Características Morfológicas y Morfométricas de la Silla Turca Según Clase Esqueletal / Morphological and Morphometric Characteristics of the Sella Turcica According to Skeletal Class

El desarrollo craneofacial es un proceso complejo con diversos factores involucrados. Cuando las maloclusiones son de origen esqueletal pueden generar una relación ortognática (clase I), retrognática (clase II) o prognática (clase III) de la mandíbula respecto de la maxila. Esta configuración está estrechamente relacionada con la base del cráneo donde la silla turca ha sido estudiada con este fin debido a su origen ectomesenquimático (Dasgupta et al., 2018) y sus relaciones anatómicas. Diversos estudios se han realizado para dilucidar esta relación y este trabajo busca aportar a la discusión comparando las características de la silla turca entre las maloclusiones esqueletales a través de telerradiografías laterales. El estudio se realizó mediante 52 placas radiográficas de individuos de entre 18 a 24 años con igual número de sujetos masculinos y femeninos, 15 de clase I, 7 de clase II y 30 de clase III. Se realizó la medición digital del área radiográfica de la silla turca y se clasificó morfológicamente mediante las categorías de Axelsson et al. (2004). Se utilizó coeficiente de correlación intraclase con un 95 % de confianza arrojando un valor de 0,88 para el área de la silla turca, 0,89 para el ángulo ANB y de 0,70 para el valor Wits demostrando una excelente fiabilidad del observador. Con un 95 % de confianza la prueba exacta de Fisher evidenció una asociación significativa (p = 0,029) entre las variaciones morfológicas de la ST y la clase esqueletal siendo más frecuentes en clase III. La prueba H de Kruskal Wallis no arrojó diferencias significativas (p=0,550) en las medianas del área selar entre las clases esqueletales. Las variaciones morfológicas parecen ser más relevantes que las variaciones anatómicas en esta asociación. Se requieren nuevos estudios en población chilena con un mayor número de casos.

SUMMARY: Craniofacial development is a complex process with several factors involved. When malocclusions have a skeletal origin, they can generate an orthognathic (class I), retrognathic (class II) or prognathic (class III) relationship of the mandibular bone respect to the maxilla. This configuration is closely related to the base of the skull where the sella turcica has been studied for this purpose due to its ectomesenchymal origin (Dasgupta et al., 2018) and its anatomical relationships. Several studies have been conducted to elucidate this relationship and this work seeks to contribute to the discussion by comparing the characteristics of the sella turcica among skeletal malocclusions through lateral teleradiographies. The study was conducted using 52 radiographic plates of individuals between 18 and 24 years old with an equal number of male and female subjects, 15 class I, 7 class II and 30 class III. The radiographic area of the sella turcica was digitally measured and morphologically classified using the categories of Axelsson et al. (2004). An intraclass correlation coefficient was obtained with 95 % confidence, yielding a value of 0.88 for the sella turcica area, 0.89 for the ANB angle and 0.70 for the Wits value, demonstrating excellent observer reliability. With 95 % confidence, Fisher's exact test showed a significant association (p = 0.029) between the morphological variations of the ST and the skeletal class, being more frequent in class III. The Kruskal Wallis H test did not show significant differences (p=0.550) in median sellar area between skeletal classes. Morphological variations seem to be more relevant than anatomical variations in this association. New studies are required in the Chilean population with a greater number of cases.

Potential role of the sella turcica X-ray imaging aspects for sex estimation in the field of forensic anthropology: a systematic review and meta-analysis.

Several studies have evaluated the parameters of normality of the sella turcica (ST), which is important to face different craniofacial syndromes that may affect this structure. Therefore, this research summarized the scientific evidence on the role of ST in the sex estimation of non-syndromic individuals. The research protocol was registered (Prospective International Registry of Systematic Reviews # CRD42021256469), followed by an electronic search in six databases (PubMed, LILACS, Web of Science, Scopus, EMBASE, and LIVIVO) and gray literature (Google Scholar and OpenGrey). Meta-analysis of linear (width, length, height, and diameter) and volumetric measurements, in addition to an assessment of risk of bias (RoB) and certainty of evidence, were performed. After the screening of 986 articles, 13 were evaluated by meta-analysis (1 307 males and 1 231 females). In subgroup analysis, females had lower values for width (lateral radiograph; -0.67 mm; P = 0.040), length (computed tomography; -0.23 mm; P = 0.020), and diameter (computed tomography; -0.27 mm; P < 0.001) compared to males. There was no statistically significant difference regarding height (P = 0.95), area (P = 0.72), and volume (P = 0.21). Most studies exhibited moderate RoB, and the certainty of evidence of the outcomes was very low. In this review, significant differences were observed between the sexes for the length and diameter of the ST; however, the heterogeneity of the studies must be considered. Key points: Studies from different geographic regions evaluated the morphology of ST according to sex and showed this anatomical structure as an important indicator of dimorphism.Meta-analysis showed shorter ST length and diameter in women.Subgroup analysis found lower ST width in women based on lateral skull radiographs.Subgroup analysis found smaller lengths and diameters in women based on CT scans.

Calcification patterns and morphology of Sella turcica are related to anteroposterior skeletal malocclusions: A cross-sectional study.

BACKGROUND: The sphenoid bone is an irregular, unpaired, symmetrical bone located in the middle of the anterior skull and is involved in craniofacial growth and development. Since the morphology of Sella turcica (ST) is associated with different craniofacial patterns, this study aimed to investigate if there is a correlation between ST morphology on the one hand and sagittal craniofacial patterns on the other hand. METHODS: This study was conducted with a convenience sample that included Brazilian individuals undergoing orthodontic treatment. Lateral cephalograms were used to evaluate the calcification pattern and morphology of ST, as well as skeletal class by analyzing the ANB angle. Pearson's chi-square test with Bonferroni post-hoc test was performed to evaluate the association between ST calcification pattern and morphology, and anteroposterior skeletal malocclusion. The established significance level was 0.05. RESULTS: The study collective was comprised of 305 orthodontic patients (178 (58.4 %) female, 127 (41.6 %) male), who had a mean age of 23.2 (±10.6) years. 131 participants (42.9 %) presented skeletal class I, 142 (46.6%) skeletal Class II, and 32 (10.5%) had a skeletal class III. The degree of prognathism of the mandible showed a homogenous distribution within the study collective (91 (29.9 %) orthognathic, 100 (32.9 %) retrognathic, 113 (37.2 %) prognathic mandible). Concerning the maxilla, 92 (30.2%) individuals presented an orthognathic upper jaw, whereas 60 (19.7%) showed maxillary retrognathism and 153 (50.2%) maxillary prognathism. Compared to patients with skeletal class I, skeletal class III individuals presented significantly more hypertrophic posterior clinoid process (p<0.007) and pyramidal shape of the dorsum of the ST (p<0.038). CONCLUSIONS: Our results suggest that the hypertrophic posterior clinoid process and pyramidal shape of the ST dorsum are more prevalent in individuals with skeletal class III malocclusion.

Macroprolactinoma in a 14-Year-Old Girl in the Northeast of Iran: A Case Report / Macroprolactinoma em uma garota de 14 anos no nordeste do Irã: Relato de caso

Prolactinoma is frequently found not only in females but also in males with abnormal reproductive and/or sexual function. Patients typically complain about amenorrhea and infertility because of anovulation. Approximately 15% to 20% of cases of secondary amenorrhea are caused by prolactinemia. Galactorrhea may occur simultaneously, before or after menstrual disorders, and sometimes it may not be clinically obvious, or only detected by breast examination. We reported a case of a 14-year-old girl who presented primary amenorrhea accompanied by frequent headaches and blurred vision. Hormonal tests showed severe hyperprolactinemia (prolactin [PRL] concentration: 1,570 ng/ml). Further tests confirmed a mass in the pituitary with an extension to the left parasellar and suprasellar regions. Some parts of the sella turcica tumor were removed by transcranial surgery. During the follow-up, the clinicopathological examinations revealed the patient had hyperprolactinemia. Clinicians should be aware of the diagnostic and therapeutic problems regarding the management of hyperprolactinemia.

O prolactinoma é frequentemente encontrado não apenas em mulheres, mas também em homens com função reprodutiva e/ou sexual anormal. Os pacientes geralmente se queixam de amenorreia e infertilidade devido à anovulação. Aproximadamente 15% a 20% dos casos de amenorreia secundária são causados por prolactinoma. A galactorreia pode ocorrer simultaneamente, antes ou depois dos distúrbios menstruais, e às vezes pode não ser clinicamente óbvia ou ser detectada apenas pelo exame das mamas. Relatamos o caso de uma menina de 14 anos que apresentou amenorreia primária acompanhada de dores de cabeça frequentes e visão turva. Os testes hormonais mostraram hiperprolactinemia grave (concentração de prolactina [PRL]: 1.570 ng/ml). Outros exames confirmaram uma massa na hipófise com extensão para as regiões parasselar e suprasselar esquerda. Algumas partes do tumor da sela turca foram removidas por cirurgia transcraniana. Durante o acompanhamento, os exames clinicopatológicos revelaram que o paciente apresentava hiperprolactinemia. Os médicos devem estar cientes dos problemas diagnósticos e terapêuticos relativos ao manejo da hiperprolactinemia.

Bilateral visual disturbances caused by a glomus vagale: illustrative case.

BACKGROUND: A glomus vagale tumor is an infrequent paraganglioma primarily characterized by auditory symptoms, cranial nerve involvement, or autonomic symptoms. However, visual involvement is not commonly observed, and to date, no cases have been reported in the literature. OBSERVATIONS: The case involves a 62-year-old female patient with a history of right carotid body tumor resection. She presented to the emergency department with a sudden decrease in visual acuity and bitemporal hemianopsia, accompanied by a left parietal headache. Initial brain magnetic resonance imaging (MRI) revealed a pituitary macroadenoma, which was completely resected. However, postoperatively, the patient developed left amaurosis. Subsequent brain MRI showed the presence of hemostatic material mixed with blood in the sellar region, causing displacement of the optic chiasm. A repeat intervention was performed, identifying bleeding from both cavernous sinuses. Head and neck angiography demonstrated a right glomus vagale tumor with abundant blood drainage into the right cavernous sinus. Embolization of the glomus vagale tumor was performed, resulting in no further bleeding and improvement of symptoms. LESSONS: The aim of this case report is to describe a rare occurrence of bilateral visual disturbances caused by bleeding in both cavernous sinuses due to venous hypertension caused by a right glomus vagale tumor.

Juvenile xanthogranuloma as a differential diagnosis for sellar and suprasellar lesions in child: Case report and review of literature.

Juvenile xanthogranuloma (JXG) is a rare type of non-Langerhans cell histiocytosis. Its systemic form affects 4% of patients. Lesions in the Central Nervous System (CNS) occur in 2% of systemic cases. Sellar JXG should be one of the differential diagnoses for sellar lesions in young. This is a 15-year-old patient with non-specific headache, progressive visual loss and magnetic resonance imaging showing sellar lesion with suprasellar extension. The patient underwent microsurgery by pterional craniotomy with partial resection of the tumor. Pathology evidenced JXG. It progressively evolved with impairment of neuroendocrine functions, new lesions in different CNS locations and death two years after diagnosis. Sellar JXG without cutaneous manifestations is rare. There are no specific findings of the disease. Diagnosis requires additional tests, being defined by pathological analysis. Total resection presents a greater potential control comparing to partial resection. Even so, some patients may have progressive disease with poor clinical outcome.

Morphometric Analysis of the Sella Turcica and Sphenoid Sinus: A Retrospective Cross-Sectional Study / Análisis Morfométrico de la Silla Turca y Seno Esfenoidal: Un Estudio Transversal Retrospectivo

SUMMARY: This study evaluated the effects of ethnicity, sex, and age on the linear dimensions of the sella turcica (ST) and the pneumatization patterns of the sphenoid sinus (SS). In this cross-sectional retrospective study, we examined digitally standardized computed tomography scans of 100 Jordanians. These study participants comprised 50 men and 50 women, and their age ranged from 23 years to 77 years. We assessed linear ST dimensions and SS pneumatization patterns and correlated this data to age and sex. Furthermore, we compared the data with different ethnic groups from previous studies. The mean (standard deviation [SD]) length, diameter, width, and depth of the ST were 9.98 (1.89) mm, 12.45 (2) mm, 11.96 (1.76) mm, and 8.38 (1.63) mm, respectively. The mean (SD) interclinoid diameter was 8.84 (2.03) mm. These measurements were not significantly correlated with sex or age. With regards to pneumatization patterns of the sphenoid sinus, the conchal type was observed in 2 % of the study participants. Presellar involvement was observed in 30 % of the patients. The sellar and postsellar type was observed in 66 % and 2 % of patients, respectively. In our study, ST measurements did not differ significantly between the sexes. Pneumatization patterns of the SS differed from the patterns reported for other races. The findings of this study could assist neurosurgeons, orthodontists, and forensic medical investigators in diagnosing and planning treatment for pituitary gland pathologies.

Este estudio evaluó los efectos de la etnia, el sexo y la edad sobre las dimensiones lineales de la silla turca y los patrones de neumatización del seno esfenoidal (SE). En este estudio retrospectivo transversal, examinamos tomografías computarizadas estandarizadas digitalmente de 100 jordanos. Los participantes del estudio comprendían 50 hombres y 50 mujeres entre los 23 y los 77 años de edad. Evaluamos las dimensiones lineales del SE y los patrones de neumatización del SE y correlacionamos estos datos con la edad y el sexo. Además, comparamos los datos con diferentes grupos étnicos de estudios previos. La media (desviación estándar) de la longitud, el diámetro, el ancho y la profundidad del SE fueron 9,98 (1,89) mm, 12,45 (2) mm, 11,96 (1,76) mm y 8,38 (1,63) mm, respectivamente. El diámetro interclinoideo medio era de 8,84 (2,03) mm. Estas medidas no se correlacionaron significativamente con el sexo o la edad. Con respecto a los patrones de neumatización del seno esfenoidal, el tipo conchal se observó en el 2 % de los participantes del estudio. Se observó afectación preselar en el 30 % de los pacientes. El tipo selar y postsillar se observó en el 66 % y el 2 % de los pacientes, respectivamente. En nuestro estudio, las medidas del SE no difirieron significativamente entre los sexos. Los patrones de neumatización de la silla turca diferían de los patrones informados para otras razas. Los hallazgos de este estudio podrían ayudar a los neurocirujanos, ortodoncistas e investigadores médicos forenses en el diagnóstico y el tratamiento de las patologías de la hipófisis.

Assessing the relationship between single nucleotide polymorphisms in Wingless signaling pathway genes and sella turcica morphology.

Sella turcica development involves molecular factors and genes responsible for ossification. It is possible that single nucleotide polymorphisms (SNPs) in key genes are involved in morphological variation of sella turcica. Genes belonging to the WNT signaling pathway are involved in the ossification process and are candidates of sella turcica morphology. This study aimed to evaluate if SNPs in WNT6 (rs6754599) and WNT10A (rs10177996 and rs3806557) genes are associated with the calcification and patterns of the sella turcica. Nonsyndromic individuals were included in the research. Cephalometric radiographs were examined and the sella calcification was evaluated and classified according to the calcification of the interclinoid ligament (no calcification, partial calcification, and incomplete calcification) and sella turcica pattern (normal sella turcica, bridge type A-ribbon-like fusion, bridge type B-extension of the clinoid processes, incomplete bridge, hypertrophic posterior clinoid process, hypotrophic posterior clinoid process, irregularity in the posterior part, pyramidal shape of the dorsum, double contour of the floor, oblique anterior wall, and oblique contour of the floor). DNA samples were used to evaluate SNPs in the WNT genes (rs6754599, rs10177996, and rs3806557) using real-time PCR. Chi-square test or Fisher's exact test were used to compare the allele and genotype distributions according to sella turcica phenotypes. The alpha was set as 5% for all comparisons. A total of 169 individuals were included, 133 (78.7%) present sella turcica partially or completely calcified. Sella turcica anomalies were found in 131 individuals (77.5%). Sella turcica bridge type A (27.8%), posterior hypertrophic clinoid process (17.1%), and sella turcica bridge type B (11.2%) were the most prevalent morphological patterns observed. Individuals carrying the TT genotype in rs10177996 (TT vs. CT + CC) had higher chance to present a partially calcified sella turcica (p = 0.047; Odds ratio = 2.27, Confidence Interval 95% 1.01-5.13). In conclusion, the SNP in WNT10A is associated with the calcification phenotype of the sella turcica, the pleiotropic effect of this gene should be taken into consideration in future studies.

Anatomical features of sella turcica with comprehensive literature review

SUMMARY OBJECTIVE: This study aimed to explore the relationship between skeletal patterns and the frequency of sella turcica bridging in a sample of young Turkish adults in order to provide a better understanding of the relationship between craniofacial morphology and sella turcica abnormalities. METHODS: A total of 90 individuals aged between 18 and 25 years were examined in this study. The individuals were classified according to their skeletal pattern, specifically Class I, Class II, and Class III. Each group consisted of 15 males and 15 females. The length, depth, and anteroposterior diameter of sella turcica were calculated. The shape and bridging of sella turcica were estimated using lateral cephalometric images. All data were correlated and statistically analyzed according to skeletal patterns, genders, and age. RESULTS: The mean length, depth, and anteroposterior diameter of sella turcica were 7.02±2.13, 7.56±1.38, and 10.54±1.3 mm in Classes I-III, respectively. There was no significant difference between the dimensions of sella turcica according to gender and age (p˃0.05). The length of sella turcica was larger in Class III, and the depth of sella turcica was larger in Class II individuals (p<0.05). A total of 44.4% of the individuals had normal sella turcica, while the remaining 56.6% had other types of sella turcica. It was determined that 31.1% of the individuals have no calcification, 62.2% had partial calcification, and 6.7% had total calcification. CONCLUSION: The normal dimensions, shape, and bridging of the sella turcica can be used by the orthodontist for diagnosis, treatment planning, and evaluation of various pathological conditions associated with the sella turcica.

Volumetric assessment of the sella turcica: a re-evaluation.

BACKGROUND: The sella turcica volume is widely measured by the Di Chiro-Nelson method. The purpose is to compare the fidelity of a proposed volumetry method vs. the Di Chiro-Nelson method, using computed tomography (CT) images. MATERIALS AND METHODS: Morphometric examination of 173 CT scans were included, of which 52.6% were female. The mean age was 53.2 ± 17.6 years. Considering the Di Chiro-Nelson method, two measurements were added for each axis in the CT evaluation: length (central, left, and right), width (central, anterior, and posterior), and height (central, left, and right). RESULTS: The mean measurements were length: central 10.11 ± 1.44, left 7.45 ± 1.67, right 7.53 ± 1.59; width: central 12.27 ± 2.11, anterior 10.99 ± 1.92, posterior 10.10 ± 1.74; height: central 7.68 ± 1.38, left 7.16 ± 1.35, right 7.40 ± 1.41. A statistically significant difference between sexes was found only in the anterior width (p = 0.01). Using the proposed method, the volume was 342.2 ± 88.5 and 378. 6 ± 113.9 mm³, respectively for females and males (p = 0.02) vs. 476.1 ± 132.4 and 523.8 ± 186.0 mm3 (p = 0.05) using the Di Chiro-Nelson's method. CONCLUSIONS: Women had significantly smaller sella turcica volume than men. This proposed method considers the sella turcica as a not strictly symmetrical structure and indicates reduced variation between the maximum and minimum values, compared to the Di Chiro-Nelson's. Our findings may be useful for reassessment the volume of the sella turcica as the measurements indicate a higher precision.

Diagnóstico radiológico del síndrome de interrupción del tallo hipofisario. Neurohipófisis ectópica / Radiological Diagnosis of Pituitary Stalk Disruption Syndrome. Ectopic Neurohypophysis

Resumen: El síndrome de interrupción del tallo pituitario es una anomalía congénita que se caracteriza por la demostración neurorradiológica de un tallo pituitario ausente, interrumpido o hipoplásico, adenohipófisis aplásica/hipoplásica y neurohipófisis ectópica. Este síndrome se ha relacionado con formas severas de hipopituitarismo congénito, asociado a múltiples deficiencias de hormonas pituitarias. Los signos y los síntomas perinatales que presentan los pacientes incluyen hipoglucemia hasta en un 61%, ictericia en un 38%, micropene en un 77% y colestasis en un 19%, las convulsiones neonatales se dieron en el 75% de los niños. Durante la infancia suelen tener talla baja y disminución en la velocidad del crecimiento, así mismo pueden presentar retardo en la expresión de los caracteres sexuales secundarios (1). En nuestro caso clínico se trata de un paciente adolescente el cual tenía como manifestaciones clínicas principales, retardo en los caracteres sexuales secundarios, los hallazgos principales que se encontraron en la resonancia magnética nuclear, incluyeron ausencia del tallo hipofisario, neurohipófisis ectópica, localizada adyacente al túber cinereum y adenohipofisis hipoplásica.

Abstract: Pituitary stalk disruption syndrome is a congenital anomaly characterized by neuroradiologic demonstration of an absent, interrupted, or hypoplastic pituitary stalk, aplastic/ hypoplastic adenohypophysis, and ectopic neurohypophysis. This syndrome has been related to severe forms of congenital hypopituitarism, associated with multiple deficiencies of pitu- itary hormones. Perinatal signs and symptoms presented by patients include hypoglycemia in up to 61%, jaundice in 38%, micropenis in 77% and cholestasis in 19%, neonatal seizures occurred in 75% of children. During childhood, they tend to have short stature and a decrease in growth speed, as well as a delay in the expression of secondary sexual characteristics. In our clinical case, an adolescent patient was presented whose main clinical manifestations were delayed secondary sexual characteristics, the main findings were found in nuclear magnetic resonance, including absence of the pituitary stalk, ectopic neurohypophysis, located adjacent to the tuber cinereum and hypoplastic adenohypophys.

Assessment of the relationship between size, shape and volume of the sella turcica in class II and III patients prior to orthognathic surgery.

PURPOSES: The main purpose of this study was to assess the measurements and shape of the sella turcica by using cone beam computed tomography (CBCT) and to associate the data to skeletal class II and class III patients, including correlations with gender, age and measurements of the anterior cranial base. MATERIAL AND METHODS: A trained examiner specialist in dental radiology selected and evaluated randomly 95 CBCT images of pre-orthognathic surgery patients, 60 (63.2%) being female and 35 (36.8%) male with age between 16 and 57 years. All images were evaluated to determine the size, shape and volume of the sella turcica. The anterior cranial base, represented by the S-N line (sella-nasion), was also measured. RESULTS: Of these 95 patients, 48 (50.5%) had class III facial skeletal pattern, whereas 47 (49.5%) had class II. No statistically significant differences were found between class II and class III patients in the measurements and shape of the sella turcica (P > 0.05). The diameter and volume of the sella turcica had higher values in female patients, whereas the measurements of the anterior cranial base were higher in males (P < 0.05). CONCLUSION: Therefore, one can conclude that measurements of the sella turcica are not reliable parameters to evaluate whether a class II or class III patient will or will not need orthognathic surgery.

Variaciones anatómicas de la silla turca en radiografías laterales de cráneo. Hospital "Faustino Pérez", 2017-2018 / Anatomic variants of sella turcica in lateral crania radiographies. Hospital "Faustino Pérez¨, 2017-2018

RESUMEN Introducción: diversos autores reflejan que la morfología de la silla turca constituye un factor predisponente para algunas enfermedades. Por ejemplo, se considera que existe correlación entre la morfología de esta estructura anatómica y varias patologías; como el síndrome de la silla turca vacía, síndrome de Williams, paladar hendido, entre otras. Objetivo: describir las variaciones anatómicas de la silla turca que se observan en las radiografías laterales de cráneo del Hospital Universitario "Faustino Pérez" de la ciudad de Matanzas, en el período de enero del 2017 a enero del 2018. Materiales y métodos: el universo fue 140 radiografías laterales de cráneo, de estas 85 pertenecieron al sexo femenino y 55 al masculino. Las variables estudiadas fueron edad, sexo y variaciones anatómicas de la silla turca. Se emplearon métodos teóricos y empíricos. Resultados: se observó un predominio de la variación anatómica de la silla turca en forma de U, en ambos sexos. Seguido de la forma de J, predominando la variación en forma de U en el grupo etario de 41 a 50 años y la forma de J en los pacientes mayores de 60 años. Conclusiones: es imprescindible el conocimiento de la anatomía normal de la silla turca y de sus variaciones anatómicas, tanto para las especialidades quirúrgicas como para las no quirúrgicas. Un análisis exhaustivo de la morfología de esta estructura es necesario para establecer parámetros que excluyan determinadas patologías.

ABSTRACT Introduction: several authors declare that sella turcica morphology is a predisposing factor to several diseases. For example, it is considered that there is a correlation between the morphology of this anatomical structure and several pathologies like empty sella turcica syndrome, Williams syndrome, cleft palate and others. Objective: to describe the anatomical variants of sella turcica observed in side cranial radiographies of the University Hospital ¨Faustino Perez¨ of Matanzas, in the period January 2017-January 2018. Materials and methods: the universe was 140 side cranial radiography: 85 belonged to female patients and 55 to male patients. The studied variables were age, sex and sella turcica anatomical variables. Theoretic and empirical methods were used. Results: it was observed a predominance of the U-shaped sella turcica anatomical variant in both sexes, followed by the J-shaped one. The U-shaped form predominated in the 41-50-years-old age-group and the J-shaped form in patients elder than 60 years. Conclusions: it is essential to know sella turcica normal anatomy and its anatomical variables, both for the surgical specialties and for the non-surgical ones. It is necessary the exhaustive analysis of this structure to establish parameters excluding several pathologies.

Aneurysmal Bone Cyst of the Skull Base ­ Case Report

Introduction Aneurysmal bone cysts (ABCs) are pseudotumoral bone lesions of unknown etiology that are also hypervascularized, benign, and locally destructive. They are rare in the base of the skull. The present case report describes a case of aneurysmal bone cyst in the sella turcica. Case Report The present study was developed at the department of neurosurgery of the Hospital Universitário Professor Alberto Antunes of the Universidade Federal de Alagoas (HUPAA-AL, in the Portuguese acronym), Maceió, state of Alagoas, Brazil, and is accompanied by a review of the literature from the PubMed database. A 17-year-old female patient with bitemporal hemianopia and intense left hemicranial headache associated with symptoms from the cranial nerves contained in the cavernous sinus. Neuroimaging evidenced a large lesion in the suprasellar region with calcification foci, sellar erosion, and extension to the cavernous sinus. The patient was submitted to a partial lesion resection and the histopathological analysis showed an aneurysmal bone cyst. Conclusion A rare case of intracranial aneurysmal bone cyst, with the important differential diagnosis from pituitary adenoma.

Magnetic resonance imaging of sellar and juxtasellar abnormalities: atypical findings of common diseases and typical findings of rare diseases.

The sellar/juxtasellar region comprises the bone component of the sella turcica, pituitary gland, cavernous sinus, and suprasellar cistern. Abnormalities in this region can be attributed to underproduction or overproduction of hormones or to the neurological signs and symptoms resulting from the compression of adjacent structures. Magnetic resonance imaging (MRI) is currently the imaging method of choice, having supplanted computed tomography. The aim of this study was to demonstrate the common and uncommon imaging aspects of sellar and juxtasellar changes, which could facilitate the differential diagnosis. We retrospectively evaluated the MRI scans of 70 patients with sellar/juxtasellar abnormalities from didactic files, and report those with more unusual changes, where MRI played an important role in diagnosis. All cases were confirmed histologically or clinical laboratory.

Anormalidades selares e justasselares: achados na ressonância magnética atípicos de doenças comuns e típicos de doenças incomuns / Magnetic resonance imaging of sellar and juxtasellar abnormalities: atypical findings of common diseases and typical findings of rare diseases

Resumo A região selar/justasselar abrange o componente ósseo da sela turca, a glândula hipofisária, o seio cavernoso e a cisterna suprasselar. As alterações dessa região podem se manifestar por consequência de hipoprodução ou hiperprodução hormonal ou por sinais e sintomas neurológicos decorrentes da compressão de estruturas adjacentes. A ressonância magnética (RM) é, atualmente, o método de avaliação por imagem de eleição para o estudo dessa região, tendo suplantado a tomografia computadorizada. O presente trabalho tem como objetivo demonstrar aspectos comuns e incomuns de imagem dessas alterações selares/justasselares que auxiliem no diagnóstico diferencial. Avaliamos, retrospectivamente, as imagens de RM de 70 pacientes com anormalidades selares/justasselares do arquivo didático e relatamos os casos com alterações mais incomuns, em que a RM teve papel importante no diagnóstico. Todos os casos foram confirmados histopatologicamente ou clinicolaboratorialmente.

Abstract The sellar/juxtasellar region comprises the bone component of the sella turcica, pituitary gland, cavernous sinus, and suprasellar cistern. Abnormalities in this region can be attributed to underproduction or overproduction of hormones or to the neurological signs and symptoms resulting from the compression of adjacent structures. Magnetic resonance imaging (MRI) is currently the imaging method of choice, having supplanted computed tomography. The aim of this study was to demonstrate the common and uncommon imaging aspects of sellar and juxtasellar changes, which could facilitate the differential diagnosis. We retrospectively evaluated the MRI scans of 70 patients with sellar/juxtasellar abnormalities from didactic files, and report those with more unusual changes, where MRI played an important role in diagnosis. All cases were confirmed histologically or clinical laboratory.

Prevalencia de silla turca vacía en una población colombiana y su relación con la edad, el sexo y el número de gestaciones / Empty Sella Prevalence in a Colombian Population and Its Relation with Age, Sex and Pregnancies Number

Objetivo: Determinar la prevalencia de silla turca vacía (STV), evaluada por resonancia magnética (RM), en una población colombiana y su asociación con el número de gestaciones, la edad y el sexo. Materiales y métodos: Estudio observacional descriptivo de corte transversal y estudio analítico de casos y controles pareado. Resultados: La prevalencia del hallazgo de silla turca vacía es mayor en el sexo femenino, adicionalmente, se encontró la edad como factor de riesgo, que se conoce como un gradiente biológico, y que existe una asociación estadísticamente significativa con el número de gestaciones, lo cual se resume en que a mayor cantidad de hijos, mayor es el hallazgo de STV. Conclusión: La prevalencia de silla turca vacía en la población estudiada es del 24 %, lo cual concuerda con datos de la literatura mundial en la que se describe su prevalencia en el sexo femenino y la relación directamente proporcional con la edad como factor de riesgo para STV.

Objective: To determine the prevalence of empty sella syndrome (ESS), evaluated by magnetic resonance (MR), in a Colombian population and its association with the number of pregnancies, age and gender. Materials and methods: Descriptive observational cross-sectional study and paired case-control analytical study. Results: The prevalence of the finding of empty sella is greater in females, in addition, age was found as a risk factor, which is known as a biological gradient, and there is a statistically significant association with the number of pregnancies, which is summarized in that the greater the number of children, the higher the ESS finding. Conclusion: The prevalence of empty sella in the studied population is 24%, which agrees with data from the world literature in which its prevalence in females is described and the relationship is directly proportional with age as a risk factor for ESS.

Investigation of the relationship between "sella turcica bridge" and "ponticulus posticus": a lateral cephalometric study / Investigación sobre la relación entre "puente silla turca" y "ponticulus posticus": un estudio cefalométrico lateral

The ponticulus posticus (PP) is a bridge of bone sometimes found on the atlas vertebra surrounding the vertebral artery and the first cervical nerve root. Sella turcica bridging (STB) is the fusion of anterior and posterior clinoid processes. The objective of this study was to find out the association between STB and PP. For the study, 752 digital lateral cephalograms were retrieved from the archived records of Necmettin Erbakan University, Faculty of Dentistry, Konya, Turkey. There was a significant relationship between the presence of STB and PP (p=0.000, p<0.001). This study indicates that there is a significant correlation between the presence of STB and PP.

El Ponticulus Posticus (PP) es un puente de hueso que se encuentra, a veces, en el atlas y rodea la arteria vertebral y la primera raíz del nervio cervical. El puente de la silla turca (PST) es la fusión de los procesos clinoides anteriores y posteriores. El objetivo de este estudio fue conocer la asociación entre PST y PP. Para el estudio, fueron utilizados 752 cefalogramas digitales laterales, obtenidos de los registros archivados de la Facultad de Odontología de la Universidad Necmettin Erbakan, Konya, Turquía. Hubo una relación significativa entre la presencia de PST y PP (p = 0,000, p <0,001). Este estudio indica que existe una correlación significativa entre la presencia de PST y PP.

Expanded Endoscopic Endonasal Transtuberculum / Transplanum Approach to the Suprasellar Area: A Stepwise Approach / Abordagem via endoscópica expandida transtuberculum - transplanum para a região supraselar: os passos da abordagem

The Expanded Endoscopic Endonasal Transtuberculum / Transplanum (EEETT) approach emerged as an amenable option to remove midline lesions, such as giant pituitary tumors, craniopharyngiomas, and tuberculum sellae meningiomas. Herein, the author's aim is to show a stepwise approach to the suprasellar area by EEETT and a case illustration.

A abordagem endoscópica endonasal expandida (AEEE) trans- tubérculo/ trans-plano têm se mostrado uma opção favorável para lesões da linha média para lateral, como tumores da hipófise, craniofaringiomas gigantes e meningiomas selares. O objetivo do autor é demonstrar os passos desta abordagem para a região suprasellar, por AEEE e um caso de ilustração.

Pituitary macroadenoma: analysis of intercarotid artery distance compared to controls / Macroadenoma de hipófise: análise da distância intercarotídea comparada a controles

ABSTRACT Objective To evaluate the intercarotid distance (ICD) of patients with pituitary macroadenoma and compare to heatlhy controls. Method We retrospectively reviewed contrast-enhanced MRI images from twenty consecutive patients diagnosed with non-functioning pituitary macroadenoma, measured the ICD at two different levels (petrous segment – ICD1 and horizontal cavernous segment – ICD2) and compared to twenty paired controls. Results There was no statistically significant difference of the mean ICD1 between the groups and subgroups. For the ICD2 there was statistically significant difference between the case and controls. However, there was no significant difference between the patients with smaller adenomas and the controls. In contrast, the patients with giant adenomas showed statistically significantly higher ICD2 than the controls. Conclusion The ICD at the horizontal segment of the cavernous carotid tends to be wider in patients with giant pituitary adenomas than in healthy individuals or patients with smaller adenomas.

RESUMO Objetivo Avaliar a distância intercarotídea (DIC) de pacientes com macroadenoma de hipófise e comparar com controles saudáveis. Método Foram analisados retrospectivamente imagens de ressonância magnética com contraste de vinte pacientes consecutivos com diagnóstico de macroadenoma hipofisário não-funcionante, medidas as DIC em dois níveis diferentes (segmento petroso – DIC1 e segmento cavernoso horizontal – DIC2) e comparados com vinte controles pareados. Resultados Não houve diferença estatisticamente significativa da DIC1 média entre os grupos e subgrupos. Para a DIC2 houve diferença estatisticamente significativa entre os casos e controles. No entanto, não houve diferença significativa entre os doentes com adenomas menores e os controles. Entretanto, os pacientes com adenomas gigantes tiveram estatisticamente significativamente DIC2 que os controlos. Conclusão A DIC no segmento horizontal da carótida cavernoso, tende a ser mais larga em doentes com adenomas hipofisários gigantes do que em indivíduos saudáveis ou de pacientes com adenomas menores.