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

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 can 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, as evidenced by the use of MRI for evaluation of the pituitary and sellar regions, which can confirm the absence or ectopia of the posterior pituitary gland, and characterize an empty sella, even without IV contrast 1.

Key Considerations

• Patients should inform their pain management specialist about their empty sella syndrome diagnosis before the procedure.
• If the empty sella syndrome is associated with pituitary hormone deficiencies requiring hormone replacement therapy, these medications should be continued as prescribed before and after the epidural.
• Special attention should be paid to any steroid medications, as epidural steroid injections could potentially affect the hypothalamic-pituitary-adrenal axis temporarily.
• The connection between these conditions is important because both involve the central nervous system, though they affect different anatomical regions.

Monitoring and Precautions

• Patients with empty sella syndrome who experience neck pain requiring epidural treatment should have their hormone levels monitored, especially if receiving steroid injections, to ensure proper pituitary function is maintained throughout treatment.
• MRI using high-resolution pituitary protocols is the preferred diagnostic imaging modality for evaluation of the pituitary and sellar regions, and can be used to monitor patients with empty sella syndrome undergoing cervical epidural procedures 1.

From the Research

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

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

• The studies focus on the clinical presentation, diagnosis, and management of ESS, with no mention of CE 2, 3, 4, 5, 6.
• ESS is characterized by the presence of cerebrospinal fluid in the sella turcica, with associated compression of the pituitary gland, and is often associated with endocrine, neurological, and ophthalmological symptoms 2, 3, 4, 5, 6.
• The pathogenesis of ESS is thought to be related to increased intracranial pressure, sellar diaphragm incompetence, and changes in pituitary volume 2, 6.
• Treatment of ESS often involves surgical intervention, such as CSF shunt placement, to relieve symptoms and improve quality of life 2, 4.

Lack of Direct Evidence

• There are no research papers provided that directly address the relationship between ESS and CE.
• Further studies would be necessary to investigate any potential link between these two conditions.