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Assessment of the Size of Sella Turcica Among Nepalese Population by Computed Tomography

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Assessment of the Size of Sella Turcica Among Nepalese Population by Computed Tomography ORIGINAL ARTICLE http://dx.doi.org/10.3126/njr.v9i2.27429 Assessment of the Size of Sella Turcica among Nepalese Population by Computed Tomography Makaju G, Joshi BR, Chand RB Department of Radiology, TU Teaching Hospital, Maharajgunj, Kathmandu, Nepal Received: September 2, 2019 Accepted: November 30, 2019 Published: December 31, 2019 Cite this paper: Makaju G, Joshi BR, Chand RB. Assessment of the Size of Sella Turcica among Nepalese Population by Computed Tomography. Nepalese Journal of Radiology 2019;9(14):40-47.http://dx.doi.org/10.3126/njr.v9i2.27429 ABSTRACT Introduction: The deformity of the sella turcica is often a major clue that an abnormality exists within the cranium, hence a familiarity with the sella turcica anatomy and radiological appearance is important. The aim of this study was to assess the dimension of sella turcica of normal Nepalese people by using computed tomography scan of head and to correlate the dimension with the patient’s age and gender. Methods: This prospective study was performed in a tertiary hospital in Kathmandu. Data were collected over the period of 4 months from June to September 2018 with the total of 73 patients who underwent CT of head. The age and gender of the patients were noted. The dimensions of sella turcica were measured at the predefined three directions: length, depth and antero-posterior diameter of the sella turcica. Results: The sella turcica had a mean length of 8.375mm, AP diameter of 7.029mm, and depth of 10.13mm.The dimensions of the sella turcica increased with age till the age of 80 years and then decreased. Conclusions: This study concluded that the length, AP diameter and depth of the sella turcica vary with respect to age group. The length and depth of sella turcica were higher in males while AP diameter in females. Keywords: Cranium; Sella Turcica; Skull INTRODUCTION The deformity of the sella turcica is often a major clue that an abnormality exists within the cranium, hence a familiarity with the sella turcica anatomy and radiological appearance is important.1 One of the clinical significance of the sella turcica is the empty sella syndrome Correspondence to: Dr. Birendra Raj Joshi which is the condition of a shrunken or Department of Radiology flattened pituitary gland.2,3 TU Teaching Hospital, Maharajgunj Kathmandu, Nepal Licensed under CC BY 4.0 International License which permits use, distribution and reproduction in any Email: [email protected] medium, provided the original work is properly cited NJR VOL 9 No. 2 ISSUE 14 July-Dec; 2019 40 Makaju G et al. Sella Turcica The sella turcica also known as hypophyseal METHODS fossa is a saddle shaped depression in the body of the sphenoid bone in the human This cross sectional prospective study skull that houses the pituitary gland; it is was performed in a tertiary hospital in a cephalometric landmark in the skull.4 Kathmandu. Data were collected over the Anatomically, it is located in the sphenoid period of 4 months from June to September bone behind the chiasmatic groove and the 2018 with the total of 73 patients who tuberculum sellae situated within the middle underwent CT of head. Siemens Somatom cranial fossa and on a lateral skull radiograph, Definition AS+ machine was used. Patients the image of the sella turcica is U-shape.5 having pathological conditions like Down Any abnormality of the pituitary gland could syndrome, Williams syndrome, Sickle manifest from an altered shape of sella turcica, disease, lumbosacral myelomeningocele, to disturbance in regulation of secretion of associated hypopituitarism and dwarfism with glandular hormones.6 Also, a deviation from small sella turcica were excluded. the normal size and shape of the sella turcica due to its malformation may be implicated in The age and gender of the patients were an undetected underlying disease and it can noted. The dimensions of sella turcica were be an indication of a pathological condition of measured at the predefined three directions: 7,8 the gland. The anatomy of the sella turcica length, depth and antero-posterior diameter of varies in size and shape; it has been classified the sella turcica. The normal size of the sella 9 into three types: round, oval and flat. The turcica was measured by tracing the contour of floor of the sella turcica, which in most cases the pituitary fossa from the tip of the dorsum 10 is concave, may be flat or even convex. The sellae to the turberculum sellae and then sella turcica is usually demarcated by a dense, following a straight line from the turberculum thin white line in lateral radiographs. It is sellae back to the origin. This corresponds to sometimes more important to recognize this the position of the diaphragmatic sellae. The 11 feature than to estimate the size of the fossa. length of the sella turcica was measured as the Many studies have reported several changes distance from the turberculum sella to the tip in the size of the sella turcica in various of the dorsum sellae, and the depth of sella pathological conditions such as Down turcica was measured perpendicular to this syndrome, Williams’s syndrome, Sickle line to the deepest point on the floor. disease and lumbosacral myelomeningocele. The present study made use of lateral Computed Tomography images of the skull was undertaken to establish the normal dimensions of sella turcica in Nepalese population with a view to establish whether the size of the sella turcica vary with age and gender. The result of this study will provide a base line data on the normal size of the sella turcica for Figure 1: Illustration of normal morphology this population, which could be of assistance of sella turcica (TS = Turberculum Sellae, in the evaluation and detection of pathological DS = Dorsum Sellae, BPF = Base of pituitary conditions of the sella turcica. fossa). According to Silverman et al.12,13 the following lines in the above diagram were measured NJR VOL 9 No. 2 ISSUE 14 July-Dec; 2019 41 Makaju G et al. Sella Turcica to determine the size of the sella turcica; Table 1: Distribution of sample size according the reference lines used were situated in the to age group midsagittal plane. Age group Frequency Percentage A) The Length: was obtained by measuring <10 6 8.2 the distance from the tuberculum sellae to the 11-20 10 13.7 tip of dorsum sellae. 21-30 15 20.5 B) The Depth: was obtained by measuring a perpendicular from the line mentioned above 31-40 15 20.5 to the deepest point on the floor of the fossa. 41-50 9 12.3 C) The Antero-posterior Greatest Diameter: 51-60 7 9.6 was obtained by measuring from the 61-70 5 6.8 tuberculum sellae to the furthest point on the 71-80 3 4.1 posterior inner wall of the fossa, below the >81 3 4.1 dorsum sellae. Total 73 100 Multiple planar reconstructions were generated on a view workstation (Siemens Medical Systems). The slices were manually Table 2: Calculation of mean and standard adjusted for mid sagittal section of the brain deviation of Age, Length, AP diameter and in bone window with sharp resolution. The Depth of the sella turcica. Std. Devia- dimensions were measured with an electronic Variables N Mean caliper. Data were analyzed using SPSS tion Windows Version 20. Descriptive statistics Age 73 38 20.76 of Mean ± Standard error of mean (S. E. M) Length 73 0.8375 0.20115 were used to summarize the data obtained. AP diameter 73 0.7029 0.13183 Two-sided P values were calculated using the Depth 73 1.0130 0.20219 Paired sample T-test for observed variables. P values < 0.05 were considered statistically The length, AP diameter and depth for significant. female subjects were 0.8267cm, 0.7112cm and 1.0021cm respectively where as RESULTS these measured 0.8465cm, 0.6961cm and 1.02202cm for male subjects. (Table 3) The sample consisted of 73 subjects; 33 female (45.2%) and 40 male (54.8%). The samples Table 3: Mean and Standard deviation of were classified according to the age from <10 Length, AP diameter, and Depth of sella to >81, as presented in Table 1. Data were turcica with respect to gender. presented as mean and standard deviation for AP Length Depth all variables. Detailed results are shown in the Gender diameter [cm] (cm) tables and figures below. ( Figure 2) (cm) Female Mean 0.8267 0.7112 1.0021 SD 0.16378 0.12978 0.18854 Male Mean 0.8465 0.6961 1.0220 SD 0.22914 0.13476 0.21475 Total Mean 0.8375 0.7029 1.0130 SD 0.20115 0.13183 0.20219 Figure 2: Bar chart of the distribution of sample size according to the age group. NJR VOL 9 No. 2 ISSUE 14 July-Dec; 2019 42 Makaju G et al. Sella Turcica The length of sella turcica was found to is highest for the age group of 71-80 years be highest for the age group of 71-80 years measuring 1.42cm and lowest for age group measuring 1.1167cm and lowest for the age less than 10 years measuring 0.7517cm. group less than 10 years measuring 0.7276cm. (Table 4). The AP diameter was found to be highest Correlation between Age, Length, AP for the age group of 71-80 years measuring diameter and Depth of the sella turcica and 0.87cm and lowest for the age group of less paired sample t-test between all the variables than 10 years measuring 0.5067cm. The depth are shown in table 5 & 6.
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