title: Clinical characteristics of acromegalic patients with empty sella and their outcomes following transsphenoidal surgery.
abstract: OBJECTIVE
  To analyze the clinical characteristics of acromegalic patients with empty sella (ES, herniation of the subarachnoid space within the sella turcica) and the impact of ES on transsphenoidal surgery in such patients.
  
  
  METHODS
  Seventy-eight patients, newly diagnosed with acromegaly who underwent transsphenoidal surgery were included. ES was defined as the pituitary gland and adenoma occupying less than 50% of the sella turcica on midsagittal magnetic resonance (MR) imaging.
  
  
  RESULTS
  Twelve patients (15.4%), predominantly female (10 women, p = .047), had ES in preoperative MR imaging. ES patients had smaller mean tumor diameter (6.3 mm) than non-ES patients (11.2 mm, p = .001). In preoperative MR imaging, occult adenoma was found in three (25%) ES and three (4.5%) non-ES patients (p = .044). Intraoperative cerebrospinal fluid (CSF) leakage was more frequent in the ES patients than in the non-ES patients (58.3 vs. 25.8%, p = .024). This led to an increased rate of sellar floor reconstruction using abdominal fat and/or postoperative lumber drainage in the ES patients (ES: 41.7 vs. non-ES: 16.7%, p = .063). Endocrinological remission after surgery was more frequent in the non-ES patients (72.7%) than in the ES patients (58.3%) (p = .248).
  
  
  CONCLUSIONS
  Co-existence of acromegaly with ES is not rare, and is associated with occult adenoma, intra/postoperative CSF leakage, and a worse endocrinological outcome after transsphenoidal surgery; although, the underlying mechanism remains unclear.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan. y-sasa@med.kanazawa-u.ac.jp.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sasagawa
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of Neurosurgery, Kanazawa Medical University, KanazawaIshikawa, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Tachibana
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Oishi
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
authors.forename: Issei
authors.initials: I
authors.lastname: Fukui
authors.affiliation: Department of Neurosurgery, Kanazawa Medical University, KanazawaIshikawa, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Iizuka
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Nakada
mesh_terms: D000172:Acromegaly / Q000000981:diagnostic imaging* / Q000601:surgery; D000368:Aged; D004652:Empty Sella Syndrome / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Acromegaly; Empty sella turcica; Growth hormone; Transsphenoidal surgery