What is the relationship between Empty Sella Syndrome (ESS) and Cervical Epidural (CE) hematoma?

From the Guidelines

Empty sella syndrome and cervical epidural procedures are generally not contraindicated for each other. Empty sella syndrome is a condition where the pituitary gland appears flattened or shrunken within the sella turcica, a bony structure at the base of the brain. This condition may be primary (idiopathic) or secondary to various causes like previous pituitary surgery or radiation. For patients with empty sella syndrome who require cervical epidural injections for pain management, the procedure can typically proceed normally. However, patients should inform their healthcare provider about their empty sella syndrome diagnosis before undergoing the epidural. If the empty sella syndrome is associated with pituitary hormone deficiencies requiring hormone replacement therapy, these medications should be continued as prescribed around the time of the epidural procedure. Special attention should be paid to patients on glucocorticoid replacement, as they may need stress-dose steroids for the procedure, as noted in studies discussing pituitary function and its potential impact on various medical procedures 1.

The relationship between empty sella syndrome and cervical epidural hematoma is not directly addressed in the provided evidence, but it is essential to consider the potential risks and complications associated with cervical epidural procedures in patients with empty sella syndrome. The epidural itself involves injecting medication into the epidural space of the cervical spine to reduce inflammation and pain, and the anatomical changes in the sella turcica (which is in the brain) do not directly affect the cervical spine anatomy where the epidural is administered. However, patients with empty sella syndrome may have underlying conditions that could increase the risk of complications, such as bleeding or infection, and therefore, close monitoring and careful management are necessary.

Some key points to consider when evaluating the relationship between empty sella syndrome and cervical epidural procedures include:

• The potential for pituitary hormone deficiencies and the need for hormone replacement therapy
• The risk of bleeding or infection associated with the epidural procedure
• The importance of informing healthcare providers about the empty sella syndrome diagnosis before undergoing the epidural
• The need for special attention to patients on glucocorticoid replacement, as they may need stress-dose steroids for the procedure, as discussed in studies on neuroendocrine imaging 1.

Overall, while the provided evidence does not directly address the relationship between empty sella syndrome and cervical epidural hematoma, it is crucial to consider the potential risks and complications associated with cervical epidural procedures in patients with empty sella syndrome and to manage these patients carefully to minimize the risk of adverse outcomes 1.

From the Research

Relationship Between Empty Sella Syndrome (ESS) and Cervical Epidural (CE) Hematoma

There is no direct evidence in the provided studies to suggest a relationship between Empty Sella Syndrome (ESS) and Cervical Epidural (CE) hematoma.

• The studies focus on the diagnosis, management, and treatment of ESS, its symptoms, and associated conditions such as intracranial hypertension, cerebrospinal fluid rhinorrhea, and endocrine disturbances 2, 3, 4, 5, 6.
• None of the studies mention Cervical Epidural (CE) hematoma as a related condition or complication of ESS.
• The provided evidence discusses the pathogenesis, clinical presentation, and treatment options for ESS, but does not explore its potential relationship with CE hematoma 2, 4, 6.

Clinical Presentation and Diagnosis of ESS

• ESS is characterized by the presence of cerebrospinal fluid in the sella turcica, with associated compression of the pituitary gland, often resulting in hormonal deficiencies 3, 5.
• The clinical presentation of ESS can include endocrine, ophthalmological, and neurological symptoms, such as headache, irregular menses, overweight/obesity, and visual disturbances 2, 6.
• Diagnosis of ESS is typically made through imaging studies, such as MRI or CT scans, and may involve evaluation of pituitary function and assessment of papilledema 3, 6.

Treatment and Management of ESS

• Treatment options for ESS may include CSF shunt placement, surgical repair of the sellar floor, and management of associated endocrine and neurological symptoms 2, 4.
• The goal of treatment is to relieve symptoms, improve quality of life, and prevent further complications, such as cerebrospinal fluid rhinorrhea and worsening of visual acuity 2, 4, 6.