Spontaneous Cerebrospinal Fluid Fistulae Associated with Empty Sellae: Surgical Treatment and Long-term Results

Abstract

In this series, confirmation of CFFs was easy, although localization of the sites remained difficult. Recurrences were more numerous and occurred sooner after treatment with shunts; packing of the sella through a craniotomy achieved better and more stable results, although differences were not statistically significant.

A tomographic study of the skull base in primary spontaneous cerebrospinal fluid leaks

“…The fact that these three conditions are predominant in obese females between the ages of 36 and 50 years old reinforces such a relationship [5,7,10,27,33]. In the present study, half of the PSL cases were overweight and the other half were obese.…”

“…In this syndrome, besides the projection of the subarachnoid space into the interior of the sella with flattening of the hypophysis in its floor, there is also an increase in the diameters of the referred structure [27]. According to Lang, the anteroposterior and superiorinferior diameters of the sella turcica were 1.07 and 0.68 cm, respectively [13].…”

Symptomatic spontaneous pneumocephalus after spinal fusion for spondylolisthesis

“…2 Empty sella syndrome is also a cause of spontaneous CSF rhinorrhea. 3 Dural tear and the ball-valve effect are the two mechanisms that may cause pneumocephalus. Entry of air into the skull causes separation of the frontal tips, which is known as ''Mount Fuji sign" 4 ( Fig.…”

“…1-3 Extra-axial cavernomas are rare (0.4-2%), 3 but most commonly occur in the middle cranial fossa, related to the cavernous sinus. 1,3,4 Other locations (tentorium, convexity, anterior cranial fossa, cerebellopontine angle, Meckel's cave, sella turcica, internal auditory meatus or related to cranial nerves) are rarer, and only about 20 reports have been published. [3][4][5][6][7][8][9][10][11][12] Differential diagnosis includes other extra-axial enhancing tumours, mainly meningiomas.…”

Treatment of empty sella syndrome with ventriculoperitoneal shunt

“…One report showed a high (50%) recurrence rate after lumboperitoneal shunting for empty sella. 17 Compared with lumboperitoneal shunt, ventriculoperitoneal shunt, being a more common procedure with a larger caliber tube, may theoretically produce a more reliable effect. As many patients with empty sella do not have dilated ventricles, it has only been used in the empty sella patients with hydrocephalus.…”