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Evaluation of Empty Sella in Patients with Cerebral Arteriovenous Malformations

To evaluate the incidence of empty sella in patients with cerebral arteriovenous malformations we retrospectively evaluated the pituitary gland height (PGH) on midsagittal T1 -weighted images in 216 patients with cerebral AVM (37.5% female, 62.5% male, mean age 33.4). Complete empty sella was defined as PGH<2 mm and partial empty sella as PGH<3 mm. Empty sella in patients with cerebral AVMs was analysed on the basis of nidal size, nidal location and age. We compared our results with those found in a normal population. Mean PGH in our patient population was 3.96 mm (range 1–9 mm). 3.4 mm in males and 4.8 mm in females. The overall incidence of empty sella was 41.2% (89/216). Empty sella occurred in 32% (48/150) of patients less than 40 years old and 62% (41/66) of patients over 40. The distribution of mean PGH values in AVM patients grouped by age was lower than but parallel to the distribution in normal PGH values. A statistically significant increased incidence of empty sella was found with cortical AVM location (48%; 69/144, p<0.0001), and nidal size> 3 cm (60%; 75/125, p<0.0001). Our results indicate that empty sella occurs more frequently in patients with cerebral AVM especially with a cortical location or a nidus greater than 3 cm. We conjecture that this may be related to altered CSF flow dynamics in these patients. Further studies may explain the higher incidence of empty sella in patients with cerebral AVM.