1 Embryology of the Sellar Region.- A. Development of the Sphenoid Bone.- I. Membranous Stage.- II. Cartilaginous Stage.- III. Stage of Ossification.- 1) Ossification Centers, Ossifying Periods, and Fusion.- 2) Prenatal Development of the Pre- and Postsphenoid Ossification Centers.- IV. Postnatal Development of the Basisphenoid.- 1) Postsphenoid.- 2) Presphenoid.- B. Development of the Sphenoid Sinus.- I. Prenatal Development.- II. Postnatal Development.- C. Development of the Pituitary Gland.- I. Neurohypophysis.- II. Adenohypophysis.- III. Capsule of the Pituitary Gland.- D. Main Anomalies in the Fetal Development of the Sellar Region.- I. In the Postsphenoid.- II. In the Pre- and Orbitosphenoid.- III. In the Pituitary Gland and the Pituitary Stalk.- 2 Anatomy of the Sellar Region.- A. Descriptive Anatomy of the Sellar Region.- I. Sella Turcica.- 1) Dorsum Sellae.- 2) Floor of the Sella Turcica.- 3) Anterior Wall of the Sella Turcica.- 4) Tuberculum Sellae.- 5) Middle Clinoid Processes.- 6) Anterior Clinoid Processes.- 7) Carotid Sulcus.- II. Presellar Region.- 1) Chiasmatic Sulcus.- 2) Planum Sphenoidale.- 3) Limbus Sphenoidale.- III. Ligaments and Unusual Ossifications of the Sellar Region.- 1) Interclinoid Ligaments.- 2) Petroclinoid Ligaments.- 3) Unusual Ossifications of the Sellar Region.- B. Relationships Between the Sella Turcica and the Surrounding Structures.- I. Structures Above the Sella Turcica.- 1) Dura Mater of the Sella Turcica.- 2) Pituitary Gland.- 3) Suprasellar Vascular and Nervous Structures.- II. Lateral Structures: The Cavernous Sinus.- 1) Walls of the Cavernous Sinus.- 2) Contents of the Cavernous Sinus.- 3) Afferent and Efferent Veins of the Cavernous Sinus.- III. Structures Below and Anterior: The Sphenoid Sinus.- 1) General Shape and Size of the Sphenoid Sinus.- 2) The Septa in the Sphenoid Sinus.- 3) Important Variations in the Walls of the Sphenoid Sinus.- 4) Recessus Sphenoethmoidalis.- IV. Posterior and Anterior Structures.- C. Vascular Supply of the Sellar Region.- I. Dura Mater and Osseous Structures.- 1) Sellar Floor.- 2) Cavernous Sinus.- 3) Presellar Region.- II. Pituitary Gland.- 1) Superior Hypophyseal Group.- 2) Inferior Hypophyseal Arteries.- III. Optic Chiasm.- D. Innervation of the Sellar Region.- 3 Radiographic Techniques.- A. Plain Radiography.- I. Equipment and Film Quality Factors.- II. Projections.- 1) The Two Basic Projections for the Sella Turcica.- 2) Direct Magnified Views.- 3) Other Projections.- B. Tomography.- I. Tomographic Devices.- 1) Linear Blurring Movement.- 2) Pluridirectional Blurring Movement.- II. Tomographic Projections.- 1) Lateral Tomograms.- 2) Frontal Tomograms.- 3) Axial Tomograms.- III. When is Tomography Required?.- 1) Clinical or Laboratory Findings.- 2) Radiologic Signs.- 4 Radiologic Anatomy.- A. Radiologic Anatomy of the Sella Turcica and of the Presellar Region.- I. Children.- 1) Sellar Region During the First Year of Life.- 2) Sellar Region From One to Four Years.- 3) Sellar Region From Four Years to Adulthood.- II. Adults.- 1) Lateral Projection.- 2) Frontal Projection.- 3) Half Axial View.- 4) Axial View.- 5) Other Projections.- B. Regional Radiologic Anatomy.- I. Vascular Anatomy.- II. Ventricular and Cisternal Anatomy.- 5 Variations and Normal Limits.- A. Variations in the General Appearance of the Sella Turcica.- I. Variations in Shape.- II. Variations in Size.- III. Unusual Configurations.- 1) Lack of Visibility of the Floor of the Sella on the Routine Posteroanterior Projection.- 2) Vertical Chiasmatic Sulcus.- 3) Bridged Sella Turcica.- 4) Sella Turcica with Thin Cortical Bone.- 5) Small Sella Turcica on One Side.- IV. Normal Limits.- 1) Empty Sella in the Early Stage.- 2) Sella Turcica and Multiparity.- 3) Sella Turcica and the Internal Carotid Artery.- 4) Sella Turcica in Old Age.- 5) Sella Turcica and Craniostenosis.- B. Variations in Different Anatomic Structures.- I. Variations in the Sphenoid Sinus.- II. Variations in the Presellar Region.- III. Variations in the Sella Turcica Itself.- 1) Tuberculum Sellae, Anterior and Middle Clinoid Processes.- 2) Dorsum Sellae and Posterior Clinoid Processes.- 3) Calcification of the Ligaments and the Dura Mater of the Sellar Region.- 4) Floor of the Sella.- 6 Intrasellar Pathology.- A. The Empty Sella Turcica.- I. Primary Empty Sella Turcica.- 1) History.- 2) Pathogenesis.- 3) Clinical Symptomatology.- 4) Radiology.- II. Special Types of Empty Sella Turcica.- B. Pituitary Adenomas.- I. General Considerations.- II. Clinical Findings.- 1) Nonsecreting Adenomas.- 2) Secreting Adenomas.- III. Radiology.- 1) Nonsecreting (Chromophobe) Adenomas.- 2) Prolactin-Secreting Pituitary Adenomas.- 3) Growth Hormone Secreting (Eosinophilic) Adenomas.- 4) Other Hypersecreting Adenomas.- IV. Development of Pituitary Adenomas.- 1) Spontaneous Progression of Adenomas.- 2) Expansion.- 3) Rapid Growth of Pituitary Adenomas.- 4) Abscess Formation.- 5) Spontaneous Necrosis of Pituitary Adenomas.- 6) Remodeling of the Sella Turcica After Treatment.- C. Intrasellar Craniopharyngiomas.- D. Miscellaneous Disorders.- I. Metastases.- II. Primary Malignant Tumors of the Pituitary Gland.- III. Sarcoidosis.- IV. Abscesses.- V. Pituitary "Calculus".- VI. Rathke's Cleft Cysts and Other Intrasellar "Cysts".- VII. Granular Cell Tumors.- VIII. Vascular Disease.- IX. Rare Intrasellar Disorders.- 7 Suprasellar Pathology.- A. Craniopharyngiomas.- I. General Considerations.- 1) Pathology.- 2) Topography.- 3) Age, Sex, and Incidence.- II. Symptoms.- III. Radiology.- 1) Calcification.- 2) Changes in the Sella Turcica.- B. Hypothalamic Gliomas.- C. Gliomas of the Optic Chiasm.- D. Miscellaneous Disorders.- 1) Histiocytosis X of the Hypothalamus.- 2) Hypothalamic Sarcoidosis.- 3) Colloid Cysts of the Third Ventricle.- 4) Suprasellar Germinomas.- 5) Suprasellar Arachnoid Cysts.- 6) Dermoid and Epidermoid Tumors.- 7) Hamartomas of the Tuber Cinereum.- 8) Meningiomas of the Diaphragma Sellae.- 9) Esthesioneuroblastomas.- 10) Suprasellar Aneurysms.- 11) Suprasellar Arachnoiditis.- 8 Presellar Pathology.- A. Gliomas of the Optic Pathways (Nerve and Chiasm).- I. General Considerations.- II. Radiology.- B. Presellar Meningiomas.- I. General Considerations.- II. Radiology.- C. Diagnosis of an Abnormal Presellar Region.- I. Excessively Dense or Thick Planum Sphenoidale.- II. Excessively Short or Demineralized Planum Sphenoidale.- III. Depressed or Scalloped Planum Sphenoidale.- IV. Blistering of the Planum Sphenoidale.- V. Abnormal Chiasmatic Sulcus.- 9 Parasellar Pathology.- A. Vascular Disease.- I. Aneurysms of the Internal Carotid Artery.- 1) Bony Changes.- 2) Calcification.- 3) Presence of Soft Tissue Mass Within the Sphenoid Sinus.- II. Carotid-Cavernous Fistulas.- B. Meningiomas.- C. Gasserian Neurinomas and Meningiomas.- D. Diseases of Temporal Lobe.- I. Gliomas.- II. Epidermoids.- III. Lipoid Proteinosis.- 10 Retrosellar Pathology.- A. Chordomas.- I. General Considerations.- II. Radiology.- 1) Bone Changes.- 2) Tumor Calcification.- 3) Soft Tissue Mass.- B. Chondromas.- I. General Considerations.- II. Radiology.- C. Clivus Meningiomas.- D. Aneurysms of the Basilar Artery.- 11 Infrasellar Pathology.- A. Inflammatory, Infectious, and Mycotic Lesions of the Sphenoid Sinus.- I. Acute Sinusitis.- II. Chronic Sinusitis.- III. Mucoceles.- IV. Fungal Infections.- V. Sarcoidosis.- B. Infrasellar Neoplastic Diseases.- I. Malignant Tumors.- II. Nonmalignant Infrasellar Tumors.- 12 Sella Turcica in Raised Intracranial Pressure and Hydrocephalus.- A. Raised Intracranial Pressure.- B. Sella Turcica in Chronic Obstructive Hydrocephalus.- C. Changes in the Sella Turcica in Childhood.- D. Sella Turcica in Craniostenosis.- 13 Generalized Diseases and Changes in the Sella Turcica.- A. Congenital Anomalies of the Sella Turcica.- I. Congenital Skull Dysplasias.- 1) Cleidocranial Dysostosis.- 2) Osteopetrosis.- 3) Achondroplasia.- 4) Apert's Syndrome.- 5) Osteogenesis Imperfecta (Lobstein's Disease).- II. Neurofibromatosis.- 1) Dysplasic Bone Changes.- 2) Bone Changes Related to Neighboring Tumors.- III. Chromosomal Syndromes.- IV. Mental Retardation.- V. Meningoencephaloceles.- 1) Transsphenoid.- 2) Sphenoethmoid.- VI. Persistent Infundibular Recess.- VII. Vascular Anomalies.- 1) Transsphenoidal Communicating Artery.- 2) Persistent Trigeminal Artery.- B. Metabolic Diseases.- I. Mucopolysaccharidoses.- 1) Hurler-Hunter Syndrome (Gargoylism).- 2) Maroteaux-Lamy Syndrome.- II. Hypophosphatasia and Hyperphosphatasia.- III. Idiopathic Infantile Hypercalcemia and Hypervitaminosis D.- IV. Fluorine Intoxication.- V. Alcoholism.- C. Endocrine Diseases.- I. Hypopituitarism.- 1) Hypopituitary Dwarfism.- 2) Congenital Absence of Pituitary Gland.- 3) Postpartum Pituitary Necrosis (Sheehan's Syndrome).- II. Small Sella Turcica and Infertility.- III. Primary Target Gland Insufficiency.- 1) Hypothyroidism.- 2) Hypogonadism.- 3) Hypoadrenalism.- IV. Hyperparathyroidism.- V. Cushing's Syndrome.- D. Hematologic Diseases.- I. Histiocytosis X.- II. Multiple Myeloma.- E. Neoplasms.- I. Secondary Neoplasms.- II. Primary Neoplasms.- 1) Malignant.- 2) Benign.- F. Infectious Diseases.- G. Fractures of the Sellar Region.- I. Mechanism of Fractures of the Sellar Region.- II. Clinical Picture.- III. Complications.- 1) Rhinorrhea.- 2) Vascular Lesions.- 3) Hypothalamic and Pituitary Lesions.- 4) Pneumocephalus.- IV. Radiology.- 1) Fractures of the Planum Sphenoidale and Chiasmatic Sulcus.- 2) Fractures of the Anterior Wall and Floor of the Sella Turcica.- 3) Fractures of the Dorsum Sellae.- 4) Comminuted Fractures.- H. Miscellaneous.- I. Arterial Hypertension and Atherosclerosis.- 1) Arterial Calcifications.- 2) Vascular Tortuosity.- 3) Arterial Hypertension.- II. Fibrous Dysplasia.- III. Paget's Disease.- IV. Dystrophia Myotonica.- 14 Exercises and Pitfalls.- 15 Advances in CT of the Pituitary Gland.- A. Method of CT Examination.- B. Results.- I. Normal Results.- II. CT of Pituitary Adenomas.- 1) Adenomas with Suprasellar Expansion.- 2) Intrasellar Adenomas.- 3) Treated Adenomas.- C. Bibliography.- References.
