How common is empty sella in neuro-ophthalmology patients not suspected of raised intracranial pressure
Reviewed by Lauren Hepworth

The study aimed to assess how common the presence of empty / partially empty sella is amongst neuro-ophthalmology patients undergoing magnetic resonance imaging (MRI) excluding for papilledema and raised intracranial pressure (ICP). The study retrospectively reviewed case records of consecutive patients undergoing MRI seen by two neuro-ophthalmologists over a four-year period. Cases with papilledema and suspect raised ICP were excluded. The following data were extracted from the records; demographics, medical and ocular history, best corrected visual acuity, intraocular pressure, optical coherence tomography averages, indication for MRI and any mention of sella in the MRI report. The sagittal T1 sequence were reviewed by two independent blinded neuroradiologists. They graded the sella based on published classification criteria. The study included a total of 613 patients, with balanced numbers of males / females. The most common indications for imaging were optic neuropathy, ocular misalignment and visual field defects. Almost half of cases were identified to have empty / partially empty sella (46%). No significant differences were found between the group with and without sella abnormalities in terms of most demographics or ophthalmic findings. The exception was age, with older patients (>40 years) significantly more likely to have empty / partially empty sella. The authors acknowledge a limitation of the study being absence of computerised tomography scans for all included patients and heterogeneity of MRI acquired. This study highlights a high prevalence of empty / partially empty sella in patients not suspected of ICP, which is also higher than the general population. Therefore, the finding of an empty / partially empty sella should not be interpreted in isolation when differential diagnosis includes idiopathic intracranial hypertension.

Empty sella in neuro-ophthalmology patients without raised intracranial pressure.
Sayal AP, Jhaveri A, Diouf AA, et al.
JOURNAL OF NEURO-OPHTHALMOLOGY
2024;44:61–5.