Empty Sella Is a Sign of Symptomatic Lateral Sinus Stenosis and Not Intracranial Hypertension

A 47-year-old female patient who presented with right-sided disabling pulsatile tinnitus disappearing on compression of the right jugular vein. MR imaging with an axial CISS sequence (A) shows enlargement and CSF infiltration of the sella turcica. Sagittal T1-weighted MR imaging with gadolinium shows flattening of the pituitary gland (B). Ratios of pituitary gland height/sellar height were calculated on sagittal reconstruction of a 3D gadolinium-enhanced T1 MRI sequence using the cut showing the thickest section of pituitary gland (B). Sellar volumes were estimated on the basis of dimensions measured on a preoperative CTA. The laterolateral dimension of the sella was measured on the coronal MPR of the preoperative CTA as shown in C using the longest measurement between the medial walls of the cavernous segments of the internal carotid arteries (white arrow). The sellar height and anterior-posterior diameter were measured on the 3D-MPR in the midsagittal plane as shown in D. Height was the longest measurement intersecting a line joining the tuberculum and dorsum sellae and the lowest point in the sella. The anterior-posterior measurement was defined as the longest measure on the midsagittal plane (white arrows).