Asymptomatic Empty Sella: A Literature Review and Suggestions for Evaluation in Clinical Practice

Abstract

To complete our literature review on ES, we conducted a comprehensive search of relevant articles in the PubMed database. We conducted a simple search on PubMed, and our search terms included the following: 'Incidental Empty Sella Syndrome,' 'Asymptomatic Empty Sella Syndrome,' 'Incidental Empty Sella,' 'Asymptomatic Empty Sella,' 'Incidental Arachnoidocele,' and 'Asymptomatic Arachnoidocele. No search filters other than the date were applied. Because "Empty Sella" and "arachnoidocele" are synonymous, we included both terms to broaden the results of our search. The use of "syndrome" implies an accompanying constellation of neurological, ophthalmological, and/or endocrine symptoms, so we excluded this term from some of our additional search queries to ensure that we were capturing our topic of interest. Inclusion and Exclusion Criteria Our review included publications that specifically addressed "asymptomatic" or "incidental" ES. The aim of our search was to incorporate articles that were focused on presentations of ES without endocrine, ophthalmological, and/or neurological manifestations. Such cases were typically discovered through imaging to investigate a different clinical presentation and suspected etiology. Amongst these articles, our primary focus was papers that emphasized diagnostics and management of this condition. We included papers meeting these criteria, which were published in English and spanned a variety of publication types, including case reports, literature reviews, systematic reviews, and meta-analyses. We did not include articles that did not meet the aforementioned inclusion criteria, in addition to those meeting one or more of the following exclusion criteria: papers limited to a pediatric population (<18 years) or a geriatric population (>65 years), animal and laboratory studies, clinical trials focused on novel treatments of ESS without mention of asymptomatic ES, papers published in non-peer-reviewed journals such as editorials and opinion columns, papers requiring translation for inclusion, or papers requiring payment for inclusion. Data Extraction Each publication was independently screened by two reviewers to determine eligibility based on the inclusion and exclusion criteria. Articles were first screened by title and abstract, followed by a separate screening process of the complete publication content. The screened papers were split between the reviewers, and data was extracted on the following variables of interest: publication year, study design, age, sex, prevalence, patient-reported symptoms if present, diagnostic method, diagnostic findings, treatment, and outcomes.