The occurrence of the syndrome of an empty Turkish saddle has many causes and explanations. The thing is that, being called empty, it a priori cannot be hollow. Due to a significant decrease in the volume of such a gland as the pituitary gland, the space once occupied by it passes under the cerebrospinal fluid and other meninges.
So it turns out that the pituitary gland is practically invisible on x-rays, and only the cerebrospinal fluid and the membrane are visually accessible. Therefore, such a space is called empty. Therefore, this condition is detected by specialists in MRI or CT of the head. Then neuropathologists and neurosurgeons develop a treatment regimen and, in accordance with it, determine further actions.
Where is the Turkish saddle?
The natural location of the Turkish saddle is a saddle-shaped depression in the bone structure of the base of the human skull. It is a part of the sphenoid sinus, namely the section of the upper wall. It has a rather small size both in length (about 10 mm) and in height (7-13 mm). CavityTurkish saddle, in which the pituitary gland is located, is called the pituitary fossa. It is separated from the subarachnoid space by the diaphragm, the hard shell of the brain. Through a tiny hole in the diaphragm passes the so-called pituitary stalk, which has a connection with the hypothalamus.
Research in this field
Even in the middle of the twentieth century, the concept of "empty Turkish saddle" became known to the whole world. What this means, was able to accurately determine the American pathologist Bush in the early 50s. During lengthy long-term studies, he managed to detect the absence or underdevelopment of that same diaphragm in half of the dead. Studying the autopsy material of almost 800 corpses, he was able to conclude that not in all lethal cases, the pathological conditions of the gland became the main factor. Bush noticed that the pituitary gland in the pituitary fossa had changed significantly, acquired a vague shape and looked like a thin layer of tissue.
Russian researcher Savostyanov in 1995 modified the classification of syndromes proposed by Bush, differing in the type of diaphragm, the volume of intrasellar cisterns formed between the cerebellum and the medulla oblongata. At the same time, scientific findings indicated the following: in 8 out of 10 women over forty years old who have given birth more than once, pathology is formed, and symptoms of the syndrome of an empty Turkish saddle begin to appear. In addition, more than two-thirds of sick women suffered from various degrees of obesity during their lifetime. Already throughFor several years, scientists have been able to link pathology with clinical manifestations, highlight the primacy and secondary of the syndrome of an empty Turkish saddle.
Disease forms
Due to the possible division of the disease into primary and secondary forms, it is possible for the patient to determine the most appropriate treatment option. In practice, this is of great importance in predicting the course of the disease.
Primary syndrome of an empty Turkish saddle, the symptoms of which are manifested by an increase in intracranial pressure, practically does not affect the state of the pituitary gland. Despite minimal "suffering" of the gland, there is a certain defect in the diaphragm. In the future, the deforming effect on the pituitary gland is reflected in its volume, reducing it, after which the space of the Turkish saddle is occupied by the meninges and fluid (liquor) lowered down.
Neurological symptoms in secondary disease are more pronounced. Since the gland itself is the first to be hit, it often requires immediate surgical treatment, radiation therapy, and the use of many medications to prevent hemorrhage. It follows that the secondary syndrome of an empty Turkish saddle is considered the most dangerous. The causes of the origin of the disease lie in many factors that need detailed consideration.
Probable circumstances of the onset of the disease
First of all, the risk group should include people who have a hereditary predisposition to the occurrence of this problem. From biological parents, children often get immaturediaphragm, which is an underdeveloped, incomplete shell.
Basically, even in the prenatal period, the fetal brain in the womb can be formed with defects under the negative influence of environmental factors. The most dangerous elements are considered to be radiation, environmental insecurity, modified food, stress experienced by the expectant mother, poor quality of drinking water and much more.
Consequences of increased intracranial pressure
Dangerous complications of some diseases have a significant impact on the appearance of this factor. Increased intracranial pressure may be due to:
- traveled skull injuries, bruises, concussions;
- hypertension and other cardiovascular diseases;
- oncological neoplasms;
- adverse pregnancy, difficult childbirth, abortion;
- thrombosis;
- osteochondrosis of the cervical spine (this disease prevents the normal flow of blood into the cranial cavity);
- various infections affecting the central nervous system (encephalitis, meningitis, hemorrhagic fever, etc.).
The secondary nature of the syndrome of the "saddle turkish empty" significantly affects the size of the pituitary gland due to increased pressure inside the cranial cavity.
It first noticeably increases, forming a tumor, and then significantly reduced in volume due to necrosis, tissue breakdown,atrophy, undergone neurosurgical and oncological operations.
General brain symptoms
Basically, until undergoing a specialized examination, many people have no idea about the term "empty Turkish saddle". What kind of pathology is this and what is dangerous, many patients will find out only by having the results of tomography in their hands. Often they have no complaints, and they feel absolutely he althy. However, this does not at all indicate that there can be no complaints at all. Often, neurological symptoms manifest themselves as follows:
- frequent headaches, sometimes constant (they do not have a specific localization and have different intensities);
- dizziness;
- unsteadiness, unsteady walking (a person is thrown from side to side);
- decrease in memory and concentration, the appearance of absent-mindedness;
- unnatural fatigue, decline in performance and endurance;
- psycho-emotional disorders.
Ophthalmic disorders
Ophthalmologists often manage to identify a suspicion of a disease. Patients come to them with complaints of deterioration in the state of the organs of vision. The following changes are often observed:
- pain when moving the eyeball;
- constant tearing;
- conjunctival edema;
- fogging;
- bright flashes in the eyes.
During a detailed examination, specialists can detect some characteristic pathological manifestations,which include swelling and hyperemia of the optic nerve, distortion of the visual field, the occurrence of asthenopia. Such dysfunctions of the human visual system may be present due to high intracranial pressure. In the absence of timely adoption of the necessary therapeutic measures, further hypersecretion of intraocular fluid can lead to the formation of glaucoma.
Changes in the endocrine system
As mentioned earlier, the majority of patients are women over 35 years of age. The manifestations of the disease directly depend on the phase of exacerbation and the achieved remission. On the part of the endocrine system, disorders caused by vegetative syndromes are most common:
- deep dyspnea even at rest, labored breathing;
- chills, fever;
- pain and body aches;
- persistent subfebrile body temperature;
- frequent fainting;
- tachycardia, heart pain;
- stool disorder.
Hormonal malfunction of the pituitary gland in medical practice has been repeatedly mistaken for a manifestation of an oncological tumor of the gland. In addition, the combination of microadenoma and the "empty Turkish saddle" is not uncommon. Due to the difficult intake of the required number of hormones through the pituitary stalk and the decrease in the control of the hypothalamus over the gland, some sexual disorders may occur not only in women, but also in male patients (decreased libido and potency, amenorrhea, hypothyroidism, etc.). In severe cases, there is a possibility of dischargeCSF through the nasal passage.
Diagnosis
In order to detect a disease, it is worth turning to the most reliable method. To date, MRI can be considered the undisputed leader in diagnosing neurological diseases of the brain. The results of the performed tomography provide the greatest amount of information about the patient's condition. At the same time, it is important to take into account the primary complete safety of this type of examination.
On an MRI image of a patient with empty Turkish saddle syndrome, available for visualization:
- presence of cerebrospinal fluid;
- noticeable deformity of the pituitary gland (curved shape resembling a crescent or sickle), centrally located infundibulum;
- a suprasellar cistern protrudes asymmetrically in the cavity of the Turkish saddle;
- the funnel of the gland has significantly lengthened and become thinner.
The method of determining intracranial increased pressure in the picture can also determine other indirect indicators (an increase in the size of the ventricles and spaces containing cerebrospinal fluid).
Doctors also resort to additional diagnostic methods, including laboratory clinical studies (venous blood sampling to determine the balance of hormones produced by the pituitary gland in plasma) and ophthalmological examination of the condition of the fundus.
Features of treatment
Asking the question of whether it is possible to cure the "empty Turkish saddle" syndrome, it should be understood that only comprehensive treatment measures will help solve this problem. After all, one cannot do without the help of neurologists, neurosurgeons, endocrinologists and ophthalmologists.
Primary empty sella syndrome usually does not require special treatment. Without delivering tangible troubles to the patient, the disease in this form does not pose a threat to life. Although sometimes there is a need to take medications and conduct certain hormone therapy.
If a secondary syndrome is detected, hormonal treatment is indispensable. Since vital glands, the hypothalamus and pituitary gland are subject to significant changes, often this more severe stage of the disease can be cured only by an operable method. For example, when squeezing the optic nerves and sagging intersection in the diaphragmatic opening, only surgery with the participation of a neurosurgeon can help. The indication for surgical intervention is the leakage of cerebrospinal fluid from the nose. The thinned bottom of the Turkish saddle allows CSF to seep through.
Prognosis for recovery
The chances of recovery are quite high, especially if the severity of clinical manifestations is low and primary empty sella syndrome is detected. Treatment of emerging hypopituitarism with hormone replacement therapy ends in most cases with a favorable outcome. However, often the prediction of the course of the disease depends on the accompanying pathologies of the pituitary gland and the brain.
