1979, British Journal of Radiology, 52, 862-864 A new variety of "empty sella" with cystic intrasellar dilatation of the recessus infundibuli By M. Schumacher M.D.,and J. Gilsbach M.D. Department of Neuroradiology, Institute of Radiology, University of Tubingen, Rontgenweg 11, 7400 Tubingen and Department of General Neurosurgery, University of Freiburg {Received January 1979 and in revised form March 1979) ABSTRACT A new variety of the "empty sella" consisting of poly- cystic intrasellar dilatation of the infundibular recess is described. The underlying embryonal developmental anomaly of the pituitary gland and diaphragma sellae and the possible effect of increased intracranial pressure are discussed and the malformation is compared with embryonal stages of ventricular development. Isolated intrasellar cysts (Friedmann and Marguth, 1961; Guiot et al., 1971; Nadjmi, 1965; Shanklin, 1949; Schaeffer, 1924; Taveras and Wood, 1976; Weber et al., 1970) as well as cisternal intrasellar herniations (Bajraktari et al., 1977; Bernasconi, 1972; Busch, 1951; Calkins, 1968; Engels, 1958; Kauff- mann, 1968; Kaufmann et al., 1977; Lee and Adams, 1968; Peeters, 1973; Ring and Waddington, 1966; Sutton and Vezina, 1974) are well known findings which can be shown on the axial computed tomo- graphy as zones of hypodensity. However, further differentiation between intrahypophyseal cysts and arachnoidal herniations is only possible by cistern- ography. A third variety of intrasellar cerebrospinal fluid containing space has been reported in two cases (Kiihne and Schwartz, 1975; Cabanes, 1978) in which there was a protrusion of the third ventricle down to the hypophysis, which was confirmed by ventriculography. A comparable case is demonstrated. The underlying disorder of development and its possible relation to increased intracranial pressure are discussed. CLINICAL FINDINGS A female patient, 47 years old, presented with a three months history of increased intracranial pressure, occurring intermittently with signs of head- ache, nausea, vomiting, vertigo, combined with a progressive psycho-organic syndrome and signs of a bilateral pyramidal tract lesion. VENTRICULOGRAPHY After percutaneous needle trepanation (Gilsbach and Schumacher, 1978) and puncture of the anterior horn of the right ventricle ventriculography with Dimer-X revealed symmetrical hydrocephalus due to complete block of the cerebral aqueduct at the point where it leaves the third ventricle (Fig. 1). There was dilation of the infundibular recess of the third ven- tricle, which showed multi-cystic dilatation within the sella with a smooth surface and a basal convex margin, conforming to the configuration of the floor of the sella. Right retrograde brachial angiography demonstra- ted an haemangioblastoma in the region of the left cerebellar hemisphere. After preoperative decompression the tumour, which had the histological appearances of a capillary haemangioblastoma, was removed. DISCUSSION According to Faglia et al. (1973) and Caplan and Dobben (1969) a partly empty sella is not uncommon occurring in between 8 and 35% of the population. Up to now, the empty sella has been shown to be due to a protrusion of the subarachnoidal space (du Boulay and Gammal, 1966; Schaeffer, 1924; Schiil- ler, 1926; Tonnis et al, 1954; Weisberg, 1975), a communicating cavity caused by rupture of a primary FIG. 1. Ventriculogram. Symmetrical hydrocephalus internus as a result of complete obliteration of the cerebral aqueduct. Extended infundibular recess with polycystic distension in the sella. (Water soluble contrast medium.) 862
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