height, bony sella and optic sheath width, taking into consideration the various venous sites and dominant drainage pattern.

This retrospective cohort study followed patients diagnosed with cerebral sinus vein thrombosis in a single primary healthcare center between the years 2000 and 2022. Data was collected from both CT/V and MR/V scans available on the local PACS system. Dural sinuses were divided into main anatomical sites and scored for patent, partially or totally blocked lumen. Dominant drainage flow was noted for each patient. For most scans, pituitary mid height, maximal depth and AP width of the bony sella and dorsum sella to tuberculum sella distance were assessed. Optic sheath width was measured for both sides at the maximal retrobulbar diameter. Regression methods, including linear mixed models, and non-parametric tests were used to analyze the data.

90 patients (mean age, 44 years ±16.8, 54 women) were evaluated. Overall thrombus burden did not correlate with pituitary mid-height, however a relationship was observed between the change (from presentation) in the superficial thrombus score and the average width of the optic nerve sheath; the width of the optic sheath tended to decrease as thrombus burden improved and vice versa (p = 0.010).

Thrombus recanalization had a favorable effect on the optic nerve sheath diameter but did not appear to reverse the flattening of the pituitary gland, regardless of temporal improvement.