CSF circulation in subjects with the empty sella syndrome

Area of Science:

• Neurology
• Neurosurgery
• Radiology

Background:

• The exact cause of empty sella syndrome (ESS) remains unclear.
• Increased intracranial pressure (ICP) is a suspected contributing factor to ESS.
• Understanding CSF circulation is crucial for ESS diagnosis and management.

Purpose of the Study:

• To investigate cerebrospinal fluid (CSF) circulation patterns in patients with ESS.
• To correlate CSF dynamics with clinical manifestations in ESS.
• To evaluate diagnostic methods for assessing CSF circulation in ESS.

Main Methods:

• Analysis of CSF circulation in 48 ESS subjects using gamma cisternography, pneumoencephalography (PEG), and computed tomography (CT).
• Correlation of imaging findings with clinical signs and symptoms.
• Assessment of CSF transport pathways and cisterns.

Main Results:

• 80% of ESS subjects exhibited retarded CSF circulation, often with a convexity block.
• Widened CSF transport pathways and basal cisterns were observed in affected individuals.
• Many clinical symptoms, including memory impairment, balance disturbances, ataxia, papilledema, hypertension, and pituitary disorders, correlated with impaired CSF circulation.

Conclusions:

• Impaired CSF dynamics and intermittent ICP increases play a significant role in the development of ESS.
• Most patient complaints in ESS are attributable to disturbances in CSF circulation.
• PEG or CT are recommended initial examinations for CSF dynamics in ESS, with regular patient follow-up advised.