CT iopamidol cisternographic diagnosis of coexisting partial empty sella and pituitary adenoma. Report of two cases.

In the last 3 years 86 patients were referred for suspected primary intrasellar pathology. Two of them had coexisting pituitary adenoma and partial empty sella. This situation has been diagnosed pre-operatively thanks to CT Iopamidol cisternography. The pre-operative diagnosis of this common anatomic condition allows safer operations, preventing intra-operative CSF fistulas.

Computed tomographic cisternography with iopamidol in the diagnosis of primary empty sella.

Twenty-one patients with primary empty sella were studied with computed tomography iopamidol cisternography. Ten milliliters of iopamidol at a concentration of 200 mg I/mL was administered intrathecally via the lumbar route. Eleven patients had a partial and 10 a complete empty sella. In six cases the third ventricle had prolapsed to the level of the interclinoid plane. There was no relationship between the clinical presentation and the grade of empty sella. The quality of the images obtained was always good or excellent. Cisternographies were performed in all of the patients although in 13 of them the correct diagnosis could have been achieved with a standard contrast-medium-enhanced computed tomography scan. The overall complication rate was 29%. Four patients (19%) had mild headaches and nausea; two patients (10%) had more severe side effects: vomiting, discomfort, and meningism. Computed tomographic cisternography with low-concentration iopamidol is a safe diagnostic procedure that allows a definite visualization of the anatomic alterations that occur in patients with empty sella. We think that this procedure should always be employed in symptomatic patients.

Remarks concerning 102 watersoluble contrast ventriculographies.

The Authors report their experience in using water-soluble contrast medium in ventriculographies having carried out 102 ventriculographies partly with Dimer X and partly with "Uromiro 300". Their conclusions are practically similar to those already reported by the many Authors who have written on this subject: 1) facility of examination particularly in urgent cases; 2) excellent neuroradiological definition of the cases; 3) possibility of obtaining a selective ventriculography; 4) indication especially in space-occupying lesions of the posterior cranial contrast medium; 6) possibility of reducing complication rate by carefully carrying out the examination and by avoiding the use of excessive quantities of contrast. In particular the Authors describe some useful methods for obtaining better technical results from the examination and reducing the complication rate.