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. 2023 Jan 5;13(1):158.
doi: 10.3390/life13010158.

Clinical Applicability of the Sellar Barrier Concept in Patients with Pituitary Apoplexy: Is It Possible?

José Ignacio Pailler  1 , Juan Francisco Villalonga  1 , Tomás Ries-Centeno  2 , Amparo Saenz  1 , Matías Baldoncini  1 , Derek Orlando Pipolo  1 , Eugenio Cárdenas Ruiz-Valdepeñas  3 , Ariel Kaen  3 , Lena Hirtler  4 , David Roytowski  5 , Domenico Solari  6 , Andrés Cervio  2 , Alvaro Campero  1
Affiliations

Clinical Applicability of the Sellar Barrier Concept in Patients with Pituitary Apoplexy: Is It Possible?

José Ignacio Pailler et al. Life (Basel). .

Abstract

There is evidence of association between sellar barrier thickness and intraoperative cerebrospinal fluid (CSF) leakage, impacting the postoperative prognosis of the patients. The aim of this study is to analyze the clinical applicability of the sellar barrier concept in a series of operated patients with pituitary apoplexy (PA). A retrospective study was conducted including 47 patients diagnosed with PA who underwent surgical treatment through a transsphenoidal approach. Brain magnetic resonance imaging (MRI) of the patients were evaluated and classified utilizing the following criteria: strong barrier (greater than 1 mm), weak barrier (less than 1 mm), and mixed barrier (less than 1 mm in one area and greater than 1 mm in another). The association between sellar barrier types and CSF leakage was analyzed, both pre- and intraoperatively. The preoperative MRI classification identified 10 (21.28%) patients presenting a weak sellar barrier, 20 patients (42.55%) with a mixed sellar barrier, and 17 patients (36.17%) exhibiting a strong sellar barrier. Preoperative weak and strong sellar barrier subtypes were associated with weak (p ≤ 0.001) and strong (p = 0.009) intraoperative sellar barriers, respectively. Strong intraoperative sellar barrier subtypes reduced the odds of CSF leakage by 86% (p = 0.01). A correlation between preoperative imaging and intraoperative findings in the setting of pituitary apoplexy has been observed.

Keywords: CSF leakage; pituitary apoplexy; sellar barrier; skull base.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Results.
Figure 2
Figure 2
A 43-year-old patient presenting pituitary apoplexy in the context of a non-functioning macroadenoma. (A–C): Preoperative MRI; (D,E): intraoperative findings; (F–H): postoperative MRI.
Figure 3
Figure 3
A 23-year-old patient with pituitary apoplexy in the context of a giant prolactinoma. (A–C): Preoperative MRI; (D,E): intraoperative findings; (F–H): postoperative MRI.
Figure 4
Figure 4
A 35-year-old patient with pituitary apoplexy in the context of a non-functioning macroadenoma. (A–C): Preoperative MRI; (D,E): intraoperative findings; (F–H): postoperative MRI.
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