metrizamide and Empty-Sella-Syndrome

Computerized tomography is usually adequate to explore supratentorial lesions of the skull and brain. However, it is often inadequate for a detailed analysis of lesions of the base of the skull and their anatomical rapports. Opacification of the subarachnoid spaces by means of a contrast medium (computerized cisternography) has proved extremely useful in such cases. The contrast media utilized are tri-iodized, water-soluble compounds which are well tolerated. The technique and anatomical data of the method are described, and its applications in different fields of tumoral and non-tumoral pathology are discussed.

Topics: Arachnoid; Brain Neoplasms; Brain Stem; Cerebrospinal Fluid Rhinorrhea; Cisterna Magna; Contrast Media; Craniopharyngioma; Cysts; Empty Sella Syndrome; Humans; Injections, Spinal; Iopamidol; Iothalamic Acid; Metrizamide; Neuroma, Acoustic; Pituitary Neoplasms; Tomography, X-Ray Computed

A 34-year-old woman was admitted for the chief complaints of headache and blurred vision. She had bilateral papilledema and slight increase in CSF pressure (175mmH2O) with normal visual acuity and field. Neurological and hormonal examination were normal except for over response of PRL and TSH to TRH test. The sella was enlarged and MRI and metrizamide CT demonstrated intrasellar CSF filling with remodeling of the pituitary gland. The patient was diagnosed as primary empty sella syndrome associated with benign intracranial hypertension. The complaints did not subside for six months. The patient was treated via the transsphenoidal approach. The dura mater of the floor of the sella was elevated by extradural balloon expansion filled with silicone, and subsequently the empty sella was obliterated. Her headache disappeared and amblyopic attack also improved. Obliteration of the empty sella with an extradural silicone balloon via the transsphenoidal approach seemed to have been effective for headache and visual complaints of primary empty sella syndrome which did not respond to medical therapy.

Topics: Adult; Catheterization; Empty Sella Syndrome; Female; Humans; Methods; Metrizamide; Silicones; Tomography, X-Ray Computed

Two cases of the primary empty sella complaining of intractable headache for many years are reported. Case 1. A 73-year-old female was admitted on August 23, 1983 because of intractable headache. Plain skull radiograph showed slightly enlarged sella with deepening of the floor. Metrizamide CT scan demonstrated the sella cavity filled with metrizamide extensively. Operation was done performing intrasellar intradural plugging via transsphenoidal route (Hardy's technique). Postoperatively headache was improved. Case 2. A 43-year-old female was admitted on July 24, 1984 after many years of intractable headache. Craniogram demonstrated deep sella of slightly increased volume and unaltered dorsum sellae. On metrizamide CT scan, contrast medium occupied greater parts of the sellar cavity. Extradural intrasellar plugging (Guiot's technique) was performed. Postoperative course was uneventful. Surgical procedure on the primary empty sella relieved headache by decreasing intrasellar pressure and alleviating pulsatile pressure on the dulla. Operation via transsphenoidal method was the suitable procedure because of less trauma on the optic nerve and advantageous plugging of the sellar cavity. Guiot's technique with extradural intrasellar plugging may be more preferable because of accompanying no postoperative cerebrospinal fluid rhinorrhea.

Topics: Adult; Aged; Empty Sella Syndrome; Female; Humans; Methods; Metrizamide; Tomography, X-Ray Computed

Two patients who had histories of allergy to iodine compounds underwent air-enhanced CT of the sellar cisterns. In both patients, the basal cisterns and empty sella were well demonstrated. The technique, results of which compared favorably with those of metrizamide cisternography, is described.

Topics: Empty Sella Syndrome; Humans; Metrizamide; Pneumoencephalography; Tomography, X-Ray Computed

An enlarged, balloon-shaped sella was detected by chance in a completely asymptomatic 14-year-old girl, who presented with tall stature. While all endocrine functions were found to be normal, metrizamide cisternography with computer tomography revealed a flattened pituitary at the bottom of an empty sella. This could be compared later with nuclear magnetic resonance tomography, thus avoiding intrathecal contrast material and radiation exposure for the patient. The new technique depicts the sellar contents very well.

Topics: Adolescent; Empty Sella Syndrome; Female; Humans; Magnetic Resonance Spectroscopy; Metrizamide; Pituitary Gland; Sella Turcica; Tomography, X-Ray Computed

Topics: Adenoma; Diagnosis, Differential; Empty Sella Syndrome; Humans; Metrizamide; Pituitary Neoplasms; Pneumoencephalography; Tomography, X-Ray Computed

A 10-year-old boy presented with marked growth retardation. He was found to have an empty sella demonstrated by CT and Metrizamide cisternography. Endocrinological investigation confirmed the diagnosis of panhypopituitarism. This is the first case reported in a twin and the fifth pediatric case with marked endocrine dysfunction reported in the literature.

Topics: Child; Diseases in Twins; Empty Sella Syndrome; Growth Disorders; Humans; Hypopituitarism; Male; Metrizamide; Myelography; Tomography, X-Ray Computed

Topics: Aged; Empty Sella Syndrome; Female; Humans; Injections, Spinal; Male; Metrizamide; Middle Aged; Sella Turcica; Tomography, X-Ray Computed

Three patients with empty sella syndrome with various visual field disturbances were reported. In one patient there was evidence of enlargement of Mariotte spots, and in the others, irregular visual field defects. These three patients were initially suspected to have intraocular tumors because of the balloonings of the sella and visual field disturbances. However, the diagnosis of empty sella was confirmed by metrizamide cisternography and metrizamide computed tomography(CT). The results indicate that the patient with enlargement of the sella on the plain skull X-ray and visual field disturbance should be examined by metrizamide cisternography and metrizamide CT scan to differentiate from the intrasellar tumor.

Topics: Aged; Empty Sella Syndrome; Female; Humans; Male; Metrizamide; Pneumoencephalography; Tomography, X-Ray Computed; Visual Fields

Topics: Cerebrospinal Fluid Otorrhea; Cerebrospinal Fluid Rhinorrhea; Cerebrospinal Fluid Shunts; Empty Sella Syndrome; Humans; Injections, Spinal; Intracranial Pressure; Male; Meningomyelocele; Metrizamide; Middle Aged; Tomography, X-Ray Computed

Sixty-four patients with intrasellar and suprasellar lesions on conventional computed tomography (CT) have been studied retrospectively to determine the indications for metrizamide CT cisternography (MCTC). Enhancing or calcified lesions, like a craniopharyngioma, pituitary adenoma, meningioma or aneurysm are adequately evaluated by conventional CT and MCTC is usually not needed. Determination of the exact suprasellar extent of an enhancing pituitary adenoma is best accomplished with coronal thin-section conventional CT alone. However, for isodense or hypodense suprasellar and intrasellar lesions, MCTC is indicated if conventional CT does not define their extent accurately. Differentiation of an empty sella from the occasional entirely lucent pituitary adenoma or other low density intrasellar lesions remains difficult by conventional CT at times, especially when the infundibulum is not identified. Then MCTC will also be indicated.

Topics: Adenoma; Adult; Aged; Cerebral Ventricle Neoplasms; Cerebral Ventriculography; Cranial Nerve Neoplasms; Craniopharyngioma; Diagnosis, Differential; Empty Sella Syndrome; Female; Glioma; Humans; Male; Metrizamide; Myelography; Optic Chiasm; Pituitary Diseases; Pituitary Neoplasms; Retrospective Studies; Tomography, X-Ray Computed

Topics: Empty Sella Syndrome; Humans; Metrizamide; Tomography, X-Ray Computed

Topics: Empty Sella Syndrome; Humans; Metrizamide; Myelography; Pneumoencephalography; Risk

Topics: Adult; Empty Sella Syndrome; Female; Humans; Injections, Spinal; Metrizamide; Myelography; Tomography, X-Ray Computed; Vision Disorders; Visual Field Tests

Pneumoencephalography, the usual method for demonstrating air within the sella turcica in empty sella syndrome (ESS), has been approached with reluctance by most physicians because of its technical difficulty and patient morbidity. For these reasons, neuroradiologists have investigated other contrast media in search of an ideal agent; metrizamide seems to be such an agent. Metrizamide is a nondissociable, water-soluble glucose amide containing three iodine molecules. This agent is miscible with CSF, and small recesses of the CSF-brain interface can be delineated with hypocycloidal tomography without performing cumbersome patient maneuvers to fill the cisterns. Furthermore, morbidity has been minimal, particularly with use of lower concentrations of metrizamide, allowed by the sensitivity of computerized tomographic (CT) scanning. Thus, at the present time, metrizamide cisternography (especially in conjunction with CT scanning) appears useful in evaluating an enlarged sella turcica, particularly when considering an entity such as ESS.

Topics: Adult; Brain; Empty Sella Syndrome; Female; Humans; Metrizamide; Middle Aged; Radiography; Tomography, X-Ray

Metrizamide cisternography with both hypocycloid and computed tomography was performed on 23 patients with a sellar or a suprasellar lesion. The degree of an extrasellar tumour extension or the presence of an empty sella was detected precisely. The procedure was easy to perform and the side-effects were mild to moderate in most patients. When used carefully this diagnostic method provides valuable information when choosing the appropriate treatment for patients with sellar or parasellar lesions.

Topics: Adult; Aged; Empty Sella Syndrome; Female; Humans; Male; Metrizamide; Middle Aged; Pituitary Neoplasms; Sella Turcica; Tomography, X-Ray; Tomography, X-Ray Computed

In children, hypothalamic-hypophyseal syndromes such as diabetes insipidus, precocious puberty, growth retardation, and panhypopituitarism can be due either to structural lesions or to functional disorders of the cerebral endocrine complex. When clinical and endocrinological parameters fail to distinguish between these etiologies, neuroradiographical diagnosis becomes extremely important. Although conventional intravenously enhanced computed tomography (IVCT) is satisfactory for the diagnosis of lesions larger than 1 cm, metrizamide CT cisternography (MCTC) greatly improves the diagnostic yield for smaller juxtapituitary masses in the suprasellar cistern, clearly defines their sizes and relationships with contiguous structures, and definitively confirms the diagnosis of empty sella syndrome. Six patients with endocrinopathies and normal or ambiguous IVCT findings are presented to illustrate how MCTC can influence their management and outcome without the patient discomfort and technical complexity associated with pneumoencephalography.

Topics: Adenoma; Adolescent; Astrocytoma; Brain Diseases; Brain Neoplasms; Child; Dysgerminoma; Empty Sella Syndrome; Female; Hamartoma; Humans; Hypothalamo-Hypophyseal System; Infant; Male; Metrizamide; Pituitary Neoplasms; Tomography, X-Ray Computed; Tuber Cinereum

Metrizamide computerized tomographic cisternography was performed with a small dose and low concentration of intrathecal metrizamide using a newer generation of computerized tomography scanner for the evaluation of sellar and suprasellar abnormalities. The examination was performed with thin sections in axial, direct coronal, and (when feasible) direct sagittal projections in a high-resolution technique. The relationship of the lesions with carotid arteries, optic chiasms, and hypothalamic structures was accurately defined.

Topics: Adenoma; Adenoma, Chromophobe; Adolescent; Adult; Cranial Nerve Neoplasms; Empty Sella Syndrome; Female; Humans; Male; Meningioma; Metrizamide; Middle Aged; Myelography; Optic Chiasm; Pituitary Diseases; Pituitary Neoplasms; Sella Turcica; Tomography, X-Ray Computed

A neuroradiological technique for demonstrating the empty sella syndrome using a low dose of intrathecally injected Amipaque (metrizamide) combined with computerized tomography scanning is described. Two case reports illustrating the potential value of the technique are presented. We have performed 55 cisternograms and have demonstrated the empty sella syndrome in six patients. The procedure is easier to perform and the morbidity is less than in pneumoencephalography.

Topics: Adult; Brain; Empty Sella Syndrome; Female; Humans; Metrizamide; Sella Turcica; Tomography, X-Ray Computed

Seventy-five suprasellar metrizamide cisternograms were obtained, 25 in normal individuals who had had cervical myelography and 50 in patients with pituitary or juxtapituitary lesions. The technique accurately delineates a suprasellar extension of a small or moderate-sized pituitary lesion and usually shows its relationship to the optic chiasm. Large suprasellar masses, however, are not well visualized. 'Empty sellae' are readily demonstrated and have a high incidence in both normal individuals and those with pituitary tumors. This procedure can be supplemented by metrizamide CT cisternography and is simpler to perform and often better tolerated by patients than is pneumoencephalography.

Topics: Acromegaly; Adenoma; Adenoma, Chromophobe; Contrast Media; Craniopharyngioma; Empty Sella Syndrome; Female; Humans; Male; Metrizamide; Myelography; Nelson Syndrome; Pituitary Neoplasms

The use of stereotactic necrotizing proton beam irradiation for treatment of pituitary adenoma has prompted the use of computed tomographic cisternography (CTC) as an adjunct to intravenous enhanced computed tomographic (CT) scanning. A technique for obtaining sagittal pluridirectional tomographic sections prior to coronal and axial CTC is outlined. Experience with 19 cases is described.

Topics: Adenoma; Adult; Aged; Empty Sella Syndrome; Female; Humans; Male; Metrizamide; Middle Aged; Myelography; Sella Turcica; Skull Neoplasms; Tomography, X-Ray Computed

Topics: Adult; Empty Sella Syndrome; Female; Humans; Metrizamide; Myelography; Tomography, X-Ray Computed

Topics: Adenoma, Chromophobe; Adult; Drug Evaluation; Empty Sella Syndrome; Female; Humans; Injections, Spinal; Male; Methods; Metrizamide; Middle Aged; Pituitary Neoplasms; Tomography, X-Ray; Tomography, X-Ray Computed

Intrathecal instillation of metrizamide has provided a useful tool for the in vivo evaluation of smaller structures adjacent to or within the subarachnoid cisterns. The authors report a case in which metrizamide filled the thin subarachnoid space surrounding the optic nerve in its course through the orbit. The finding appears to be infrequent, however, since it was not observed in any instance in a review of 80 metrizamide computed tomographic cisternograms in patients with normal intracranial pressure.

Topics: Adult; Empty Sella Syndrome; Female; Humans; Injections, Spinal; Male; Metrizamide; Optic Nerve; Orbit; Subarachnoid Space; Tomography, X-Ray Computed