Modern imaging techniques have supplanted the skull series as a tool for searching for pituitary or hypothalamic disease; however, an enlarged sella may be noted on children in whom skull series are obtained for other reasons (e.g., head trauma). THE roentgenologic interpretation and significance of changes, in and about the sella turcica are so dependent on an accurate knowledge of the normal and pathologic anatomy of this structure that this study was undertaken in an effort to demonstrate in a series of 110 cases the normal and pathologic changes found postmortem. The sella turcica is a bony depression in the sphenoid bone. 35, No. 2 Trends in the radiological study of pituitary adenoma These techniques are limited because they do not necessarily reflect true pituitary size. The sella is covered by a dural reflection (i.e., diaphragma sellae) above which lies the suprasellar cistern. 4, American Journal of Orthodontics and Dentofacial Orthopedics, Vol. As the roentgen image of the sella is dependent on the configuration of the sphenoid bone, dorsum sellæ, and clinoid processes, observation was limited to the variations found in these structures. The pituitary gland, sella turcica and the parasellar region can be involved by a wide variety of nonneoplastic tumor-like lesions as well as by numerous benign and malignant neoplasms. 4, 20 April 2013 | European Journal of Trauma and Emergency Surgery, Vol. Journal of Cranio-Maxillofacial Surgery, Vol. Thin-section (1–2 mm), high-resolution, multidirectional tomography was initially expected to improve the sensitivity for diagnosis of pituitary lesions, particularly microadenomas. It was called the sella turcica (the Turkish saddle) because of its resemblance to a saddle used by the Turks which had supports in the front and back. The cavernous sinus is made up of very thin walled veins that make up a venous plexus. Subcranial Relationships The pituitary gland and sella are located in the cranial base below the center of the brain (Fig. Access to the sella… The anterior lobe, adenohypophysis, forms about 75–80% of the gland and is a center for hormone synthesis, including thyroid-stimulating hormone, adrenocorticotropic hormone (ACTH), and prolactin. Anteriorly, the sella turcica is bound by the tuberculum sellae and anterolaterally by the anterior clinoid processes. Hurler disease is associated with elongation of the posterior aspect of the sella, creating a J-shaped configuration. The sella is bordered laterally by the cavernous sinuses, superiorly by the diaphragma sella (dural fold), anteroinferiorly by the sphenoid sinus and posteriorly by the pontine cistern. It is covered also by the brain coverings and has no connection with the exterior of the cranium… Read More The cavernous sinus is located on either side of the sella turcica and superior to the sphenoid bone. According to Taveras and Wood [1], 17 mm is the upper limit of normal for the maximum anteroposterior diameter of the sella. The posterior lobe, neurohypophysis, is connected to the hypothalamus by the pituitary stalk and receives hormones from the hypothalamus via the pituitary stalk (i.e., antidiuretic hormone). Sella Bony anatomy. The two can be differentiated on imaging because the posterior lobe characteristically demonstrates increased T1 signal on unenhanced images, while the anterior lobe is isointense to gray matter on T1-weighted images. Eventually it was recognized that tomograms added little to the diagnosis of microadenomas, although they were useful to better define such bony changes as sclerosis, bone destruction, and the presence of calcification. The anteroposterior diameter of the sella has been defined as a line connecting the tuberculum with the farthest portion of the posterior sella wall. On a coronal section through the brain the reference structure is the pituitary gland which lies in the sella turcica. Sella turcica – a saddle-shaped depression. This chapter focuses on the anatomic basis of the microsurgical and endoscopic approaches to the sellar and parasellar regions. The sella turcica is best visualized on lateral views of the skull. 5, The British Journal of Radiology, Vol. Investigators have also attempted to use the area and the volume of the sella turcica to serve as better predictors of pituitary disease. Ray N. Conley, Gary A. Longmuir, in Clinical Imaging (Third Edition), 2014. The depth measured perpendicular to the sella floor, from a line drawn between dorsum and tuberculum, should not exceed 13 mm in most cases. Initial enthusiasm emphasized visualization of small areas of sella floor erosion and/or depression. Recent studies report an overall incidence on imaging of 12%.3 Most patients with an empty sella on imaging are asymptomatic. Gross anatomy The diaphragma sellae consists of two horizontal leaves of dura mater on the sphenoid bone. • outpouching of the arachnoid protrudes through the central opening in the diaphragma into the sella turcica … 39, No. Marcel Maya, Barry D. Pressman, in The Pituitary (Fourth Edition), 2017. In an autopsy study of 739 cancer patients, one-half of the pituitary metastases constituted the only metastatic deposit in the CNS. 6, Neurosurgery Clinics of North America, Vol. The sella is bordered laterally by the cavernous sinuses, superiorly by the diaphragma sella (dural fold), anteroinferiorly by the sphenoid sinus and posteriorly by the pontine cistern. Anatomy of the Sella Turcica The anterior, posterior, and inferior walls of the sella turcica are bony while the lateral walls and roof are made of dura that slings between the anterior and posterior clinoid processes. Eric C. Bourekas, ... H. Wayne Slone, in Handbook of Neuro-Oncology Neuroimaging (Second Edition), 2016. Empty sella is the presence of CSF within an enlarged sella turcica. It divides the middle cranial fossa in the medial plane into a right and a left half. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. The sella turcica is a spherical depression in the superior surface of the sphenoid bone. It serves as a cephalometric landmark. The pituitary gland normally sits within the sella. Other patients may develop an empty sella secondarily in response to pituitary surgery or radiotherapy for adenomas (Figs. The sella and surrounding processes were removed in toto and the soft tissues dissected from the bone. It has three parts: Tuberculum sellae – forms the anterior wall of the sella turcica, and the posterior aspect of the chiasmatic groove. Anatomy [edit | edit source]. At this stage of development the pituitary gland is small and pale pink in color. The sellar floor can be studied on frontal radiographs angled tangentially to the plane of the floor (Caldwell view). The anterior boundary of the sella turcica is completed by two small eminences, one on either side, called the middle clinoid processes, while the posterior boundary is formed by a square-shaped plate of bone, the dorsum sellæ, ending at its superior angles in two tubercles, the posterior clinoid processes, the size and form of which vary considerably in different individuals. The pituitary gland, which weighs about 0.5 g in the adult, is the only structure of … The sellar floor may become sclerotic in some cases of craniopharyngioma and nasopharyngeal carcinoma [1]. If you have empty sella syndrome, your sella turcica is … Lateral to the sella turcica are the cavernous sinuses containing the carotid arteries and cranial nerves III, IV, V1 (ophthalmic division of trigeminal nerve), and VI. Metastases are also the most frequent tumor of the eurohypophysis, which is affected about twice as often as the adenohypophysis. He also measured the length, breadth, anterior depth and posterior depth of the fossa. However, in the first 6 weeks of life the anterior pituitary is bright as well on T1-weighted images in 82%.3 The size and configuration of the pituitary gland are thought to vary by age and sex. Completing the formation of the saddle posteriorly is the dorsum sellae which is continuous with the clivus, … The pituitary gland normally sits within the sella. 5, 1 December 2011 | The Journal of Psychiatry & Law, Vol. The dimensions of the sella turcica in normal, specimens were measured in the antero-posterior, vertical, and transverse directions. An area greater than 130 mm2, and a volume greater than 1092 mm3, have been reported to be abnormal [2]. Anatomy. The Sellar spine was first described by Lang (1977). The gland itself is composed of an anterior lobe, intermediate (vestigial) lobe, and posterior lobe. …portion of this seat, or sella turcica (“Turk’s saddle”), is actually wall-like and is called the dorsum sellae. Surgery may be warranted. \ Medical Definition of sella turcica : a depression in the middle line of the upper surface of the sphenoid bone in which the pituitary gland is lodged Learn More about sella turcica 2, American Journal of Medical Genetics Part A, 10 March 2008 | Journal of Oral Pathology & Medicine, Vol. The sella turcica ("Turkish saddle") is a concave, midline depression in the basisphenoid that contains the pituitary gland (also called the hypophysis). Hypophyseal fossa – the deepest part of the sella turcica, where the pituitary gland is located. A variety of conditions can lead to sellar enlargement, including tumors of the pituitary or functional hypertrophy of the pituitary, which may occur in primary hypothyroidism or primary hypogonadism. The sella turcica is a bony depression in the sphenoid bone. The posterior lobe, neurohypophysis, is connected to the hypothalamus by the pituitary stalk and receives hormones from the hypothalamus via the pituitary stalk (i.e. Pituitary tumour, most common cause of enlargement of the sella turcica, the bone cavity in the head in which the pituitary gland is located. The sella turcica is a bony depression in the sphenoid bone. His study of the various shapes of the fossa showed the oblong and cuboidal types to prevail. The suprasellar cistern contains the supraclinoid internal carotid arteries, pituitary stalk, and the optic nerves, chiasm, and tracts. In cancer patients, metastasis to the pituitary gland is more common than pituitary adenoma. The height of a normal gland can be up to 9 mm.4 The gland tends to enlarge during puberty and pregnancy. Unfortunately this has not withstood the close scrutiny of subsequent carefully performed radiologic/pathologic/surgical studies [3,4]. The above photos are from young rats ranging from 2.5 – 8 weeks of age. Focal erosion of the lateral margins secondary to an aneurysm, focal erosions of the floor by pituitary lesions, and selective erosion of the posteroinferior floor secondary to chronic increased intracranial pressure [3,4] are some of the more dependable findings. The antero-posterior measurements were taken from the most dorsal point of the tuberculum sellæ in the sagittal plane to the anterior edge of the dorsum sellæ in the same plane. Dennis M. Marchiori, in Clinical Imaging (Third Edition), 2014. Eval. Copyright © 2021 Elsevier B.V. or its licensors or contributors. The height of a normal gland can be up to 9 mm [4]. 14-9).14 The depth of the sella is measured as the greatest distance perpendicular to a line connecting the tip of the dorsum sellae to the tuberculum sellae. If the address matches an existing account you will receive an email with instructions to reset your password. The sella turcica is a protruding bone of the sphenoid bone (sphenoid bone) at the inner base of the skull. It is divided into three fragments and consists of an anterior wall, a floor, and a posterior wall. Blood Supply. Sella Turcica and Parasellar Region. 2 Anatomy of the Sellar and Parasellar Region Albert L. Rhoton Jr. Although variations exist, the sella turcica generally should not exceed an anteroposterior dimension of 16 mm or a vertical depth of 12 mm on a lateral skull radiograph. Intrasellar, parasellar, or suprasellar fat and calcifications may be excellent indicators of pathology. antidiuretic hormone (ADH)). 21, No. The sella is bordered laterally by the cavernous sinuses, superiorly by the diaphragma sellae (dural fold), anteroinferiorly by the sphenoid sinus, and posteriorly by the pontine cistern. That line corresponds to the plane of the diaphragma sellae. The pituitary gland normally sits within the sella. The appearance of two cortical lines is known as a “double-floor” sign, suggesting osseous erosion of the floor by an expansile mass. The sella turcica is a midline depression in the sphenoid bone which contains the pituitary gland and distal portion of the pituitary stalk. The sella turcica is a structure in the skull which is designed to support the pituitary gland.This important gland at the base of the brain releases a number of different hormones from its snugly positioned spot in the sella turcica. 46, No. There are two general types of pituitary tumours—hormone secreting and nonsecreting. An enlarged sella turcica is a significant finding, suggesting the presence of a pituitary neoplasm, empty sella syndrome, extrapituitary neoplasm, or possibly a normal variant of the patient's anatomy. 19.2–19.4). There are five types of hormone-secreting pituitary tumours, named according to the cells that produce the particular hormone. Its most important value is its relative stability, practicality and the ease of location of both points Sella and Nasion. Numerous studies of the “normal” sella turcica size were performed and reported prior to CT and MR. Enlargement of the sella turcica was thought to be an indicator of pituitary pathology, as were distortion of shape and contour of the sella. The various averages for these dimensions are given in Figure 1, under their respective headings. The pituitary gland normally sits within the sella. In adults, the gland is slightly larger in females when compared to males. 14, No. Sella turcica: A depression in the base of the skull where the pituitary gland is situated. The anterior cranial base or the Sella-Nasion (SN) line is often used by orthodontists as a reference line for assessment of dentofacial deformities. These figures do not vary greatly from those obtained by other observers, and various discrepancies are probably due to the different methods of measurement elected. Adjacent to the posteroinferior aspect of the cavernous sinus lies Meckel’s cave, which harbors the gasserian ganglion. Strictly speaking, empty sella syndrome is not a syndrome at all, since a syndrome is a set of medical signs or symptoms that tend to occur together. The dorsum sellae is part of the sphenoid bone in the skull.Together with the basilar part of the occipital bone it forms the clivus.. The size and configuration of the pituitary gland is thought to vary by age and sex. This review is based on a presentation given by Walter Kucharczyka and was adapted for the Radiology Assistant by Marieke Hazewinkel. Abstract THE roentgenologic interpretation and significance of changes, in and about the sella turcica are so dependent on an accurate knowledge of the normal and pathologic anatomy of this structure that this study was undertaken in an effort to demonstrate in a series of 110 cases the normal and pathologic changes found postmortem. Treatment entails supporting the patient and addressing any associated endocrine dysfunction present. Sella Turcica is a bony cavity housing the pituitary gland, which is located in the brain and responsible for secreting a number of hormones. This has been referred to as the empty sella syndrome (Figs. SELLA TURCICA Simplified - Anatomy | Presented By Dr. Afshan Jabeen Former Jr. Resident Doctor, JPNTC, AIIMS 39, No. The sella turcica is a bony depression in the sphenoid bone. By continuing you agree to the use of cookies. 2.1). The average length of the sella is 10.5 mm and a range of 5 - 16 mm and an average width of 14.0 mm and a range of 10 - 16 mm. These are only guidelines and sella turcica enlargement can only be used as a suggestion of pituitary abnormality and is certainly not sufficient for diagnosis. The name goes back to the Belgian anatomist and professor of anatomy and surgery Adriaan van den Spieghel (1578 - 1625). The bony spine was 4.35 mm long and protruded from the dorsal side of the pituitary fossa into the fossa itself. The sella turcica from Latin (turkish chair) is a saddle-shaped depression in the dorsal surface of the basisphenoid's body; with a median depression corresponding to the pituitary gland, the hypophysial fossa (Fossa hypophysialis), limited caudally by a plate more or less prominent and lifted forward: the dorsum sellae. The vertical or depth measurement was taken along a line dropped from the antero-posterior line to the deepest point on the floor of the sella. Empty sella syndrome designates the presence of related symptoms. The posterior surface of attached with membrane, which is termed as dorsum sellae amd the anterior order is attached with the tuberculum sellae. Reliability of … Various shapes of the Sella Turcica In the sphenoid bone, the anterior boundary of the sella turcica is completed by two small eminences, one on either side, called the middle clinoid processes, while the posterior boundary is formed by a square-shaped plate of bone, the dorsum sellae, … The shape and linear dimensions of the sella turcica are highly variable (Fig. Enter your email address below and we will send you the reset instructions. 4, 13 September 2009 | The European Journal of Orthodontics, Vol. Shown Sella turcica, anterior and posterior clinoid processes, dorsum sallae, and clivus are shown. Radiology department of the University of Toronto, Canada and the Radiology department the Medical Centre Alkmaar, the Netherlands. 37, No. The sella turcica derives its name from the Latin words for Turkish saddle. The dural roof of the … A Comparison of two Radiological Methods of Measurement, Radiographic Determination of the Growth of the Pituitary Fossa in Pre-school Children, Further roentgenographic studies of the sellaturcica in abnormal children, On the dimensions of the hypophyseal fossa in man. Dorsum sellae – forms the posterior wall of the sella turcica. Although any tumor can metastasize to the pituitary gland, carcinomas of the breast and lung account for 50% and 20% of cases respectively, based on a review of 220 cases by McCormick et al. The pituitary gland is thus situated in almost the centre of the cranial cavity. Anatomy. A parallel study of the roentgen anatomy of the sella turcica and the histopathology of the pituitary gland in 205 autopsy specimens Neuroradiology, Vol. Therefore, caution must be exercised in suggesting pituitary gland pathology in young adolescent patients and women of child-bearing age. A wide range of normal exists, and this has been expanded with information gained from CT and MR. For instance, visualization of an “enlarged” empty sella in an asymptomatic patient indicates that sella turcica size alone is not a valid determinant of pituitary disease. The sella is bordered laterally by the cavernous sinuses, superiorly by the diaphragma sellae (dural fold), anteroinferiorly by the sphenoid sinus, and posteriorly by the pontine cistern. In adults, the gland is slightly larger in females compared to males. The pituitary (hypophyseal) fossa or sella turcica is a midline, dural lined structure in the sphenoid bone, which houses the pituitary gland. Fitzgerald, in a study of one hundred skulls, endeavored to show a relationship between the size of the pituitary fossa and the skull. The sphenoid sinus is inferior and anterior to the sella turcica, the paired cavernous sinuses are lateral, the suprasellar cistern and its contents are superior, and the basilar artery and brainstem are posterior . The real designation of the sella turcica, however, was introduced to the anatomical nomenclature by the anatomist Adrianus Spigelius (1578-1625) in … Therefore, caution must be exercised in suggesting pituitary gland pathology in young adolescent patients and women of childbearing age. Meningiomas frequently calcify, and on rare occasions pituitary tumors calcify (pituitary stone). ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL: https://www.sciencedirect.com/science/article/pii/B9780128042571000141, URL: https://www.sciencedirect.com/science/article/pii/B9780128041697000234, URL: https://www.sciencedirect.com/science/article/pii/B9780323065610000069, URL: https://www.sciencedirect.com/science/article/pii/B9780323084956000336, URL: https://www.sciencedirect.com/science/article/pii/B9780128009451000422, URL: https://www.sciencedirect.com/science/article/pii/B9780123708632500415, URL: https://www.sciencedirect.com/science/article/pii/B9780323445498000195, URL: https://www.sciencedirect.com/science/article/pii/B9780123809261100197, URL: https://www.sciencedirect.com/science/article/pii/B9780323084956000166, Chordomas and Chondrosarcomas of the Skull Base, Chordomas and Chondrosarcomas of the Skull Base and Spine (Second Edition), Sharon E. Oberfield MD, ... Daniel Esten Hale MD, in, Handbook of Neuro-Oncology Neuroimaging (Second Edition), Schmidek and Sweet Operative Neurosurgical Techniques (Sixth Edition), Diagnostic Reference Index of Clinical Neurology (Second Edition), Enlarged sella resulting from expanded cavernous segment of the carotid artery; linear vascular calcification often is present, projecting over the enlarged sella on a lateral radiograph, Seen in children and young adults, this tumor may produce bone destruction of the sella; most lesions calcify; gliomas of the optic chiasm may cause similar changes, Appears as an enlarged sella without bone destruction or considerable deformity; the syndrome is believed to result from a congenital or acquired defect of the diaphragm sellae, which allows an intrasellar extension of the suprasellar arachnoid space; pulsations of the cerebrospinal fluid are thought to cause the sellar enlargement; the pituitary function typically is normal, Enlarged sella, uneven erosion of the floor, producing a “double-floor” appearance; pituitary tumors may be classified by size (a microadenoma is <1 cm and a macroadenoma is >1 cm in diameter) or by their appearance after staining; eosinophilic adenoma (causing acromegaly), chromophobe adenomas (causing hypopituitarism), and basophilic adenoma (causing Cushing disease) occur, Blumenbach clivus, representing the sloping surface of bone between the dorsum sellae and the foramen magnum (composed of the body of the sphenoid and pars basilaris of the occiput); the clivus is a target location for chordomas, which may secondarily involve the sella turcica from its posterior aspect; their appearance is marked by bone destruction and likely tumor matrix calcification; chordoma occurs most often in 30- to 60-year-old individuals, Associated with other conditions such as hydrocephalus, intracranial tumors, and edema; chronic increased intracranial pressure may manifest as erosion and deformity of the sella, resulting from downward pressure of an enlarged third ventricle, Arising from arachnoid and dura mater in the area of the diaphragma sellae, not within the pituitary fossa; meningioma appears with bone destruction and sclerosis; calcification is uncommon. 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