The occurrence of the empty Turkish saddle syndrome has many causes and explanations. The thing is that, being called empty, it cannot be a priori hollow. In connection with a significant reduction in the volume of such a gland as the pituitary gland, the space once occupied by it passes into the cerebrospinal fluid and other meninges.
So it turns out that the pituitary gland is practically not noticeable on the radiological images, and only cerebrospinal fluid and the membrane are visually accessible. Therefore, such a space is called empty. Therefore, this condition is detected by specialists in MRI or CT of the head. Then, neuropathologists and neurosurgeons develop a treatment regimen and determine further actions in accordance with it.
Where is the turkish saddle located?
The natural location of the Turkish saddle is a depression of the saddle shape in the bone structure of the base of the human skull . It is part of the sphenoid sinus, namely a portion of the upper wall. It has rather small dimensions both in length (about 10 mm) and in height (7-13 mm). The cavity of the Turkish saddle, in which the pituitary gland is located, has the name of the pituitary fossa. It is separated from the subarachnoid space by the diaphragm - the dura mater. Through a tiny hole in the diaphragm passes the so-called pituitary leg, which has a connection with the hypothalamus.
Research in this area
Even in the middle of the twentieth century, the concept of “empty Turkish saddle” became known to the whole world. What this means was Bush was able to pinpoint the American pathologist in the early 1950s. During lengthy lengthy studies, he was able to detect the absence or underdevelopment of that same diaphragm in half of the dead. Studying autopsy material of almost 800 corpses, he was able to conclude that not all fatal cases of pathological conditions of the gland became the main factor. Bush noted that in the pituitary fossa, the pituitary gland substantially changed, acquired a vague form and had the appearance of a thin layer of tissue.
Russian scientist Savostyanov in 1995 modified the classification of syndromes proposed by Bush that differ in the type of diaphragm and the volume of intrasellar tanks formed between the cerebellum and the medulla oblongata. At the same time, scientific findings spoke of the following: in 8 out of 10 women over forty years of age who gave birth more than once, pathology formed, and symptoms of the empty Turkish saddle syndrome began to appear. In addition, more than two-thirds of sick women suffered obesity of varying degrees during their lifetime. Within a few years, scientists were able to connect the pathology with clinical manifestations, identify the primary and secondary syndrome of the empty Turkish saddle.
Forms of the disease
Due to the possible division of the disease into primary and secondary forms, it seems possible for the patient to determine the most suitable treatment option. In practice, this is of great importance in predicting the course of the disease.
The primary syndrome of the empty Turkish saddle, the symptoms of which are manifested by an increase in intracranial pressure, practically does not affect the state of the pituitary gland. Despite the minimal “suffering” of the gland, a certain defect of the diaphragm is present. Subsequently, the deforming effect on the pituitary gland is reflected in its volumes, decreasing it, after which the space of the Turkish saddle is occupied by the dorsal membranes and liquid (cerebrospinal fluid) lowered down.
Neurological symptoms with secondary disease are more pronounced. Since the gland itself “comes under attack”, it often requires immediate surgical treatment, radiation therapy and the use of many medications to prevent hemorrhage. It follows that the most dangerous is the secondary syndrome of an empty Turkish saddle. The causes of the origin of the disease lie in many factors that require detailed consideration.
Probable circumstances of the onset of the disease
First of all, people with a hereditary predisposition to the occurrence of this problem should be attributed to the risk group. From biological parents, children often get an immature diaphragm, which is an underdeveloped, non-integral shell.
Basically, even in the prenatal period, the fetal brain in the womb can form with the presence of defects under the negative influence of environmental factors. The most dangerous elements are radiation, environmental insecurity, modified food, stress experienced by the expectant mother, poor quality of drinking water and much more.
The consequences of increased intracranial pressure
Dangerous complications of some diseases have a significant impact on the appearance of this factor. Intracranial pressure may increase due to:
- transferred skull injuries, bruises, concussions;
- hypertension and other cardiovascular diseases;
- oncological neoplasms;
- adverse pregnancy, difficult birth, abortion;
- thrombosis;
- osteochondrosis of the cervical spine (this disease prevents the normal flow of blood into the cranial cavity);
- various infections affecting the central nervous system (encephalitis, meningitis, hemorrhagic fever, etc.).
Secondary syndrome of the "empty Turkish saddle" significantly affects the size of the pituitary gland due to increased pressure inside the cranial cavity.
At first, it noticeably increases, forming a tumor, and then significantly decreases in volume due to necrosis, tissue breakdown, atrophy, and neurosurgical and oncological operations.
Common brain symptoms
Basically, before undergoing a specialized examination, many people have no idea about the term "empty Turkish saddle." What kind of pathology is this and what is dangerous, many patients will find out only with the results of tomography on hand. Often they have no complaints and they feel completely healthy. However, this does not at all mean that there can be no complaints at all. Often, neurological symptoms are manifested in the following:
- frequent headaches, sometimes persistent (they do not have a specific location and have different intensities);
- dizziness;
- shakiness, uncertain walking (throws a person from side to side);
- decreased memory and concentration, the appearance of distraction;
- unnatural rapid fatigue, decline in the level of performance and endurance;
- psycho-emotional disorders.
Ophthalmic disorders
Often, eye doctors can identify a suspected disease. Patients come to them with complaints of deterioration in the state of their organs of vision. Often there are such changes:
- pain when moving the eyeball ;
- constant tearing;
- conjunctival edema;
- fogging
- bright flashes in the eyes.
During a detailed examination, specialists can detect some characteristic pathological manifestations, which include swelling and hyperemia of the optic nerve, distortion of the visual field, the occurrence of asthenopia. Such dysfunctions of the human visual system may be present due to high intracranial pressure. In the absence of timely adoption of the necessary therapeutic measures, further hypersecretion of intraocular fluid can lead to the formation of glaucoma.
Endocrine changes
As mentioned earlier, the majority of women who are ill are women after 35 years. Manifestations of the disease directly depend on the phase of exacerbation and the achieved remission. From the endocrine system, the most common disorders are caused by autonomic syndromes:
- deep dyspnea even at rest, shortness of breath;
- chills, fever;
- body aches and pains;
- persistent low-grade fever ;
- frequent fainting;
- tachycardia, heart pain;
- upset stool.
Hormonal malfunction of the pituitary gland in medical practice has been repeatedly mistaken for the manifestation of an oncological tumor of the gland. In addition, the combination of microadenomas and the "empty Turkish saddle" is not uncommon. Due to the difficult supply of the required number of hormones through the pituitary gland and a decrease in the control of the hypothalamus over the gland, some sexual disorders may occur not only in women but also in male patients
(decreased libido and potency, amenorrhea, hypothyroidism, etc.). In severe cases, there is a likelihood of CSF discharge through the nasal passage.
Diagnostics
In order to detect the disease, you should turn to the most reliable method. Today, MRI can be considered the undisputed leader in the diagnosis of neurological diseases of the brain. The results of the tomography provide the largest amount of information about the patient's condition. In this case, it is important to take into account the predominant complete safety of this type of examination.
The MRI image of a patient with the syndrome of "empty Turkish saddle" for visualization is available:
- the presence of cerebrospinal fluid;
- noticeable deformation of the pituitary gland (a curved shape resembling a crescent or sickle), a centrally located funnel;
- in the cavity of the Turkish saddle, the suprasellar tank protrudes asymmetrically;
- the funnel of the gland significantly lengthened and became thinner.
Other indirect indicators (an increase in the size of the ventricles and spaces containing cerebrospinal fluid) can be determined by the method of determining intracranial increased pressure in the image.
Doctors also resort to additional diagnostic methods, including laboratory clinical studies (venous blood sampling to determine the balance of hormones produced by the pituitary gland in plasma) and an ophthalmic study of the condition of the fundus.
Treatment features
Asking the question of whether it is possible to cure the “empty Turkish saddle” syndrome, it should be understood that only comprehensive treatment measures will help solve this problem. Indeed, without the help of neurologists, neurosurgeons, endocrinologists and oculists, you can not do here.
The primary syndrome of the "empty Turkish saddle", as a rule, does not require special treatment. Without delivering tangible troubles to the patient, the disease in this form does not pose a threat to life. Although sometimes there is a need for taking medications and certain hormone therapy.
In the event of a secondary syndrome, hormonal treatment cannot be dispensed with. Since vital glands, the hypothalamus and the pituitary gland are subject to significant changes, often this more severe stage of the disease can be cured only by the operable method. For example, when squeezing the optic nerves and sagging the intersection in the diaphragmatic opening, only an operation involving a neurosurgeon can help. An indication for surgery is leakage of cerebrospinal fluid from the nose. The thinned bottom of the Turkish saddle allows liquor to seep out.
Recovery Forecasts
The chances of recovery are quite large, especially if the severity of clinical manifestations is low and the primary syndrome of an empty Turkish saddle is revealed. Treatment of hypopituitarism with the help of hormone replacement therapy ends in most cases with a favorable outcome. However, often predicting the course of the disease depends on the accompanying pathologies of the pituitary gland and brain.