[Secondary empty sella syndrome: report of three cases and review of the literature]

Area of Science:

• Neurosurgery
• Endocrinology
• Radiology

Background:

• Secondary empty sella syndrome (SES) is a rare condition.
• Its exact etiology remains unclear, though primary SES is linked to diaphragma sellae development.
• This study investigates potential causes of SES following pituitary adenoma treatment.

Observation:

• Three cases of SES are presented, all in female patients with a history of pituitary adenoma.
• Patients experienced visual disturbances, headaches, and/or hypopituitarism.
• Diagnostic imaging, including pneumoencephalography, revealed air in the sellar cavity, indicative of SES.

Findings:

• The diaphragma sellae's integrity is crucial in SES development.
• Weakening of the diaphragma sellae can result from pituitary tumor compression, surgical injury, or radiation therapy.
• This weakening may lead to herniation of optic structures into the sella.

Implications:

• Early diagnosis of pituitary tumors is vital.
• Meticulous surgical techniques, particularly careful packing of the sellar floor during transsphenoidal surgery, are essential to prevent SES.
• Further research into the biomechanics of the diaphragma sellae is warranted.